Child Protective Services System Research Articles

Profiles of Child-Welfare-Involved Caregivers Identified by Caseworkers as Having a Domestic Violence Problem: Then and Now.

Over the past 10 years, there has been a significant decline in the rate of domestic violence (DV) experienced among caregivers involved with the child protective services (CPS) system. It is unclear whether this shift is related to changes in caregiver characteristics. Furthermore, despite evidence that suggests CPS caseworkers poorly identify DV and fail to link families to DV services, limited research exists on whether the current CPS interventions that are known to improve caseworkers' DV identification will also improve chances for DV service receipt. The present study uses data from the first and second cohorts of the National Survey of Child and Adolescent Well-Being (NSCAW) to compare differences in demographic characteristics and DV experiences between caregivers in NSCAW I (1999-2000; n = 2,758) and NSCAW II (2008-2009; n = 2,207). We also examine the effects of CPS interventions on NSCAW II caregivers' receipt of DV services external to the CPS agency (i.e., external DV services). Caregivers with caseworker reports of active DV in NSCAW I and II were similar in their demographic characteristics and external DV service experiences. However, caregivers in NSCAW II generally reported lower rates of victimization for specific types of violence than NSCAW I caregivers. Finally, caregivers with active DV involved with an agency that used DV assessment tools were 7.03 times more likely to receive external DV services than those in agencies without DV tools (95% confidence interval [CI] = [2.33, 21.22]). Whereas caregivers in agencies that sometimes (odds ratio [OR] = 0.16, 95% CI = [0.03, 0.99]) or always (OR = 0.15, 95% CI = [0.02, 0.98]) had a DV specialist available were less likely to receive external DV services than those in an agency that never/rarely had a DV specialist available. We recommend CPS agencies use specialized assessment tools to identify DV-affected families and link them to services. Additional research is needed to understand what types of services DV specialists offer within CPS agencies and whether these services meet caregivers' needs.

Sexually Transmitted Infections In A Sample Of At-Risk Youth: Roles Of Mental Health And Trauma Histories.

Little is known about whether there are specific subpopulations of youth with known problem behaviors that are more likely to engage in sexual risk behaviors. This study's sample (n=4,117) was drawn from a larger longitudinal administrative data, consisting of young adults with child abuse and/or poverty histories and records of some form of high-risk behavior or mental health diagnosis during adolescence. A cluster-controlled, logistic regression resulted in eleven statistically significant relationships. Youth treated for a mental health disorder and experienced multiple forms of abuse were more likely to be treated for Sexually Transmitted Infections (STIs). Youth who were delinquent,, treated for substance abuse and had substance use related offenses were less likely to be treated for STIs. Youth treated for STIs were more likely to be identified through mental health systems or child protective services system than through known delinquent behaviors. Health care providers treating youth for STIs should explore the possible role of mental health and trauma histories.

Female Sexual Offenders in Child Sexual Abuse Cases: National Trends Associated with Child Protective Services System Entry, Exit, Utilization, and Socioeconomics

Up to 20% of child sexual abuse cases in the United States involve a female perpetrator in a primary role. However, less than 1% of incarcerated sex offenders in the United States are female. Female offenders appear to be systematically moving on different consequential trajectories than men when it comes to sexual offenses. This project assesses gendered disparities in the ways substantiated child sexual offenders experience the U.S. public child welfare system through an investigation of virtually every substantiated child sexual abuse case in the nation as documented by state level child protective services for 1 year (N = 66,765). Findings detail how during the time substantiated female sexual offenders are involved with child welfare agencies, they receive higher levels of mental health, substance abuse, family centered, and economic based services than comparable male sex offenders. Additional findings and implications are also discussed; including observed differential pathways for child welfare system entry and exit.

Are children safer with kin? A comparison of maltreatment risk in out-of-home care

Safety, or the absence of maltreatment, is the primary mandate of the child protection services (CPS) system, both for children living at home and those living away from home. Yet, few research studies have examined maltreatment in out-of-home care due to the low incidence rate and data limitations. This study used statewide administrative data to estimate the association between placement type and experiencing a maltreatment investigation or substantiation in out-of-home care. Over 6% of informal TANF-funded kinship placements experienced an investigation alleging maltreatment by an out-of-home caregiver, compared with just over 3% for formal kinship care and non-relative foster care. However, the monthly risk of maltreatment was lowest in informal kinship care because these placements tended to endure longer before maltreatment occurred. Substantiated maltreatment during an out-of-home placement was rare across all placement types. For both investigated and substantiated maltreatment, risk was highest in the first 3months.

The Role of the Family and Family-Centered Programs and Policies

Summary Families influence their children's health in two ways that are amenable to public policy--through their financial and other investments in children, and through the quality of care that they provide. In general, children who receive more resources or better parenting are healthier than those who don't. Public policies, therefore, might improve children's health either by giving families more resources or by helping parents provide better care. When it comes to financial resources, write Lawrence Berger and Sarah Font, the research is straightforward--programs that add to disadvantaged families' incomes, whether in cash or in kind, can indeed improve their children's health. The Earned Income Tax Credit, for example, has been linked to higher birth weights and greater cognitive achievement. When it comes to programs that target quality of care, however, the picture is more complex. At the low end of the spectrum, poor parenting shades into neglect or abuse, which can seriously harm children's health and development. Thus we might expect that the child protective services system, which has the power to intervene and protect children in such cases, could also improve children's health in the long run. But Berger and Font find that the system's ability to affect children's health is limited, largely because it becomes involved in children's lives only after damage has already occurred. Other programs, however, have the potential to improve parenting, reduce maltreatment, and thus enhance children's health and development. Home visiting programs show particular promise, as do large-scale, community-level primary prevention programs. ********** Childhood health is associated with a wide variety of outcomes throughout the life course, from ongoing physical and mental health to disability, mortality, and socioeconomic status. Families bear the primary responsibility for making direct investments in children, as well as for regulating and allotting other public and private investments. That is, families provide the caregiving context in which most children grow and develop; they also provide and allocate resources to children. In this way, families play the primary role in promoting child health and development. Thus, any effort to promote child health must necessarily involve families. Yet the quality of the family environments in which children are raised varies considerably; in particular, not all families provide safe, stable, and high-quality care. In this article, we first explain how families are believed to influence children's health. In particular, we focus on family context (structure, composition, and access to resources) and parenting behaviors. We consider health in a broad sense, including physical, social-emotional, behavioral, cognitive, and mental health and development. Second, we describe the role of the child protective services (CPS) system in protecting children from familial harm and intervening with families where child maltreatment has occurred. We conclude that CPS has limited ability to influence child health, because it primarily intervenes only after harm has occurred and because a combination of resource constraints and a relatively narrow mandate means that CPS focuses on only a small proportion of children and families. Third, we review other policies and programs that can influence family contexts and behaviors before harm has occurred. We highlight several promising programs--including economic support, community-level interventions, and home visiting programs--that have the potential to improve the quality of care children receive, reduce child maltreatment, and positively influence child health and development. How Do Families Influence Child Health? Families are thought to influence child health through three primary mechanisms: biological and genetic endowments, financial investments (goods and services purchased), and behavioral investments (caregiving quantity and quality). …

The influence of differential response and other factors on parent perceptions of child protection involvement

As Child Protective Services (CPS) agencies examine how to produce better outcomes with the families they serve, child welfare literature has increasingly focused on the perspectives, emotional responses, and engagement of CPS-involved parents or other primary caregivers. Despite this encouraging trend, the construct of engagement is ill-defined and our understanding of precursors to and factors affecting parent engagement is limited. This article extends the literature by presenting a conceptual framework for examining engagement and associating the identified constructs with parent outcomes. Using data from a survey of parents who were randomly assigned to receive either an assessment response (AR) or investigation response (IR) in two states’ Differential Response CPS systems, a factor analysis on 12 commonly assessed emotional responses reported by parents indicated that parents responded with three primary emotions: positive affect, worry, or anger and that these responses varied by their receipt of AR or IR. Further, the results of multivariate analyses indicate that pathway assignment (AR or IR), parents’ assessments of the quality of the casework they received, and other parent or household factors contribute to differences observed on the three emotional response factors identified.

Implementing Reinforcement-Based Treatment (RBT) for Substance Use Disorders within child protective service systems in Europe

Parental substance misuse is a major concern internationally among child protective service systems charged with protecting children from maltreatment. Research in western countries indicates that substance misuse is a contributing factor in the vast majority of maltreatment cases that require child removal from the home. Unfortunately, parents involved in child protective services rarely access or complete treatment for substance misuse. A new approach to addressing the complex interrelated problems experienced by families in which child maltreatment has occurred known as Multi systemic Therapy for Child Abuse and Neglect (MST-CAN), is being implemented in numerous sites in the US and Europe. This article describes the provision of Reinforcement-Based Treatment (RBT), an intensive behavioural intervention for substance misuse developed in the US by MST-CAN service providers in Europe. Several challenges encountered in delivering RBT within the European context including balancing abstinence-only and harm reduction perspectives, making drug testing feasible, and implementing vocational interventions are discussed as well as how each challenge was managed. The authors conclude that the implementation of RBT in Europe with a child protective service system population has been successful and encourage further adoption of the model across different European contexts. DOI: http://dx.doi.org/10.4038/ijptsud.v1i2.7692 International Journal of Prevention and Treatment of Substance Use Disorders 2014;1(2):38-52

Making Parents Pay: The Unintended Consequences of Charging Parents for Foster Care

Most families in the child protective services system also interact with the child support enforcement system. We exploit a natural experiment in Wisconsin, created by the large regional variation in child support referral policy, to estimate a potentially important effect of child support enforcement on the duration of out-of-home foster care placement. The effect we examine is whether requiring parents to pay support to offset the costs of foster care delays children's reunification with a parent or other permanent placement. We find evidence of this unintended effect, which is important not only because longer foster care spells are expensive for taxpayers, but also because extended placements in foster care may have consequences for child well-being. Our results highlight the potential importance of cross-systems analysis and the potential consequences when the policies and fundamental objectives of public systems are inconsistently coordinated. We discuss the implications of our findings for child support and child protective services policy.

Differential Response family assessments: Listening to what parents say about service helpfulness

An increasing number of Child Protective Services (CPS) systems are implementing Differential Response (DR) approaches in which lower-risk families are served through a family assessment response that emphasizes a family centered approach and the provision of concrete and preventative services. Quantitative survey data collected from parents suggests that those who receive family assessments are more engaged, receive more concrete services, and have higher overall satisfaction than those who receive a traditional investigation; yet little is known about which services provided through a family assessment are most helpful to parents. This qualitative study sought input from 20 parents who received a DR family assessment response in order to provide an in-depth analysis of which aspects of their CPS experience they perceived as most helpful. Results suggest that a positive and emotionally supportive relationship with the caseworker was of utmost significance. Other caseworker-provided services were described as helpful, particularly those that helped parents establish or improve relationships with others, including advocacy with other service providers, mediation of family disagreements, and coaching on parenting or relationship skills. Material support, such as providing cash assistance for rent or furniture, was helpful when received but occurred less frequently and was sometimes a source of frustration when accompanied by lengthy waits for assistance. These findings have implications for CPS practice, including enhancing caseworkers’ relationship-building and engagement skills through pre-service educational coursework and in-service trainings; allowing caseworkers adequate time to develop supportive relationships with parents; and reducing the institutional barriers that delay the provision of concrete support.

A Different Perspective on Managing Child Welfare in Turbulent Times

In their recent article, Gustavsson and MacEachron (2013) argued that recessions have caused significant financial burden for public child welfare agencies, leading to adverse outcomes for children and families. The most provocative suggestion by Gustavsson and MacEachron to address the financial burden is to revisit the ideas proposed more than 20 years ago by Leroy Pelton to restructure the Child Protective Services (CPS) system by having “the investigative role of child welfare be assumed by law enforcement, freeing child welfare to offer preventive and supportive services to enhance family well-being on a voluntary basis” (Pelton, 1991, p. 88). This particular suggestion by Gustavsson and MacEachron (2013) may perhaps be too provocative, as it seems to be a broader statement of what Pelton (1991) had focused on in his original article. Pelton believed that a restructuring of the child welfare system was needed based on the research and statistics of the 1980s that suggested an overreliance on out-of-home placements and not enough funding for preventative services. For example, he noted that there were 360,000 children in care in 1989, with an alarming one quarter of the children reentering foster care within one year of exiting foster care. In 1990, there were 63.6 million children in America (U.S. Census Bureau, 2013). Thus, the proportion of children in out-of-home care was about 0.57 percent. Pelton (1991) had proposed the idea of child welfare restructuring in the context of greatly narrowing child abuse and neglect laws to

Integrated Health and Human Services Information Systems to Enhance Population-Based and Person-Centered Service

& 2013 Publ In this issue of the American Journal of Preventive Medicine, Vaithianathan and colleagues have made a valuable contribution in demonstrating how administrative data from human services systems can be used to develop a predictive risk model that identifies children at high risk of maltreatment and could support targeting of prevention and early intervention services. They integrated data from the New Zealand public benefit and child protective services systems to develop their risk algorithm. It is particularly relevant to the U.S. now as many state and local governments are using the impetus of national healthcare reform to redesign health and human services information and service delivery systems. As the authors note, predictive risk modeling (PRM) is most advanced in healthcare utilization, and it is an increasingly important tool in a wide range of innovations to improve quality and “bend the cost curve” in the U.S. healthcare system. The integration of data from multiple sources, including all-payer claims databases and electronic health records, is providing the foundation for identifying individuals at high risk, targeting interventions for chronic disease management, reducing hospital admissions and readmissions, improving end-of-life care, and recognizing many other opportunities for improvement. A whole new industry is emerging to capitalize on the analytic promise of “Big Data.” In recent years, heightened attention is also being directed to modernizing the information systems that support human services. The National Human Services Interoperability Architecture (NHSIA) initiative sponsored by the Administration for Children and Families (ACF) within the U.S. DHHS and the National

Services Against Our Will: Texas Family Code § 264.203 Is Unconstitutional

There exists a well-known and ever-increasing problem throughout Texas: Texas Child Protective Services. The Texas Child Protective Services ("CPS") system is flawed, yet often, efforts are not made to correct the identifiable flaws. Perhaps progress can be made by ensuring that the statutes upon which CPS is built are, themselves, not flawed. At the most basic level, statutes must be constitutional; an unconstitutional statute will inevitably lead to application problems. One of CPS's major flaws is its at-times inappropriate insistence that families participate in "services." Upon closer inspection of this flaw, the statute that allows judges to order participation in such services at CPS's request, section 264.203 of the Texas Family Code, is unconstitutional because the statute allows for state infringement of several fundamental rights without setting out any sort of a burden of proof to be met. Even if section 264.203 was not considered unconstitutional on its face, certainly it would be unconstitutional as applied.

Are We Meeting the Mental Health Needs of Irish Children in Care?

Goals: In 2012 a harrowing report into the deaths of children in State care in Ireland was published. This confirmed the already well-established view of these children as physically and emotionally vulnerable. This study aimed to look at the training levels and need of social workers working within the child protection and social services system. Methods: This paper reports on a study examining the level of training in mental health in a cohort of 92 social workers in a Dublin area, most of whom were employed in child protection and social services posts. All participants had completed third level or university/college education in areas closely related to the care sector. A subgroup attended and evaluated a training workshop on mental health issues. Results: Nearly half (49.1%) of those responding to the survey reported no prior mental health training. The most requested topics for training included specific MH disorders and issues related to various kinds of child abuse and neglect. They also wanted training in multidisciplinary team working, play therapy and managing separation and access. Conclusions: We make recommendations to address the perceived deficits. The recognition of higher rates of mental health problems in these children emphasise the importance of adequate training in mental health for personnel working with children in care, and easy access to mental health services. Keywords: children in foster care, mental health needs, training of social workers

Increased Serum Creatine Phosphokinase in a Child With Bruising Due to Physical Abuse

Bruising is a frequent and often sentinel injury in children who are victims of physical abuse. Children who are evaluated in an emergency department for bruising, which may be due to abuse, present a challenge to physicians; the injuries themselves are medically minor and their severity can only be described qualitatively with photographs. Nonetheless, bruising in an infant or bruising in unusual locations in young children can indicate violence and risk. These children also present a challenge to the Child Protective Services system because the injuries generally resolve quickly without medical treatment and do not result in long-term sequelae. Creatine phosphokinase (CPK) is released from injured muscle and results in increased serum CPK concentrations. We report on a case of isolated bruising due to child physical abuse in which serum CPK concentrations were markedly increased, demonstrating clinically unsuspected rhabdomyolysis. The increased serum CPK concentrations provided important quantitative information about the seriousness of the bruising. A subsequent chart review of children evaluated by our hospital's child protection team for isolated bruising during a 6-year period demonstrated that there were other children with bruising due to abuse who also had increased serum CPK concentrations. This information suggests that increased serum CPK in children with bruising due to abuse may be more common than previously thought and that this information may have the potential to be used to provide quantitative, objective information about the seriousness of the bruising. We recommend that physicians consider measuring serum CPK in children with bruising due to physical abuse.

Court Testimony, Child Welfare and Justice Systems, and the Emergency Physician

Emergency physicians, because of their frequent role in evaluating child victims of abuse and neglect, are likely to come into contact with child protective services (CPS) and law enforcement and may be called to testify in court. It is important that pediatric emergency medicine physicians have an understanding of CPS and criminal justice systems as they pertain to child abuse and neglect, as well as skills in effectively providing court testimony. This article, using case illustrations, will discuss the CPS and criminal justice systems, as well as provide strategies to facilitate comfort and effectiveness as a court witness.

Intellectual Disabilities and Neglectful Parenting: Preliminary Findings on the Role of Cognition in Parenting Risk

Parents with intellectual disabilities (PID) are overrepresented in the child protective services (CPS) system. This study examined a more nuanced view of the role of cognition in parenting risk. Its goal was to validate a social information processing (SIP) model of child neglect that draws on social cognition research and advances in neuroscience. Mothers who had CPS child neglect cases were compared to mothers with no CPS involvement on a set of SIP factors. Mothers with low IQs were oversampled. As predicted, the Neglect group had significantly greater SIP problems than the Comparison mothers. SIP problems were associated with direct measures of neglect (e.g., cognitive stimulation provided children, home hygiene, beliefs regarding causes of child injuries). Further, for the direct measures that were most closely linked to CPS Neglect status, IQ did not add significant predictive capacity beyond SIP factors in preliminary model testing. Implications for intervention with PID are discussed.

Protecting Children, Preserving Families: Moral Conflict and Actuarial Science in a Problem of Contemporary Governance

The United States Child Protective Services system is shaped by the unresolved tension between the aims of child protection and family preservation. Since the 1980s, child welfare experts have recommended the use of risk assessment tools in the hopes of standardizing the decisions made by social workers and judges. In this article, I show that despite their bureaucratic appearance, the tools implemented lacked a clear directive, allowing unresolved value conflicts to be papered over by the appearance of technocratic regularity. I argue that this case not only exemplifies Max Weber's classic distinction between problems of social science and moral value in the creation of social policy, but also raises questions about the effects and uses of audit technologies in situations of ongoing moral conflict.

Risk factors and services for child maltreatment among infants and young children

Objectives Child maltreatment (CM) causes injury in large numbers of U.S. children. This study uses a large, multi-state dataset of child protective services reports for infants and young children under five years of age to examine risk factors and the effects of services in confirmed maltreatment investigations and recurrence over five years. Methods The Child Files of the National Child Abuse and Neglect Data System (NCANDS) for 2003–2007 were used to study confirmed CM reports to child protective services (CPS) using regression models and survival analysis among a cohort of children first reported during 2003. Results There were 1.2 million confirmed maltreatment reports to state child protective services agencies in 22 states during 2003–2007 in NCANDS, including 177,568 infants and young children under five years. 19.3% had a second confirmed CM report within 5 years. White race, inadequate housing and receiving public assistance were associated with significantly increased risk of CM recurrence. Infants and young children received more services and had less recurrence than did older children. Conclusions Infants and young children have different risk factors and receive different services than do older children in the CPS system. We need additional research to further assess and better target services for the special needs of infants, young children and their families if we are to protect them and reduce future child maltreatment.

Key decisions in child protection services in cases of domestic violence: maintaining services and out-of-home placement

This paper looks at the response of the child protection services (CPS) system in cases where exposure to domestic violence occurs alone or together with abuse or neglect, focusing on the factors involved in decisions to maintain the case open for ongoing services or remove children from the home. The study is based on an analysis of clinical and administrative data from the files on children reported to a CPS agency in Montreal, Canada. A total of 1 071 substantiated reports were documented, including 337 cases of co-occurrence (32%). Analysis of the data shows that domestic violence does not by itself constitute a factor liable to lead to more intrusive intervention. The CPS response appears to be influenced more by the existence of other forms of maltreatment and risk factors. Additionally, while domestic violence may be associated with more severe individual and family problems, it does not influence the decision to keep the case open because the child still need services. The lack of any connection between domestic violence and this decision is a cause for concern, as results indicate that such families need help. Knowing how to respond to their needs therefore remains a major challenge. Correspondence:

Factors predicting placement of urban American Indian/Alaskan Natives into out-of-home care

American Indian/Alaskan Native children have disproportionately been placed into out-of-home care compared to White children in the child welfare system. What were the factors that child protective services (CPS) workers considered when deciding to remove a child from the home? Utilizing data from the National Survey of Child and Adolescent Well-Being, this study examined out-of-home care factors for 2215 urban American Indian/Alaskan Native (AI/AN) and White children. In the urban sample, children from White families were younger and were more likely to be investigated for lack of supervision, while AI/AN families were investigated for physical neglect. In the placement regression models, urban AI/AN children came from homes where caregivers had greater alcohol, drug and mental health problems. Decisions by CPS workers to place AI/AN children may have been influenced by racial bias. A CPS system that acknowledges culture and race may reduce overrepresentation in placement. Efforts to work with AI/AN families prior to a child's removal may prove to be beneficial and less expensive.