A Three-Branch Approach to Child Welfare Reform

When the Commission to Eliminate Child Abuse and Neglect Fatalities released its groundbreaking report this past March, it helped launch a national dialogue about child safety, and most importantly, shifted the current narrative around maltreatment-related fatalities in a significant way.

For many who work in child welfare, the priority has long been to simply manage the crisis in the system that emerges when a child dies or is severely injured. The commission’s work is helping states rethink their approach to safety and focus more on prevention and evidence-informed policy and practice changes, rather than taking a reactive approach that promotes a culture of blame and shame in the child welfare system.

That shift is one of the reasons why the Three Branch Institute is dedicating its efforts this year and next to improving child safety and preventing child maltreatment-related fatalities.

The Three Branch Institute, a technical assistance effort that was founded in 2009 as a partnership among the National Governors Association, the National Conference of State Legislatures, Casey Family Programs, the National Center for State Courts and the National Council of Juvenile and Family Court Judges, has helped dozens of states work across the three branches of government to address the most pressing child welfare issues.

Past Three Branch Institutes have focused on strategies to safely reduce the number of children in foster care, enhance permanency for older adolescents and enhance the social and emotional well-being of children in foster care.

This year’s focus on child safety and the elimination of child fatalities due to abuse and neglect includes both children known to the child welfare system and those at risk of child welfare involvement. By aligning the work of the executive, legislative and judicial branches of state government in select states, participating states develop an integrated and comprehensive approach for addressing those pressing issues.

Eight states were selected to participate: Alabama, Kentucky, Maryland, Oregon, Tennessee, Virginia, West Virginia and Wisconsin. States were selected based on criteria that required applicants to provide a clear description of the issues the state is facing with regard to the safety of children known to the child welfare system, present a clear vision for what they wanted to achieve through the Three Branch Institute and propose a strong state team comprised of officials from the executive, legislative and judicial branches with the influence and authority to bring about practice and policy change.

The Three Branch Institute to Improve Child Safety and Prevent Child Fatalities, which will take place over 18 months, began with a kick-off meeting in July 2016. Teams will develop initial action plans by October of this year and then shift to an implementation phase in December that will continue through 2017.

The Institute will provide technical assistance to support the states in the following areas:

  • Research and background about current policy efforts and opportunities to advance child safety and stabilize families;
  • Presentations from experts on topics such as using administrative data to assess and intervene with families at risk of child welfare involvement, using evidence-informed strategies to help prevent child maltreatment, identifying ways to strengthen, coordinate and enhance existing safety efforts through cross-system collaboration and leveraging federal funding and policy opportunities; and
  • On-site consultation provided by the National Governors Association and its partners in this initiative.

Many of the policy and practice areas already identified by the states align with the recommendations of the Commission to Eliminate Child Abuse and Neglect Fatalities. Some of the areas of interest identified by states in the early planning phase include:

  • Predictive analytics to support efforts to identify children at risk of removal and entry into foster care;
  • Court practices that recognize toxic stress in families and emphasize trauma-informed care with a goal of keeping families intact to the extent possible;
  • Data sharing and data integration across agencies;
  • Plans for safe care of infants affected by substance abuse;
  • Developing partnerships between child protection, law enforcement, education, health care providers and other stakeholders outside of child welfare that interact with children and families; and
  • Adopting a “culture of safety” in child welfare, an environment where systems learn from past mistakes and tragedies rather than simply hitting the reset button.

The long-term goal is to promote effective policies and practices that improve the safety and well-being of children, while helping participating states embrace the notion that ensuring the safety and well-being of every child is a shared priority objective for each branch of government.

At the end of this initiative, the Three Branch Institute partners will disseminate lessons learned to help other states more effectively coordinate the work of the executive, legislative and judicial branches towards child welfare system reforms that will eliminate child abuse and neglect fatalities, prevent child maltreatment and stabilize families in need of services.

Alexandra Cawthorne is Senior Policy Analyst for the National Governors Association’s Economic, Human Services & Workforce Division. In this capacity, she provides technical assistance to governors’ human services policy advisors and agency leaders on a range of human services policy and practice areas including child welfare, family economic security, juvenile justice reform, family homelessness and improving service delivery systems.

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  1. Note: I posted the comment below to the article entitled “Yonatan’s Death Spurs Deep Look at How L.A. Gauges Child Abuse Risk”. The article was written by Daniel Heimpel and was posted in this publication yesterday, November 1, 2016. I am posting it here, with additional comments at the end, as it is applicable to the article written by Ms. Cawthorne.

    Nationwide, we have seen increasing attention paid to child maltreatment and child death as a result of maltreatment. While focusing on these issues is a good thing, it has not helped us in attaining success at ameliorating these terrible tragedies in our communities. As in this article, we see our “leaders” continuing to ask for reports and more data as well as them adding layers of bureaucracy (such as the Office of Child Protection) to
    address these issues, all to no productive end. We have failed to implement improvements and the required system change(s) that we can quantitatively measure so as to track our successes (and failures) toward improved outcomes for the children and families we serve. Unfortunately, our public child welfare systems have operated, more often than not, as though the process is the product. This must stop.

    The issue before us, specifically as it relates to child death at LA DCFS or any public child welfare agency, is multi-faceted with many moving parts. It is not complicated but it is complex. We need to stop talking, stop writing reports, stop analyzing the data and START problem solving by implementing obvious effective and targeted action steps that
    will proactively protect our most at-risk children and vulnerable families. And, we must infuse our system, at every level, with the philosophy of first do no harm.

    As a MSW (1981) and Licensed Clinical Social Worker (LCSW – 1985) who has
    worked in the child welfare system in several states, public and private (including with LA DCFS) for most of my career, I see several issues which we must address (nationwide) if we are to achieve improved outcomes for our most at-risk children and families. These issues are not typically addressed and evaluated by our leadership cadre or
    governance or stakeholders in public child welfare, which is apparent by the current and dismal outcomes we are achieving.

    In summary, the most vital issues before us which we must address if we are to achieve improved outcomes are the most basic and fundamental, as follows:

    As to which this article alludes, we tend to talk about “system failures” in the abstract because we rarely define what this concept really means.”System failure” is code for
    leadership failure. Leadership means having the courage to always do the next right thing, notwithstanding that it may not be the most popular or politically correct thing to do.
    It means routinely and frequently articulating and communicating our vision and mission, this includes our standards of service and our methods of holding people who work on the system and in the system, at all levels, accountable to compliance and the way in which they support and implement the vision and mission; it means engaging the workforce and community stakeholders to support the work; it means modeling and
    encouraging bi-directional communication (because those providing the services and those receiving the services are the experts with regard to what is needed and how to make things better); it means operating with transparency, regardless of risk of deleterious personal outcomes, in order to ensure accountability; it means identifying what needs to change, how change will occur, who will be affected by the change, and what happens if we do nothing and then communicating openly, honestly and routinely, at all levels, regarding these issues. This is commonly referred to as “culture change management”.

    To date, we have overwhelmingly continued in our failure to put leaders into leadership
    positions in public child welfare organizations. Rather, we have routinely sought out and settled for those individuals who are simply politically astute, which is an important attribute, but a one dimensional answer is not the solution. It is unfortunate that we have
    politicized these issues and these positions to such an extent that we are unable to tolerate professionals who have the courage to lead these systems by virtue of their credentials, practice and administrative experience in the field, and their possession of the most critical leadership core competencies (i.e., leading people, leading change,
    engaging important stakeholders, business acumen, and technical expertise). Until we (i.e., communities and power brokers) demand real leadership and then support these leaders once installed, nothing will change.

    2. Practice:
    Much has changed in practice since I started in the field almost 35 years ago. Some of
    the changes have been good and some have been not so good.One of the most significant changes, which is not a good change, is our increasing reliance on “tools” (such as the various models of Structured Decision Making) while failing to build the infrastructure to support our reliance on these “tools”.

    The Child and Family Services Reviews (CFSR) conducted by the federal Administration of Children, Family and Youth started its roll out in the early 2000’s. ACFY set out to evaluate each state’s public child welfare system. The CFSR process determined in every public child welfare system in every state, that supervision is our weakest link in public child welfare. This finding is both astonishing and deeply concerning given that in
    virtually every public child welfare agency, Child Protective Services (the most complex work we do) is always the field of practice where new and/or inexperienced hires start their career. Yet in most instances,they are not receiving adequate and/or effective supervision. In addition, as in many organizations, we tend to promote professionals to
    supervisory positions because they have either demonstrated competency as a case
    worker or because they are liked, neither of which supports such a promotion given supervision requires an entirely different skill set to case work and being everybody’s friend or teacher’s pet does not protect our children.

    An additional issue with regard to supervision and supervisors are the increased caseloads we frequently hear about as a barrier to keeping children safe. My experience
    has been that many of the “cases” on these caseloads are those that are open simply because they have not been closed (and many times they are not closed because
    supervisors have not approved them for closure because they don’t like to do paperwork). Are supervisors, management and leadership evaluating this issue? If not,
    why not? If so, what does the data tell us? What are the remedies they are implementing? What are case workers asking be done? What have supervisors/leaders done to solicit remedies from caseworkers and families? What requests for help have they (i.e., families, workers and management) proffered to correct the problem? And, if increased caseloads are a reality beyond failing to close cases timely, why are supervisors not required to carry a selective caseload or do other case work tasks to lift the burden from their subordinates so as to increase safety for children? Why are supervisors and managers not being held to account for these “increased caseloads” which we have been repeatedly told negatively impact child safety?

    Another change is the actual use of these “tools”. Tools can be helpful if implemented and then used correctly. When the decision to use “tools” is made, many times we
    fail to provide adequate training and then adequate oversight (see my comments re: supervision above). In addition, if we actually evaluate what happens when we use tools, we see that there is often a fidelity drift. This occurs because as workers become more
    comfortable with the tool, they frequently overlook the potential risks it identifies
    and/or they start to use the tool incorrectly. I have too frequently seen workers who have
    gotten so comfortable in relying solely on the tool, that they are actually looking at the form and checking off the boxes or they are looking at the computer screen and completing the fields, leaving the client to look at the top of the worker’s head as they focus on the tool. This creates a situation in which much information is missed and this then diminishes our ability to make good decisions for children and families.Bottom line: We need to ensure with all tools used that everyone understands tools are simply support for the work and that they are not effective or meaningful without adequate and insightful professional judgement.

    3. Standards and Credentialing:
    It once was true that professional social workers (i.e., BSW’s and MSW’s) were the only helping professionals employed to provide direct intervention services and supervision in
    child welfare. This was the standard of practice in hiring primarily because social work was and is the profession which “professionalized” child welfare as a distinct field of practice and because Social Work has been, and continues to be, the profession identified as uniquely qualified for this field of practice due to our focus on the most vulnerable populations and our systems perspective. These hiring and employment practices have changed.

    Today, public child welfare organizations have opened the flood gates in hiring practices for those who wish to gain employment. We see new employees with degrees in education, business, psychology, sociology, substance abuse, English, history, early
    education, etc. etc. etc. These hiring decisions put all vulnerable people we serve at risk as these sorts of credentials provide absolutely no training in working with vulnerable people. In addition, professional social workers are required to comply with a Code of
    Ethics,established by the National Association of Social Workers (NASW); non-social workers are not held to the same standards of practice. In fact,NASW has recognized our work in child welfare as so specialized that they have published a supplemental Code of Ethics for social workers providing child welfare services. The practice of hiring non-social workers in child welfare has resulted in minimizing the importance of the work to be done (which creates huge morale issues) and more significantly, hiring people who have absolutely no training or conceptual framework for the work to be done increases the risk
    of harm to children and families.

    There is no excuse for public child welfare systems to not hire professional social workers. For example, Los Angeles County has two accredited Schools of Social Work basically within a few miles of their central office; one is at UCLA and the other is at USC. In addition, Social Work students are offered the opportunity to have their tuition paid or forgiven through federal Title IV-E funding if they commit to work in a public child welfare agency for a limited amount of time at graduation; it is inexplicable that LA DCFS is not better advocating this incentive to social work students so as to hire the most qualified professionals in the work to be done. These students, both baccalaureate and graduate, are readily available for recruitment by LA DCFS. This is where leadership is required to
    engage these Schools of Social Work and the students enrolled there to ensure we are able to hire the best and most highly qualified professionals to do the important work of protecting children and serving families. In addition, if leadership were to engage in these activities, our workforce capacity would increase and our children and families would be
    better served.

    There are many other issues which need to be addressed and which many times are
    ignored, such as: implementation of a variety of Evidence-Based and Science-Based
    Practices, including a sustainability plan; a commitment to family engagement and family
    voice, implementation of trauma informed care at every level of the system; improved use of our fiscal resources (we need to stop spending money on things that don’t work or that we can’t measure), focusing on prevention and early intervention, workforce development, etc. etc. etc.

    Thanks for listening.

    As a post script to these comments of 11-01-2026, and with regard to this Ms. Cawthorne’s article above, several additional issues come to mind.

    1. Use of Data
    Many professionals in child welfare applaud and advocate the concept of using data to drive decisions in order to better serve at-risk children and to increase child safety. And many of us believe this is really the only way we should be making decisions about the work to be done and where to place our resources. However, many of our public child welfare systems currently have basic but significant issues related to the use of data and, as we have seen time and time again, when we fail to address the basic and fundamental needed “fixes” before launching off to more lofty and sophisticated business practices, we fail to achieve our goals leaving children and families ill-served and driving the morale of the workforce in a negative direction.

    In today’s public child welfare environment, data driven decision-making is typically an endeavor which is not wholly embraced by the people who need the data to lead, manage, and supervise the work. This is unfortunate because we know such activities must be embraced and championed at all levels of the system for data driven decision-making to become a reality in our work. And, while most if not all our SACWIS systems nationwide provide readily available canned data reports and are reasonably amenable to developing targeted reports as well, neither supervisors nor managers nor leaders typically use these system functions because they don’t know how to use data
    nor do they know how to do data analysis. Then there is the issue of those who enter the data (usually social workers/case managers) lacking an affinity for paperwork and/or for entering the data completely, timely and accurately; this has been a huge issue for decades in all fields of human services practice but it is a fundamental requirement for confirming meaningful data is provided with which to drive decision-making. Nothing will change if the decision to use data to drive change is not implemented by the science of
    implementation, if there is not a concurrent sustainability plan, if all system players are not supported in gaining a comfort level in using data to achieve improved outcomes for children and families, and if there is no work on system wide culture change.

    In addition, and of note, on the macro level, our Schools of Social Work and our national licensing test for social workers, both clinical and non-clinical, no longer address the importance of research methodologies and data analysis. In fact, when those of us who took our licensure exams in past years/decades, 1/3 of the national test was focused on research methodologies/statistics and data analysis competencies. More recently, in 2006 when I sought clinical licensure in Nevada, requiring me to re-take the national licensure test, I noted that not one question on the test was related to research methodology or data analysis.

    By way of anecdotal example, when I shared my experience with the current national licensure test as it related to data with a high level manager in my agency who was in charge of CQI functions, her response was “…they (workers) don’t need to be tested on research and data when they only do therapy”. She entirely missed the point that we can’t expect the workforce to use data and to understand the data, as in EBP’s, nor can we possibly explain the data to families and youth (on the micro level) for the simplest of tasks such as obtaining informed consent, if these same workers don’t understand what the data means and/or how to interpret it. There is much work to be done in developing communication plans about the importance of data, how to use data, and the expectations with regard to data if we are really serious about infusing our system with data driven models of decision making.

    2. Family Voice in Child Welfare and Children’s Mental Health

    All of the current research tells us that family and youth voice and engagement are absolutes in child welfare and children’s mental system change efforts. In fact, the research tells us that in these endeavors, families and youth are the most important change agents and champions of system change. If families and youth are not at the table from the beginning and if they are not acknowledged as the “experts” about what their children need, we know based on the research, that our systems will not be family driven and child centered. In addition, the research tells us that the people who actually do the work are the ones most knowledgeable about how to improve our deliverables (i.e., child safety) in order to achieve our mission; they, too, must be invited into the process of system change. We all know, as well, that inviting families and youth and workers into the process requires we ensure they are granted an equivalent voice to all other professionals/power brokers at the table. While this article confirms the executive, legislative and judicial branch of each state has offered up power brokers from their 3 branches of state governance, there is no mention of families, youth and workers being included in this evaluation of the system, the changes needed in the work to be done, and how this will occur. Hopefully, this critical success factor has not been overlooked or ignored.

    3. Partnerships with Important Stakeholders
    Finally, if we are to “…develop partnerships between child protection, law enforcement,
    education, health care providers and other stakeholders outside of child welfare that interact with children and families” as articulated as a goal in this article, these stakeholders also require inclusion from the beginning of the process, which I assume has been addressed (although it is not confirmed in Ms. Cawthorne’s article).

    Thanks, again, for listening.

  2. Our nation and ALL of our states need this important change. Sharing of information from state to state, agency to agency, and the collaboration of branches of government would greatly affect our ability to address the problem of child abuse and neglect.

    • Yes all should use the same mailing process also. But more importantly foster children need a voice and protection from abusive and or neglectful foster parents. Both County and State should be held responsible for the for the terrible homes these kids are forced to live in. The Foster Children’s Bill of Rights should be taken seriously and upheld at all cost. Remembering Safety first. Or the system that swore to protect them.
      PS thankful for honest to good foster homes everywhere.

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