Today, a White House-appointed commission created to end child abuse and neglect fatalities delivered a lengthy set of recommendations bent on re-orienting all the public systems that touch children towards child safety.
The through line of the 150-page report, which 10 of the 12 commissioners signed off on, is the idea that the Child Protection System (CPS) is only one cog in a much larger “21st Century Child Welfare System.” The report argues that eliminating child deaths – and mitigating the risks that lead to them – will require reapportioning the responsibility to the more than 20 federal agencies that address both child welfare and safety today.
In an interview, David Rubin, one of the commissioners and a physician at the Children’s Hospital of Philadelphia, underscored this point.
“We are not going to CPS our way out of this,” Rubin said. “We have to understand that at some point we are going to pivot to the recognition that services need to be provided on a voluntary basis, earlier, in order to avert potential harm to these young children who are at highest risk of fatality.”
In addition to the move towards prevention, the commission’s chair, David Sanders, an executive vice president at Casey Family Programs, sees the recommendations as a way to help CPS workers at the point of investigation and also after a child enters the foster care system.
“We need to bring in expertise to help with investigation and service delivery,” Sanders said in an interview, “so that CPS workers aren’t trying to deal with all the mental health, domestic violence and substance abuse issues these families face.”
The commission was established after the passage of the 2012 Protect Our Kids Act. In 2014, 12 commissioners, who had been appointed by the president and Congress, set off on a two-year, 11-jurisdiction listening tour where they heard from leaders of agencies ranging from public health to child protection.
The final report pointed to research showing that certain children are born to parents with risk factors that indicate heightened risk of maltreatment and child death.
“Without question I think everyone would say that given what we know about the risk, at a minimum we should be prioritizing kids that are at highest risk in the child protection system,” Sanders said. “Child protection is not going to be capable of addressing the needs of all the kids in the system now.”
In response to circumstances that overwhelm the child protection system, the commission calls for employing what it calls a “multi-disciplinary” or “public health” approach. The commission offers recommendations that would expand Medicaid while strengthening enforcement of existing law to make sure services are deployed earlier, before abuse or neglect happen. And in the cases where a call to the child abuse hotline is the trigger for services, the report calls for using agencies other than child protection to help keep families together.
This comes at an interesting time for us at The Chronicle. In our recent and ongoing coverage of potential reform to how the federal government pays for child welfare, I inadvertently opened up a debate about the child protection system’s obligation to keep families together.
Richard Wexler, a member of our Blogger Co-op, made the case that family preservation is child protection.
Then, Thomas Morton, who served as the child protection specialist on the aforementioned child fatality commission, wrote a column arguing that the responsibility of the child protection system is, “both a matter of ensuring a child’s physical safety and emotional security.”
“How many children are we willing to traumatize in order to protect a much smaller number of children who might be harmed if left at home?” Morton wrote. “And, if we decide to be over inclusive, are we also willing to fund and provide the services these children will need in order to have a chance at future normal development?”
His answer, given 46 years of child welfare experience, was a simple “no.”
Finally, another one of our more prolific Blogger Co-op members, Marie Cohen, took a line very closely aligned to that of the commission. Namely, that child protection systems should direct family preservation services to the families in need.
While there are dangerous circumstances where removing a child to keep him or her safe trumps the psychological damage that removal incurs, there are likely more cases where being able to keep children in their homes would be better for children.
The problem that the commission tried to tackle is the point where we intervene, and with what system.
Investigations of Differential Response (DR), a policy orientation once seen as the child protection system’s most promising bet to safely keep children in their homes after a referral of abuse had been lodged, revealed that much of its purported success had been built on a shaky evidence base. In the past two years, both Minnesota and Massachusetts discontinued or drastically altered their DR programs because of well-documented child safety concerns, including high profile child deaths.
These developments have created more questions about child protection’s capacity to successfully engage in family preservation. As the commission reports, a call of abuse, even unfounded, is the single best predictor of subsequent child maltreatment and maltreatment death.
This does not justify ripping apart families because of correlation, but it does throw into question whether the child protection system is the best vehicle for delivering services to keep families intact.
The commission’s answer is to invest more heavily in effective child maltreatment prevention efforts, and to employ the help of other agencies to do the very hard work of keeping together families at high risk of child abuse.
On the prevention side, the commission envisions enhancing screenings in hospitals, among domestic violence professionals, through law enforcement agencies and alongside mental health providers.
The most concrete recommendation regarding prevention is pulled directly from research provided by the Children’s Data Network at the University of Southern California’s School of Social Work. In a study of adolescent mothers in Los Angeles County released in 2013, researchers found that 18 percent of children born to mothers who had been victims of substantiated abuse or neglect would be substantiated victims of maltreatment by age five.
Understanding that 1-in-5 children born to mothers who are or were in foster care will wind up victims of abuse themselves, the commission calls for the targeting of nurse home-visiting programs for parents who are currently in the child welfare system.
“If we can provide home visiting to a parenting foster youth we hope we can break the intergenerational cycle of abuse,” Rubin said.
The Child Abuse Treatment and Prevention Act (CAPTA) funds child protection efforts across the country. As mentioned in the report, and previously highlighted by advocacy groups, CAPTA is underfunded and weakly enforced.
The law mandates the creation of “Plans of Safe Care,” which are meant to reduce risk to substance-exposed newborns. The commission recommends more tightly enforcing this policy, and despite a lack of consensus on how to pay for its recommendations, indicates support for an increase in CAPTA funding.
The commission also recommends using funding available for children through Medicaid’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program. This would allow parents to get mental health treatment through the child’s EPSDT eligibility, and thereby potentially keep children from entering the system.
Sanders, the commission chair, said that the mechanism for assigning parents mental health services through EPSDT may end up being involvement with the child protection system, but added that the recommendation could also be used for families identified as high risk prior to a report of abuse.
Once a child enters the system, the commission sees CPS as the conduit for services available in other systems.
This includes creating an “innovation fund” that would spur cross-agency collaboration spearheaded by child protection systems. In addition, the commission wants CPS to manage “access to voluntary home visiting services, domestic violence counseling, mental health services, and substance abuse treatment services.”
One glaring issue with the report is that it calls for a wholesale change in child protection based on the very rare occurrence of child deaths. Beyond the Congressional mandate that called for a look at child deaths specifically, Sanders pointed out that child deaths have remained a constant problem, while other measures of child safety have improved.
“You have got to start someplace and this is good as any place to start,” Sanders said. A broader focus, he added, would not have changed the recommendations substantively.