The Pernicious Failure of Child Welfare Reform

After more than 40 years of work in child welfare, I have lost count of the number of child reforms undertaken across the United States. Illinois. New York City. Florida. Los Angeles. Philadelphia. Florida, and others again and again.

They seem to blend together as an ongoing kaleidoscope of tragedy, media and public outrage, system bashing, firings and announcements of new reform plans. Just as World War I was supposed to be the war to end all wars and wasn’t, these plans never turn out to be the plan to end all plans.

Each reform brings a new set of recommendations, hope and optimism. But realistically, reforms often address the symptoms of underlying design faults rather than the fault lines themselves. This continual process of symptom patching rather than addressing the true underlying faults, ensures a repeat of the cycle. A new leader makes progress with the targeted symptoms, then leaves. The agency regresses and awaits the next tragedy-spawned reform.

The simple and inconvenient reality is this: Child welfare agencies as currently designed are predestined to fail.

What are the structural faults in the foundation of child welfare agencies? They are many, but these four stand out as among the most serious.

The core methods child welfare agencies use to support decision-making and influence change in families are absent coherent, broadly accepted theoretical foundations and research evidence.

This is possibly the San Andreas fault of child welfare. A search of the California Evidence-Based Clearinghouse for Child Welfare website using the search term “case management” found only one case management methodology and one decision-making framework used by a child protective services agency case manager that were rated as having “promising research evidence.”

Note the word “promising.” None were given the top two ratings of “well-supported” (the highest rating) or “supported by research evidence.” The clinical practice guidelines found in medicine and psychology, which are “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances” do not exist in child welfare agencies.

Though these agencies have policies and procedures that caseworkers attempt to follow, these do not come close to the scientific and theoretical rigor found in the clinical guidelines of medicine and psychology.

There is generally agreement across CPS agencies about the contribution of things like domestic violence, substance abuse and caregiver mental health. Yet, the practical reality is that there is no agreement across child welfare agencies, or the multiple professions supporting them, as to the specific set of etiological factors that should be considered when assessing maltreating families, how to measure the presence and contribution of these factors, and the best way to treat them.

The existing clinical assessment protocols are simply practitioner-consensus models, constructed without a rigorous research and literature background to support them. Just ask child welfare administrators for the specific research evidence behind their policies and procedures and see what you get. The fault lies not with these administrators but with the lack of federal and foundation leadership and a well-funded, logically progressive research agenda necessary to move practice effectiveness forward.

Compound this with the fact that the tools and criteria child welfare agencies use for the critical decision of child safety have no established evidence of predictive validity or of reliability across users. Many hope that predictive analytics (PA) will improve targeting by better-identifying families who will maltreat children. While potentially helpful in this aspect, PA is not a clinical tool and therefore does not provide guidance on what to treat and how best to treat it in order to prevent repeat maltreatment.

How can a child welfare agency reliably be effective if the principle intervention methods and decision support tools it uses have no established evidence of effectiveness?

The skills possessed by the workforce do not uniformly and reliably match the outcomes required of the agency.

The skills and other personal attributes necessary to ensure child safety and promote timely permanency have not been well defined. This follows naturally from the first point. Training competencies emerge from brainstorming sessions, and not from research that connects competencies to critical outcomes. Nor is there evidence to demonstrate that agency-based training actually develops the competencies driving training.

When looking at child welfare casework, there appear to be two broad categories of actions and related outcomes essential to the work of safety and permanency. The first involves decision-making. The second involves influencing human change. Simply put, there is no evidence that training caseworkers and supervisors receive actually develops the competencies required for accurate decision-making or influencing human change

As mentioned earlier, staff are trained on decision-making criteria that lacks empirical evidence. Equally problematic is that training may only teach staff what risks and contributing factors to look for but not how to look for them or how to positively impact them.

If practice is included in training sessions, it is often limited to one or two case examples. Further, there is no evidence that the minimum qualifications for these positions reliably include professional training in assessment of maltreating families and the safety of children.

Numerous theoreticians and researchers have identified emotional and social competencies that are essential when seeking to influence human change. But few jurisdictions select for them, or devote sufficient time to systematically train to these skill sets, leaving them to be “learned on the job.” Experience supports that the job is an imperfect teacher.

The consequence is a workforce set up for failure. Staff are not selected based on having prior professional training specific to critical child welfare decisions. In-service training is predominantly knowledge-oriented, teaching staff what to do, but not necessarily how to do it. And interpersonal effectiveness in influencing human change – perhaps the most crucial skill in promoting reunification of families – is an afterthought at best.

How can an agency be effective when the workforce does not reliably have the skills and attributes needed to succeed?

The child protection agency is embedded in a support system not sufficiently aligned to its child protection and permanency mission.

Case management essentially involves assessment, referral to specialized human service agencies, and monitoring for client progress. These assessment decisions are reviewed by courts, attorneys and other professionals.

Once assessment identifies the primary changes to be made, clients are advised to seek help from referral agencies. The word “advised” is used here because generally, child welfare agencies cannot choose the service provider, meaning also that, if an evidence-based program exists, the client has to voluntarily choose that provider.

I would wager that 80 percent or more of the services vital to change in families lie outside of the public child welfare agency. And few systems succeed uniformly in effectively connecting these families.

In round two of the Federal Child and Family Service Review, a periodic assessment of state systems, only 19 percent of state agencies met substantial conformity with the service array standard. This standard requires that the state has in place an accessible and individualized array of services that assess the strengths and needs of children and families and determine other service needs, address the needs of families in addition to individual children in order to create a safe home environment, enable children to remain safely with their parents when reasonable, and help children in foster and adoptive placements achieve permanency.

During the review, numerous child welfare agencies cited prolonged waiting lists as a major problem. But of equal concern should be the lack of any evidence that the services at the end of these waiting lists are effective.

If assessment within the child welfare agency is compromised by the absence of evidence of criterion validity, how can referrals be made accurately? If referral sources do not exist or their staff are not specifically trained to work with maltreating families, how can these agencies be effective in supporting safety and permanency?

How can a child welfare agency be effective if the capacity for influencing human change is outside of the agency, may not be accessible upon referral, or specifically equipped to address the factors underlying child safety and maltreatment?

Under-resourcing leads to chronic burnout, turning the workforce from a force for positive change into a blunt instrument of social control.

CPS agencies are chronically short of mission-critical resources. These include, but are not limited to: supply of workers, time to do the work, skills needed to do the work, an available and responsive service array, clear and instructive guidance, and internal agency supports to address the emotional toll and secondary trauma inherent in the work.

Such resources are often enhanced following the settlement of a lawsuit, or upon the recommendations of a blue ribbon commission created after a tragedy. The additions typically fall short of what is actually needed and frequently only involve the CPS agency itself, ignoring the critical role of the system that surrounds it and its essential role in facilitating change in families.

In time, the cumulative effect of misaligned tools and training takes its toll. During the day, child welfare agency staff struggle to meet the needs of children and families. At night, they experience interrupted sleep filled with anxiety about what could go wrong. They experience depression associated with their inability to do what they know or believe is right.

As Christina Maslach’s research showed, burnout progresses through emotional exhaustion, to depersonalization and cynicism about the people with whom they work, and ultimately to feelings of lessened personal accomplishment.

How can a child welfare agency be effective when its staff does not have the tools and resources it needs and has become cynical about clients and lost the belief they can be successful?

What must be done?

These critical faults have existed throughout the history of the field. One will find them beneath every tragedy and agency failure to achieve safety, achieve timely permanency and safeguard child well-being.

What one won’t find is a coordinated national investment in building a real foundation for success by fully addressing the faults beneath the surface. It is time to stop treating the symptoms and address the underlying causes. Reform is not the answer. A fundamental redesign is needed.

If there is good news it may be that, unlike geophysical faults in the earth, these fault lines were actually built into the agency and system that supports it and can be altered

There must be a sustained and adequately funded research agenda designed to better identify valid criteria and effective methods for clinically assessing maltreating families as it relates to safety and permanency and influencing the changes needed in families for this to occur.

The selection of workers, and the training of those workers, must ensure that staff possess the right competencies and that they are proficient in them. There must be a critical assessment of case management practices as they really happen, not just in the ideal. Deficiencies must be identified and these models must be validated.

Thresholds for mission-critical services must be established, And then, there must be a distinction made between ones that actually work and ones that have may seem generically relevant but have no evidence behind them.

And finally, with all of those things in place, staff must be given the resources to do the job right, not just get the job done so it can be checked off on a procedural checklist.



Tom Morton
 most recently served as the child protection practice specialist for the Commission to Eliminate Child Abuse and Neglect Fatalities. Prior to that, he served as director of the Clark County, Nevada Department of Family Services for five years and as founder, president and CEO of the Child Welfare Institute for 22 years. 

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3 Comments

  1. The whole system is a endless black pit sucking up tax dollars, breaking up families and always a day late, and a dollar short for real change. The outrageous amounts paid to private agencies is ridiculous. The mismanagement of taxpayer funds is sickening with no one watching if that investment is producing any viable results for children’s benefit. Kids turns 19, and they are shoved out the door. Now, these young people become the tax payers burden again because they aged out of a system that didn’t do enough for them but costs BILLIONS each year.

  2. Or we could finally give up doing the things that aren’t working and do what works instead. We keep trying to punish parents into being better parents, but when you take a close look at their lives you realize they’ve already experienced far more punishment than most of us can imagine, and it hasn’t done much to make them better. We keep taking children away from the people with whom they belong, and are always surprised when they tell us they grew up feeling like they didn’t belong anywhere and didn’t matter to anyone. We keep offering services, hoping what hasn’t worked so well in the past will somehow influence change in this family, this time.

    What we do know is that children with stable and committed relationships with the adults with whom they belong are best prepared to face adversity without becoming traumatized and best able to heal from traumatic experiences. We already have all the resources we need to organize these adult into roles where they help parents make sure the children stay safe and help parents make sure their needs are well met. The social workers who have learned to do their work in this way find the work easier and far more rewarding. What keeps us from doing what works?

  3. Tom Morton estimates that 80% of the resources needed by child welfare families lie outside the child welfare system. Another data point that should be linked to this estimate is that the federal government annually spends $470 billion on programs and benefits intended to help children. But child welfare families have little or no priority in allocation of these funds to other agencies. There is a resource problem, to be sure. But there is also a serious priority problem. Child welfare can’t be held accountable for resources other agencies don’t prioritize for their clients; but child welfare can be held accountable for negotiating for those resources and demonstrating how they help achieve child welfare outcomes when made available.

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