New Directions in Child Abuse and Neglect Research (2014) / Chapter Skim
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5 The Child Welfare System
5 The Child Welfare System
Pages 175-244
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From page 175... ...
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.
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From page 176... ...
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 investigate 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.
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From page 177... ...
. 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)
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From page 178... ...
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.
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From page 179... ...
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.
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From page 180... ...
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.
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From page 181... ...
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.
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From page 182... ...
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 children (e.g., the Adoption Assistance and Child Welfare Act, the Adoption and Safe Families Act)
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From page 183... ...
suggest that children in kinship foster care experience better behavioral development, mental health functioning, and placement stability
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From page 184... ...
Children in nonkinship foster care also were more likely to utilize mental health services. Several studies identify factors associated with placement disruption.
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From page 185... ...
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.
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From page 186... ...
Reentry to Foster Care Reentry to foster care refers to children who return to placement after having been discharged from foster care. Although reentry to foster care may be preceded by repeated child abuse and neglect, few studies actually follow that sequence of events.
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From page 187... ...
This section examines this issue briefly with regard to what is known about child abuse and neglect in foster care. This subject is difficult to address because of the nature of abuse and neglect that occurs while a child is under the official care of the state, the court, and the child welfare system as a result of abuse and neglect suffered in the child's biological home -- a kind of double jeopardy.
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From page 188... ...
and fail to consider the full range of child welfare systems. Yet these examples raise serious question about the possible underestimation of child abuse and neglect in foster care, although they do not provide research evidence on the size of this underestimation.
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From page 189... ...
State variation also is considerable for other indicators -- use of group care, placement stability, and reentry. It should be noted that variability within states is as significant as that among states.
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From page 190... ...
Finding: Children placed in kinship foster care have been shown to experience better behavioral development, mental health functioning, and placement stability than children placed in other forms of care, and can achieve permanency through guardianship (as supported by the Guardianship Assistance Program in the Fostering Connections to Success Act of 2008)
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From page 191... ...
, and well-being (often characterized as child well-being, focused primarily on physical health; behavioral, emotional, and social functioning; and education) -- frame the mission for child welfare services in response to child abuse and neglect.
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From page 192... ...
These changes have signaled the desire to implement programs and services that better target the needs of children in their own homes, that address service and decision-making disparities that result in the overrepresentation of children of color in the child welfare system, and that address strategies for engaging families more effectively and actively in the development of their own plan of services. The focus of child welfare services may also change after a horrific and highly visible death due to child abuse and neglect -- sometimes causing the decision-making pendulum to swing toward placing children in out-ofhome care, while at another point in time the same assessment might have resulted in a child's staying with his or her family.
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From page 193... ...
The key reforms are described in the following subsections. Legislative Reforms Legislative reforms driving child welfare services include provisions for family preservation and family support programs, the Adoption and Safe Families Act, the Fostering Connections to Success and Increasing Adoptions Act, the Child and Family Services Improvement and Innovation Act, and Title IV-E waivers.
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From page 194... ...
The legislation also emphasized the role of substance abuse in child abuse and neglect, stressed children's health and safety and clarified "reasonable efforts" emphasizing children's health and safety, and required states to specify situations in which services to prevent foster care placement and reunification are not required. The Adoption and Safe Families Act also set specific timelines for making decisions about permanent placement, requiring that states initiate termination of parental rights after a child has been in foster care for 15 of the previous 22 months.
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From page 195... ...
Child and Family Services Improvement and Innovation Act of 20117 This legislation reauthorized the Safe and Stable Families Program and further amended Title IV-B by focusing on the well-being of children, addressing the emotional trauma of children who experience the child welfare system, providing special attention to the needs of young children (under 5) , and requiring states to monitor the use of psychotropic medications for children in foster care.
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From page 196... ...
, and the findings from these programs helped set the stage for the reauthorization of both the authority and provisions related to kinship guardianship assistance that were included in the Fostering Connections Act. The new 2011 waiver authority, which enables the secretary of HHS to authorize up to 10 demonstration projects each year during FY 2012-2014, has more explicit goals than the previous waiver programs, including increasing permanency for youth; reducing time in foster care; promoting positive outcomes for children, youth, and families in their homes; and preventing child abuse and neglect and the reentry of infants, children, and youth into foster care.
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From page 197... ...
Consensus-based instruments are created based on theories of child abuse and neglect etiology, empirical research, and expert opinion on relevant case characteristics. Actuarial risk assessment instruments clearly have the greatest potential to estimate the recurrence of child abuse and neglect reliably and accurately, and child welfare agencies in the majority of U.S.
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From page 198... ...
Differential response offers multiple pathways for addressing the needs of children and families referred to child welfare services. In its simplest form, child abuse and neglect referrals are screened and, based on level of risk and other criteria, referred to either an assessment pathway or a traditional investigation pathway.
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From page 199... ...
Privatization is a cross-cutting issue because of the variety of child welfare services that can be outsourced, including case management, family preservation and support, contracting, referral, foster care, and adoptions. In Florida, all child protection functions have been outsourced except for child protection investigation (Armstrong et al., 2008)
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From page 200... ...
. Safe and stable families legislation and community-based child abuse prevention efforts have been among the forces that have promoted a number of family engagement models (see Center for the Study of Social Policy, Kempe Centre Family Group Decision-making, Friends National Resource Center, for information on different models)
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From page 201... ...
104-193. 10 As a resource for social scientific research, the archive was designed deliberately to capture children's experiences in foster care using a life-course, social ecological lens, making it possible to overlay those experiences onto age-graded trajectories that provide a basis for understanding whether placement happens and when in the life course it is most likely to happen.
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From page 202... ...
In Illinois, the first 10 years of a subsidized guardianship demonstration that used random assignment and an experimental evaluation design saw the state's foster care population shrink from 51,000 children in 1997 to 16,000 in 2007. The subsidized guardianship waiver allowed the state to use millions of dollars in IV-E reimbursements for child welfare services and system improvements that it otherwise would not have been able to accomplish (Testa, 2010)
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From page 203... ...
; • he establishment of multiple responses is codified in statute, policy, and/ T or protocols; • amilies in the assessment pathway may refuse services without conse F quence as long as child safety is not compromised; • o formal determination of child abuse and neglect is made for families in N an assessment pathway, and services are offered to such families without any such determination; and • o listing of a person in an assessment pathway as a child abuse and N neglect perpetrator in the state's central registry of child abuse and neglect. SOURCE: Merkel-Holguin et al., 2006, pp.
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From page 204... ...
. Results from the most rigorous evaluations -- three RCTs of differential response -- indicate better outcomes for families on an assessment pathway compared with investigated families.
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or significantly lower numbers of subsequent screened in child abuse and neglect reports (Loman and Siegel, 2012; Siegel and Loman, 2006) compared with traditionally investigated fami lies.
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From page 206... ...
However, the number of rigorous evaluations of differential response systems is low. More rigorous evaluations are needed to understand what factors guide successful implementation and ensure desired outcomes and to learn the extent to which the differential response approach works within different contexts.
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From page 207... ...
A critical concern identified in several privatization efforts relates to staffing issues. When Kansas privatized foster care, family preservation, and adoption in the mid-1990s, for example, the public agency caseworkers did not choose to move to the private agency, and there have been similar experiences in other states and localities (ASPE, 2008b; Flower et al., 2005)
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From page 208... ...
, a parent engagement model, addresses child abuse and neglect through promotion of a self-help and 11 See http://www.cebc4cw.org/program/family-group-decision-making/detailed (accessed January 27, 2014)
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From page 209... ...
• A range of Family Support Program models addressed a host of problems, from child abuse and neglect to school failure and de linquency. Those models with the largest effects had been tested in single sites.
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From page 210... ...
In Los Angeles County, a partnership among the public child welfare agency and diverse community agencies has yielded promising outcomes by developing stronger relationships to engage public child welfare agencies; allied public agencies; and community-based networks that offer familycentered services, economic assistance, and capacity building. Findings indicate that the Prevention Initiative Demonstration Project could make a significant contribution to the prevention of child abuse and neglect as well as its recurrence, and that both clinical and community support services are required (McCroskey et al., 2012)
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From page 211... ...
support this increased focus on child well-being, not only for children placed in foster care but also for children in families investigated for child abuse who have not been placed: • Children involved with child welfare systems (including both those placed and those not placed in foster care) showed marked eleva tions on measures of risk for behavioral and developmental prob lems compared with population norms.
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From page 212... ...
. Among children who have been in foster care for 1 year, 30 percent have chronic conditions -- 20 percent having one such condition, 3.8 percent having two, and 3.1 having three or more (Jee et al., 2006)
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From page 213... ...
13 and U.S. census data, American Indian children were disproportionately represented within foster care by an index of 2.1 and black children by an index of 2.0 nationwide, with significant variation among states (Summers et al., 2012)
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. The overrepresentation of children of color within the foster care population is a function of differences in entry and exit rates.
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From page 215... ...
THE CHILD WELFARE SYSTEM 215 Black-to-White Black-to-Hispanic Hispanic-to-White Ratio Ratio Ratio FIGURE 5-11 Change in entry rate disparity ratios, 2003-2010. SOURCE: Data from Wulczyn, 2012.
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From page 216... ...
For example, differences in the likelihood of entry into foster care often are described in relation to poverty, but only a handful of studies actually examine foster care placement across a range of spatial units (e.g., counties, neighborhoods, or census tracts) and social contexts (Freisthler et al., 2007; Lery, 2009; Wulczyn, 1986)
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From page 217... ...
Child welfare researchers also have developed methods for understanding the complex longitudinal service pathways of children as their biological and nonbiological caregivers facilitate access to mental health care. The child welfare system as a gateway to mental health services Because all children in foster care are categorically eligible for Medicaid, an examination of statistics on the use of mental health services among child and adolescent Medicaid populations highlights the increased needs for mental health services of children involved in the child welfare system.
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From page 218... ...
. NSCAW data have now confirmed that the child welfare system functions as a gateway into the child mental health care system, and this increased access to mental health care is associated with high levels of continuity of mental health care even when children leave foster care.
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From page 219... ...
. If one thinks of the child protection system as a kind of surveillance system for risky parenting behaviors and the related heightened risk for the onset of emotional and behavioral problems in children, one can also think of the child welfare system as a gateway into other service systems that can address the higher rates of problems in children involved with the child
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From page 220... ...
For example, despite the clear evidence pointing to high rates of externalizing behavior problems in children involved with the child welfare system (see Chapter 4) , much of the mental health care offered in public service systems is provided directly to children, whereas research evidence supports the use of parent training models designed to change parents' response to the problematic behaviors exhibited by their children.
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From page 221... ...
Cumulatively funded since 2001 at more than $377 million and with an FY 2013 budget of $46 million, the NCTSN represents a well-established, multidisciplinary, trauma treatment services-based network with significant potential as a national child abuse and neglect/family trauma research infrastructure. Local NCTSN centers frequently have extensive partnerships with service organizations in their neighborhoods and are well positioned for community-based research.
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From page 222... ...
The state CIP, authorized under section 438 of the Social Security Act and established by the Omnibus Budget Reconciliation Act of 1993, provides annual grants to all 50 states, the District of Columbia, and Puerto Rico to improve dependency court proceedings in child welfare cases. Funds are awarded to the highest court in the state to assess foster care and adoption laws and judicial processes and to develop and implement plans for system improvement.
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From page 223... ...
are operating an approved Title IV-E Foster Care and Adoption Assistance Program, (2) have been awarded a tribal implementation grant (indicating that they are seeking to implement a Title IV-E plan)
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From page 224... ...
help improve access to needed services? Integration of Child Abuse and Substance Abuse Programs and Services Another area of interagency collaboration and integration of programs and services with a rigorous evaluation component concerns the co-occurrence of child abuse and neglect and substance abuse and the associated risk or reality of out-of-home placement.
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From page 225... ...
Child Welfare: Systemic Issues Casey Family Programs' (2012) analysis of evidence-informed interventions to address common forms of child abuse and neglect identified many promising practices that need further testing and limited interventions that could be directly implemented by public child welfare agencies.
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From page 226... ...
This situation is especially problematic for prevention services and evidence-based practices that must follow a specific protocol and are predicated on being carried out by highly skilled staff. As noted in Chapter 8, the Child Abuse Prevention and Treatment Act's appropriation has never come close to matching its authorization level, and child welfare agencies provide services by cobbling together local and state funds, along with funds from CAPTA, Titles IV-B and IV-E, and Title XX (Social Services Block Grant)
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From page 227... ...
For example, substantiation is closely tied to definitions of child abuse and neglect, the training and caseloads of the child protective services workforce, and the type and volume of reports received. As stated earlier in Chapter 2, the utilization of substantiation is questionable in practice.
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From page 228... ...
found that providing support for social workers to obtain BSW and MSW degrees to pursue child welfare careers is an effective strategy, the major funding source for its implementation is Title IV-E entitlement. Thus the focus is more on the administration of foster care than specifically on educating social workers to be child protective service
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From page 229... ...
SOURCE: Adapted with permission from Zlotnik et al., 2005. Figure 5-15 investigators or on developing the clinical skills needed for protective service intervention (Social Work Policy Institute, 2012b)
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From page 230... ...
Furthermore, it should be recognized that, looking across all of the processes involved, child protection work is a multidisciplinary field, and evidence-based strategies are necessary to ensure competent, qualified staff in medicine, social work, nursing, early childhood, law, and other subject areas. Need for Continuous Quality Improvement Public child welfare agencies often must face negative media attention, which in turn puts pressure on politicians to take some form of action (Chenot, 2011)
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From page 231... ...
Results of the first 2 years of the second round of CFSRs, covering 32 states, indicated that foster care was more likely than in-home services to achieve outcomes and that services to mothers were stronger than services to fathers in relationship to the systemic factors that were assessed. With regard to safety, 22 percent of the cases had unaddressed safety concerns, including child abuse and neglect reports that were inappropriately screened out, child abuse and neglect allegations that were never formally reported or investigated, delays in accepting an allegation for investigation, and allegations that were not substantiated despite evidence that would support substantiation.
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From page 232... ...
In the face of all of this effort to achieve change, individual programs have been evaluated, but there has been no known analysis of how all of these efforts work synergistically to improve the lives and outcomes of children who experience child abuse and neglect. Finding: Research to date has not provided a clear understanding of differences in the experiences of children in the child welfare system based on race, socioeconomic status, and culture.
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From page 233... ...
Limited analysis has addressed the relationship between need and use, the role of the many different influences on service utilization, and the efficacy of actual interventions and their outcomes. Finding: The Court Improvement Program, integration of the provision of child abuse and substance use services, and the National Traumatic Stress Network represent notable efforts to improve collaborative ser vice provision for abused and neglected children and to create multi disciplinary research infrastructures.
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From page 234... ...
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, socioeconomic status, and culture; and the impact of varying state administrative structures on the performance of the child welfare system.
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From page 235... ...
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 organization, 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)
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From page 236... ...
Child Abuse & Neglect 18(7)
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From page 237... ...
CWLA best practice guidelines: Child abuse and neglect in foster care. Washington, DC: Child Welfare League of America.
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From page 238... ...
2007. Exploring the spatial dynamics of alcohol outlets and Child Protective Services referrals, substantia tions, and foster care entries.
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From page 239... ...
2000. Mental health care utilization and expenditures by children in foster care.
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From page 240... ...
2006. The impact of foster care on develop ment.
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From page 241... ...
2003. Black children and foster care placement in California.
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From page 242... ...
2000. Predictors of placement outcomes in treat ment foster care: Implications for foster parent selection and service delivery.
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From page 243... ...
1995. Stability and change: Initial findings in a study of treatment foster care placements.
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From page 244... ...
2007. Foster care dynamics, 2000-2005: A report from the multistate foster care data archive.
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