Our Inadequate Response to an Underestimated Problem

If we found out a public health crisis was three to four times greater than previously known, how quickly would Congress authorize emergency spending to combat it? I certainly hope it would not wait for the next budget debate, or make the response budget neutral.

Our elected officials should be held to the same standard when it comes to child protection. And recent research by the Children’s Data Network (CDN) at the University of Southern California confirms that child maltreatment is a far larger societal epidemic than we’ve previously thought.

Since I first heard about the Network’s research, I’ve been convinced that it should be a game changer for how we view and fund our nation’s child welfare systems.

There are three CDN studies in particular that should inform any conversation about reforming child welfare policy and practice:

  • An analysis of the cumulative risk of maltreatment among children zero to five.
  • Research into the rate of re-reporting for young children who remain at home following an initial CPS report.
  • An investigation into the correlation between CPS reports and subsequent child deaths.

The longitudinal study of cumulative risk established a shockingly high rate of child welfare systems involvement: 5 percent of all babies in California are reported for maltreatment in their first year of life, while one in seven children in the state is the subject of an abuse or neglect report by the time they turn five.

This rate is much higher than the single year snapshot provided by the National Child Abuse and Neglect Data System (NCANDS). In fact, the study found that “the cumulative rate of children who are born in our state and are later involved with the child protection system is roughly triple annual rates of children reported, substantiated and placed in foster care.”

The lead researcher on the cumulative risk study, Dr. Emily Putnam-Hornstein, also collaborated with Yale University to do a similar study on the frequency of substantiated maltreatment, which tracked millions of children across the country between infancy and age 18. The nationwide analysis found significantly higher rates of substantiated maltreatment than the annual snapshot provided by NCANDS.

The Yale study found that 12 percent of all American children are subjected to confirmed maltreatment by the time they reach age 18.

“Confirmed child maltreatment is dramatically underestimated in this country,” concluded Christopher Wildeman, the lead author.

So, the problem of child maltreatment is far bigger than government statistics had previously indicated.

Second, the investigation into the rate of re-reports for infants who were the subject of an initial report, but were kept in their homes, should cause alarm bells to go off.

Due to their physical fragility, fully half of the children who die each year from abuse and neglect in this country are less than one year old, according to the federal Commission to End Child Abuse and Neglect Fatalities (CECANF). Yet almost 82 percent of infants who are the subject of a maltreatment report are left at home.

Distressingly, the CDN research indicates that more than 60 percent of these infants will be re-reported as the alleged victims of abuse or neglect by the time they turn five years old, the “highest published estimate to date.” These high rates of re-reporting held both for infants whose reports were investigated but declared unsubstantiated, and those whose reports were screened out through the CPS hotline and never investigated.

Despite the extreme vulnerability of these infants to maltreatment, the research finds that just 10 percent of those who are reported but continue to remain at home receive any formal follow-up investigation or services through CPS.

My conclusion: Our current system response potentially leaves many children in danger of further victimization.

The third CDN study found an alarming correlation between CPS reports and subsequent child deaths for children under age five. CDN found that children reported for maltreatment before age five were almost six times more likely to sustain a fatal injury than children who had never been reported.

“These data indicate that a child’s report to CPS for maltreatment is not random, nor is it simply a function of poverty,” the researchers conclude. In fact, “it is an independent signal of child risk beyond what poverty or sociodemographic factors alone would indicate.”

In its final report, CECANF’s interpretation of this study was stated bluntly: “A call to a child protection hotline is the best predictor of a child’s potential risk of injury death before age 5.”

Furthermore, these high risks are not restricted to intentional fatal injuries, according to the CDN study. Children reported for maltreatment are also twice as likely as their peers to die from unintentional injuries.

“Public concerns about the problem of child maltreatment is focused disproportionately on the dangers of physical and sexual abuse, while neglect receives less attention,” observes the National Scientific Council on the Developing Child. The CDN research highlights the perils of underestimating the danger of neglect.

My conclusion: A CPS report is a significant indicator of heightened risk to child safety. As Dr. Putnam-Hornstein has said in a number of presentations and interviews: “The signal is real.”

Taken together, the research coming out of USC tells us that maltreatment is a bigger problem than we previously assumed; our systems unfortunately do very little to protect some of our most vulnerable children; and we should not ignore or underestimate the warning signs inherent in a CPS report.

This is a series about child welfare financing reform. So what does all this mean for child welfare policy and financing?

Reducing foster care caseloads has been the primary motivation of most systems reforms over the past two decades, and has often been celebrated as an accomplishment in and of itself. But CDN’s research demonstrates that both reported and substantiated maltreatment are much more prevalent than we’d assumed, and that CPS involvement is neither random nor meaningless.

We should reexamine whether it was ever appropriate to make caseload decline itself a metric of improvement for foster care systems, and even if so, whether continued reductions in caseload are safely possible in the absence of a decrease in the rates of maltreatment.

California has reduced its foster care caseload by 40 percent in the past 15 years, yet the vast majority of this decrease has been the result of a lower average length of stay in care due to the system’s improved ability to move foster youth into permanency faster.

Foster care entries in the state, which more accurately reflect the rate of maltreatment, have remained relatively stable. The need hasn’t gone away; we have really just changed how we address that need. Further, caseload declines would almost certainly require greater reductions of foster care entries, given the improved effectiveness of systems in helping foster youth find permanency.

Making the system less willing or likely to take children into foster care in the first place is likely to jeopardize safety unless we find a way to better prevent significant maltreatment from occurring in the first place. In fact, caseloads in California and across the country have actually been rising the past few years.

This research also provides children’s advocates with an important tool to call for additional funding for our under-resourced systems. As I discussed in a previous column, too many children’s advocates have embraced the canard that federal policy reform in this Congress must be budget neutral. We should not concede budget neutrality any longer when it comes to federal foster care reform efforts.

This research gives advocates the ammunition to demand greater child welfare spending across the board, from front-end prevention and early intervention programs to strengthened child protection systems, as called for in the final CECANF report. Our child welfare systems should be given the tools and resources they need to adequately support families and keep children safe.

As Mr. Wexler’s columns exemplify, much agitation for foster care reform is driven by emotion, rhetoric, misapprehension and outdated data. The new CDN research looks at population level risks, experiences and outcomes, and relies on irrefutable methodologies.

That’s the basis on which we should actually be building policy.

Sean Hughes is a managing partner at the consultancy firm Social Change Partners. Over the next few months, he will write a series of analysis pieces in The Chronicle about child welfare finance reform. We encourage readers to submit their own commentary and analysis on the subject.

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