Child Protection System Involvement Research Articles

Child Protection System Interactions for Children With Positive Urine Screens for Illicit Drugs

Young children are ingesting illicit drugs at increased rates, but it is unknown what the associated child protection system (CPS) responses are when a child tests positive. To document the child protection system involvement and the characteristics of children who test positive for illicit substances. This retrospective cross-sectional study linked medical discharge and child protection system administrative data. The setting was Rady Children's Hospital San Diego, a free-standing pediatric hospital in California. Participants included all emergency department and inpatient medical encounters involving children aged 12 years or younger with a positive urine drug test between 2016 and 2021. Statistical analysis was performed from February 2023 to January 2024. Drug type, including amphetamines, barbiturates, benzodiazepines, cannabis, cocaine, fentanyl, opiates, and phencyclidine. CPS responses associated with the medical encounter including reports, substantiations, case openings, and out-of-home placements. A total of 511 emergency department and inpatient medical encounters involving children had a positive drug test (262 [51.3%] were female; 309 [60.5%] were age 6 years or younger; fewer than 10 [<3.0%] were American Indian or Alaska Native; 252 [49.3%] were Hispanic [any race], 20 [3.9%] were non-Hispanic Asian, 56 [11.0%] were non-Hispanic Black, 143 [28.0%] were non-Hispanic White, 36 [7.0%] had other or unknown race and ethnicity; 233 [43.6%] had a CPS report prior to the medical encounter). Following the positive screen, 244 (47.7%) were reported to child protection, and 61 (11.9%) were placed out-of-home within 30 days. Mean (SD) quarterly counts of encounters with positive drug tests doubled after the COVID-19 pandemic onset (32.9 [9.8]) compared with prior to the pandemic onset (16.5 [4.7]); for encounters positive for cannabis, mean (SD) quarterly counts were 3 times as high after the pandemic onset than prior (16.6 [4.7] vs 5.7 [2.9]). Encounters for children under age 1 were significantly more likely to have associated child protection reports (relative risk [RR], 2.91 [95% CI, 2.21-3.83]) and child protection case openings (RR, 1.71 [95% CI, 1.07-2.72]) than encounters involving older children. In this cross-sectional study of emergency department and inpatient medical encounters, less than half of children with positive urine drug screens were reported to CPS; out-of-home placements were uncommon. With increased encounters for positive drug tests, it is unclear what services these children and families are receiving.

The overrepresentation of parents with disabilities in child protection

BackgroundRacial disproportionality and disparity have long plagued the United States child protection system (CPS). Determining whether disproportionality exists for parents with various disability diagnoses, and the points at which it may occur within CPS, is important to the provision of appropriate assessment and service delivery to children and families. ObjectiveThis study describes the characteristics of parents with different types of disabilities and estimates their representation at various CPS decision-making points. Participants and settingThe sample consists of a longitudinal, population-level cohort of individuals aged 15–21 identified from statewide educational records, whose disability status could be determined. Statewide CPS records were integrated to determine subsequent CPS involvement (as alleged offenders/parents involved in a child maltreatment investigation, and/or as parents of children placed in out-of-home care [OHC], and/or as parents whose parental rights were terminated [TPR]), or lack thereof. MethodsDescriptive statistics, chi-square analysis, disparity indices with decision-point enumeration, and logistic regression analyses were used to answer study questions. ResultsFindings reveal consistent and significant overrepresentation of parents with disabilities at CPS investigation as compared to parents without disabilities. Additionally there is a fairly similar trend across disability diagnoses in the reduction of overrepresentation at OHC, followed by a diagnosis-specific change in representation as parents with disability move into a situation of TPR, with some parents with disabilities being over-represented and others not. ConclusionAttention to practice, policy, and research are necessary to provide fair and equitable services to parents with disabilities and their children in CPS.

Child, parent and contextual factors associated with child protection system involvement and child maltreatment in the family: A rapid evidence review

AbstractChild abuse and neglect in the home is a prevalent and significant issue in Australia. Recent findings from the Australian Child Maltreatment Study revealed that 62.2 per cent of participants had experienced at least one type of maltreatment during childhood, with most reporting multi‐type maltreatment. This rapid evidence review was aimed at understanding factors associated with child abuse and neglect in the family context. Results from the included studies indicated that there is a complex interplay between various child‐related factors, parent or family characteristics and contextual factors in understanding child maltreatment. Implications for a reliance on proxy measures of child maltreatment, including involvement with child protection systems, are also considered. A key finding across the included studies was that parent characteristics were consistently identified and should be a key target for prevention. Further research is needed to explore the role of parenting capacity and skills in the prevention of harm, the intersection between associated factors, how protective factors and strength‐based approaches can inform prevention efforts and how policies and practices can be designed to appropriately address this issue.

Agent-based simulation and child protection systems: Rationale, implementation, and verification

Background and objectiveSimulation models are an important tool used in health care and other disciplines to support operational research and decision-making. In the child protection literature, simulation models are an under-utilized source of research evidence. Participants and settingIn this paper, we describe the rationale for and the development of an agent-based simulation of a child protection system in the US. Using the investigation, prevention service, and placement histories of 600,000 children served in an urban child welfare system, we walk the reader through the development of a prototype known as OSPEDALE. MethodsThe governing equations built into OSPEDALE probabilistically simulate the onset of investigations. Then, drawing from empirical survival distributions, the governing equations trace the probability of subsequent interactions with the system (recurrence of maltreatment, service referrals, and placement) conditional on the characteristics of children, their assessed risk level, and prior child protection system involvement. ResultsAs an initial test of OSPEDALE's utility, we compare empirical admission counts with counts generated from OSPEDALE. Though the verification step is admittedly simple, the comparison shows that OSPEDALE replicates the empirical count of new admissions closely enough to justify further investment in OSPEDALE. ConclusionsManagement of public child protection systems is increasingly research evidence-dependent. The emphasis on research evidence as a decision-support tool has elevated evidence acquired through randomized clinical trials. Though important, the evidence from clinical trials represents only one type of research evidence. Properly specified, simulation models are another source of evidence with real-world relevance.

Child protection system involvement in children of incarcerated mothers: A linked data study

BackgroundWomen prisoners are a growing portion of the prison population. Health and social outcomes of their children have been studied and found to be poor, but little is known about child protection outcomes. ObjectivesAscertain child protection system contact of children exposed to maternal incarceration. Participants and settingAll children born between 1985 and 2011 exposed to the incarceration of their mothers in a Western Australian correctional facility and a matched comparison group. MethodsA matched cohort study using linked administrative data on 2637 mothers entering prison between 1985 and 2015 and their 6680 children. We estimated hazard ratios (HRs) and incidence rate ratios (IRRs) of child protection service (CPS) contact post maternal incarceration (four concern levels), comparing rates for children exposed to maternal incarceration with a matched non-exposed group, adjusting for maternal and child factors. FindingsExposure to maternal incarceration increased risk of CPS contact. Unadjusted HRs exposed vs unexposed children were 7.06 (95%CI = 6.49–7.69) for substantiated child maltreatment and 12.89 (95%CI = 11.42–14.55) for out-of-home care (OOHC). Unadjusted IRRs were 6.04 (95%CI = 5.57–6.55) for number of substantiations and 12.47 (95%CI = 10.65–14.59) for number of removals to OOHC. HRs and IRRs were only slightly attenuated in adjusted models. ConclusionsMaternal incarceration is a warning flag for a child at high risk of serious child protection concerns. Family-friendly rehabilitative women's prisons, incorporating support for more nurturing mother-child relationships could provide a placed-based public health opportunity for disrupting distressing life trajectories and intergenerational pathways of disadvantage of these vulnerable children and their mothers. This population should be a priority for trauma-informed family support services.

Adverse childhood experiences, associated stressors and comorbidities in children and youth with fetal alcohol spectrum disorder across the justice and child protection settings in Western Australia

BackgroundIndividuals with Fetal Alcohol Spectrum Disorder (FASD) are at risk of having adverse childhood experiences (ACEs), especially those with child protection and/or justice system involvement. The complex relationship between FASD and psychosocial vulnerabilities in the affected individual is an important clinical risk factor for comorbidity. This study (1) explored the ACEs and associated stressors in individuals with FASD; (2) investigated the association between ACEs and negative outcomes, i.e., justice/child protection system involvement; and (3) examined the relationship between ACEs and comorbid conditions such as mood and neurodevelopmental disorders.MethodsData were collected retrospectively via file review from diagnostic clinics in Western Australia. Life adversity was coded using a standardised ACEs questionnaire. A total of 211 participants (72% males) with FASD with a mean age of 11 years (range = 2–21) were included in the final sample. 70% of the total sample had been involved with the child protection system and 40% had trouble with the law.ResultsExposure to drinking/substance misuse at home (70%) and domestic violence (52%) were the two most common ACEs across the total sample. In the entire cohort, 39% had four or more ACEs, indicating higher risks of poor health outcomes. Additional stressors recorded were disengagement from school (43%), transiency (19%), victims of bullying (12%), traumatic brain injury (9%) and homelessness (5%). ACEs such as drinking/substance misuse at home, emotional neglect and physical neglect were positively associated with child protection system involvement. Additionally, exposure to domestic violence was positively correlated with justice system involvement. Higher rates of life adversity in this clinical population were associated with an increased number of comorbidities. Specifically, those with FASD who had comorbidities such as attachment disorder, substance use disorder, and PTSD also reported higher ACEs scores.ConclusionACEs were common in this clinical population. Increased ACEs in this sample were associated with increased comorbidities and involvement with the child protection and/or justice system. This highlights that prevention, intervention and early diagnosis of FASD are important for at risk children to reduce the negative effects of ACEs.

A Population-Based Study of Mental Health Diagnoses and Child Protection System Involvement Among Medicaid-Insured Children

To determine the population prevalence of diagnosed mental health disorders among Medicaid-insured children <18years old in California based on levels of current and past child protection system (CPS) involvement. In this retrospective, population-based study, we examined the full population of children enrolled in California's Medicaid program for at least 1 month between 2014 and 2015 and who had at least 1 claim during that period (n=3 352 886). Records for Medicaid-insured children were probabilistically linked to statewide CPS records of maltreatment and foster care placements since 1998. A primary or secondary mental health diagnosis was classified using International Classification of Diseases codes. Overall, 14% (n=470 513) of all children insured through Medicaid in 2014-2015 had a documented mental health diagnosis. Among children with a diagnosis, the percentage with CPS involvement (ie, any report for maltreatment) was nearly twice that of the Medicaid population overall (50.4% vs 26.9%). This finding held across all diagnostic groups but with notable variations in magnitude. A graded relationship emerged between the level of CPS involvement and the likelihood of a mental health diagnosis. Diagnoses among children reported for maltreatment were common, regardless of placement in foster care. Findings document high rates of both mental health diagnoses and past child protection involvement in a population of Medicaid-insured children. Most children reported for maltreatment will never be placed in foster care, underscoring the importance of ensuring that the children who remain at home receive the proper array and coordination of services.

Intergenerational transmission of child maltreatment in South Australia, 1986–2017: a retrospective cohort study

The extent of intergenerational transmission of child maltreatment is unclear due to methodological limitations in previous studies. In this study, we aimed to examine factors associated with intergenerational transmission of child maltreatment and quantify its extent in a population sample over a 30-year period in South Australia. In this retrospective cohort study, we used linked administrative data from the South Australian Birth Registry to identify dyads of mothers and their children both born in South Australia between July 1, 1986, and June 30, 2017. Three child protection system (CPS) outcomes (any CPS involvement, substantiated maltreatment, and time spent in out-of-home care) were computed from data obtained from the South Australian Department for Child Protection. Multivariable Cox regression models were used to estimate hazard ratios (HRs) for child CPS outcomes according to their mother's CPS exposure. 38 556 unique mother-child dyads were included. 458 (2·0%) of 23 437 children whose mothers had no CPS involvement in childhood had a substantiated report of maltreatment and 127 (0·5%) spent time in out-of-home care. By comparison, 970 (22·1%) of 4382 children whose mothers experienced substantiated maltreatment in childhood had substantiated maltreatment and 469 (10·7%) spent time in out-of-home care. After adjusting for potential confounders, children of mothers with any CPS involvement in childhood had an increased risk of CPS contact compared with children whose mothers had no CPS involvement; this risk was greatest for children of mothers who had both substantiated maltreatment and spent time in out-of-home care (HR 6·25 [95% CI 5·59-6·98] for any CPS involvement, 13·69 [10·08-16·92] for substantiated maltreatment, and 25·78 [18·23-36·45] for any time in out-of-home care). Risks of child CPS outcomes were substantially increased for children of mothers who had a first CPS notification under the age of 1 year or who had any CPS notification at age 13-17 years. Children are at high risk of maltreatment if their mother experienced maltreatment as a child. Assisting survivors of childhood maltreatment, particularly female survivors, provides a crucial intervention opportunity to help prevent further child abuse and neglect. Australian National Health and Medical Research Council; Channel 7 Children's Research Foundation.

Cumulative Rates of Child Protection Involvement and Terminations of Parental Rights in a California Birth Cohort, 1999-2017.

Objectives. To document the cumulative childhood risk of different levels of involvement with the child protection system (CPS), including terminations of parental rights (TPRs).Methods. We linked vital records for California's 1999 birth cohort (n = 519 248) to CPS records from 1999 to 2017. We used sociodemographic information captured at birth to estimate differences in the cumulative percentage of children investigated, substantiated, placed in foster care, and with a TPR.Results. Overall, 26.3% of children were investigated for maltreatment, 10.5% were substantiated, 4.3% were placed in foster care, and 1.1% experienced a TPR. Roughly 1 in 2 Black and Native American children were investigated during childhood. Children receiving public insurance experienced CPS involvement at more than twice the rate of children with private insurance.Conclusions. Findings provide a lower-bound estimate of CPS involvement and extend previous research by documenting demographic differences, including in TPRs.Public Health Implications. Conservatively, CPS investigates more than a quarter of children born in California for abuse or neglect. These data reinforce policy questions about the current scope and reach of our modern CPS.

A population-based case control study of suicide among youth reported for abuse and neglect

BackgroundResearch has indicated an association between child abuse and adolescent suicide. Little population-based information exists, however, about the nature of maltreatment experiences or interactions with the child protection system (CPS). ObjectiveTo examine child maltreatment characteristics and system-level responses associated with risk of adolescent suicide. Participants and settingLinked vital death records and CPS records were used to identify the population of adolescents who died by suicide in California between 2010 and 2017 and who had a history of at least one report to CPS prior to death. MethodA case control design was used, with cases defined as a suicide of an adolescent with a history of CPS involvement. Using CPS records, living controls were then matched to cases based on year of birth, sex, race and ethnicity, and age of first child maltreatment allegation. A conditional logistic regression model was used to estimate the adjusted odds of adolescent suicide across various CPS and maltreatment characteristics. ResultsRecent CPS involvement, allegations of physical abuse, and allegations of sexual abuse emerged as significant risk factors for death by suicide. No differences in suicide risk were observed between youth with unsubstantiated or substantiated allegations. ConclusionsSuicide risk appears to be more closely tied to specific maltreatment experiences than to substantiation or placement into foster care. As adolescent suicide rates rise, better a understanding of risk factors among already vulnerable populations of youth is critical.

A Population-Based Examination of Suicide and Child Protection System Involvement

PurposeThe purpose of this study was to provide a population-based analysis of child protection system (CPS) involvement among children and adolescents who died by suicide. MethodsWe performed a case–control study of child and adolescent suicide and CPS involvement. Using linked birth, death, and CPS records, we longitudinally followed all children born in California in 1999 and 2000 (N = 1,052,333) in CPS and death records through 2017. Cases were defined as children who died in California and had a manner of death coded as suicide using the International Classification of Diseases, 10th revision (n = 170). Each suicide case was matched to four living controls, and children were classified based on CPS exposure: no history, reported for alleged child maltreatment, substantiated for child maltreatment, and placed in foster care. Crude suicide rates were documented, and conditional logistic regression models were used to estimate the adjusted odds of suicide. ResultsAmong children and adolescents who died by suicide, 56.5% had a history of past allegations of abuse or neglect. Children with any CPS history had three times the odds of suicide compared to children with no history. No additional risk was found for children substantiated or placed in foster care compared to children with only an allegation. ConclusionsSuicide risk is not isolated to the relatively small group of children and youth placed in foster care. Findings reinforce the importance of increased attention to the experiences of the larger universe of children who remain at home after alleged or substantiated maltreatment.

Hospitalizations among children involved in the child protection system: A long-term birth cohort study from infancy to adulthood using administrative data

BackgroundDespite considerable health consequences of child abuse and neglect, there is limited evidence on hospitalizations in this population. ObjectivesTo describe frequency and reasons for hospitalization by lifetime child protection system (CPS) involvement. Participants608,540 children born from January 1, 1986 to June 30, 2017 in South Australia, Australia MethodsUsing linked administrative data on CPS involvement and hospitalizations, we descriptively examined cumulative incidence, cumulative count and reasons for hospitalization from infancy to early adulthood by CPS involvement. ResultsBy 16.5 years of age, cumulative incidence of ever-being hospitalized was 58% (95% CI 58-58) for children with no CPS involvement and significantly higher (72% (95% CI 71-73) to 88% (95% CI 86-90), P < 0.001) among those with different levels of CPS involvement. Cumulative mean counts of hospitalizations were highest at every age for those placed in out-of-home-care (reaching 7.7 by 16.5 years), almost four times higher than for children with no CPS involvement (2.0 by 16.5 years). Most frequent reasons for hospitalizations were similar across CPS involvement in the early years. From adolescence through early adulthood, mental health, and ‘injury, poisoning or toxic effects of drugs’ were frequent reasons for hospitalization among individuals with CPS involvement. ConclusionsThis study highlights the vulnerability of children who have been maltreated, or are at risk of maltreatment, and the urgency of implementing effective preventive strategies early in life including consideration of adequate responses of child protection services. Frequent hospitalizations for mental health and injury confirms the potentially preventable nature of these hospitalizations.

School Absenteeism Associated With Child Protection System Involvement, Maltreatment Type, and Time in Out-of-Home Care.

Greater school absenteeism is associated with numerous negative educational outcomes. We used a retrospective cohort design with linked administrative data on 296,422 children to examine the relationship between school absenteeism and child protection system (CPS) involvement. Children with substantiated maltreatment had 4.1 times more unexplained and problem absences than children with no CPS involvement. In multivariate analyses, children with substantiated maltreatment had significantly greater "chronic" truancy (OR = 3.41) and less "acceptable" levels of absences (OR = 0.74) compared to children with no CPS involvement. Greater absenteeism was seen for children with substantiated neglect and who had their first CPS notification earlier in life. Being in out-of-home care for 3+ years was a protective factor for children who had a CPS notification before age 5. Additional adversities had a strong additive effect with CPS involvement on absenteeism and chronic truancy. This study demonstrates the potential scope for reducing problem absenteeism and helps inform the public debate regarding how the type and timing of CPS involvement might ameliorate or exacerbate harm for children.

Lifetime risk of child protection system involvement in South Australia for Aboriginal and non-Aboriginal children, 1986–2017 using linked administrative data

BackgroundChild protection services exist to reduce potential harms from child maltreatment. Many jurisdictions produce annual data on child protection system (CPS) involvement, leaving a gap in knowledge of lifetime involvement. ObjectiveTo describe lifetime involvement in CPS, by type of contact. ParticipantsAll 608,547 children born in South Australia (SA), Australia between 1986 and 2017. MethodsA retrospective cohort design using linked administrative data to report cumulative incidence of CPS involvement from birth to age <18 (or June30 2017) by Aboriginal status. CPS involvement was categorised into notifications (3 levels), investigations, substantiations and out-of-home care (OOHC). Cumulative incidence curves were derived for 5 birth cohorts. ResultsAcross childhood (to age <18 years), substantiated maltreatment was experienced by 3.2–3.6% of non-Aboriginal and 19–25% of Aboriginal children, 7 times reported annual substantiation rates. For most CPS categories CPS involvement increased until 2010, and was occurring earlier in life. By age 3, 0.5% of non-Aboriginal and 4.5% of Aboriginal children born 1986–1991 were the subject of a substantiation compared with 1.9% and 15% of non-Aboriginal and Aboriginal children, respectively, born 2010–2017. Incidence rates beyond age 3 were similar. OOHC contact was similar across cohorts, with ˜1.5% of non-Aboriginal and 12.7% of Aboriginal children ever-placed in care. ConclusionsData linkage is an essential tool for understanding life course involvement with the CPS and describing trends not observable from annual snapshots. Such information is critical for burden of disease estimates, informing policy and monitoring CPS performance.

Child protection involvement among homeless families

ABSTRACT Linked administrative records were leveraged to characterize the demographics, prevalence and timing of child protection system (CPS) involvement of families receiving services from a homeless services agency in Los Angeles County, California between 2013 and 2016. Results revealed that nearly two-thirds of families seeking homeless services between 2013 and 2016 had concurrent or historical CPS involvement. Given that CPS involvement most often preceded the families’ first homeless service encounter, the results not only underscore the value of cross-system coordination in the provision of family supports, but also highlight opportunities for prevention.

Role of pre-existing adversity and child maltreatment on mental health outcomes for children involved in child protection: population-based data linkage study

ObjectivesTo determine mental health outcomes for children with a history of child protection system involvement, accounting for pre-existing adversity, and to examine variation in risk across diagnostic groupings and child...

Child protection outcomes of the Australian Nurse Family Partnership Program for Aboriginal infants and their mothers in Central Australia.

BackgroundThe Nurse Family Partnership Program developed in the USA, designed to improve mother and infant/child outcomes, has reported lower rates of child protection system involvement. The study tested the hypothesis that an adapted Nurse Family Partnership Program implemented in an Aboriginal community in Central Australia (the FPP) would improve Child Protection outcomes.MethodsThis was a retrospective and prospective cohort study drawing on linked administrative data, including birth registry, primary health care client information system, FPP program data, and child protection data. Participants were children of women eligible for the FPP program (an exposed and a control group of women, eligible but not referred) live-born between 1/3/2009 (program commencement) and 31/12/2015. Child protection data covered all reports, investigations, substantiations and out-of-home care placements from the time of the child’s birth to 31/12/2016. Generalised linear modelling was used to estimate the relative risk (RR) of involvement with child protection and type of involvement (report, investigation, substantiation, out-of-home-care placement) among FPP and control children.ResultsFPP mothers (n = 291) were on average younger, were more likely to be first-time mothers and experiencing housing instability than control mothers (n = 563). Among younger mothers ≤20 years, FPP children had statistically significantly lower rates of involvement with child protection (ARRreport = 0.49, 95% CI: 0.29 to 0.82; ARRinvestigation = 0.34, 95% CI: 0.19 to 0.64; ARRsubstantiation = 0.45, 95% CI: 0.21 to 0.96) and experience fewer days in care (ARR = 0.10, 95% CI: 0.02 to 0.48). Among children of first-time mothers, FPP children also had statistically significantly lower rates of involvement with child protection (ARRreport = 0.50, 95% CI: 0.30 to 0.83; ARRinvestigation = 0.36, 95% CI: 0.19 to 0.67; ARRsubstantiation = 0.38, 95% CI: 0.18 to 0.80) and fewer days in care (ARR = 0.06, 95% CI: 0.01 to 0.27).ConclusionStudy results suggest a modified Nurse Family Partnership delivered by an Indigenous community-controlled organisation may have reduced child protection system involvement in a highly vulnerable First Nations population, especially in younger or first-time mothers. Testing these results with an RCT design is desirable.

“Basically, I look at it like combat”: Reflections on moral injury by parents involved with child protection services

This study considers any “moral injury” occurring among parents involved with the Child Protection System (CPS). Moral injury refers to the lasting psychological, spiritual and social harm caused by one's own or another's actions in a high stakes situation that transgress deeply held moral beliefs and expectations. The existing literature focuses on military contexts, but moral injury also may play a role in increasing the vulnerability of CPS clients who are threatened with loss of their parental rights and dissolution of their families. We administered a modified version of the Moral Injury Events Scale (MIES) (Nash et al., 2013) to 10 CPS involved parents. We then conducted in-depth, semi-structured, audio recorded individual interviews with parents to elaborate their responses to the MIES. Parents' MIES scores and interview elaborations suggest that some CPS-involved parents do experience moral injury. Moral injury was reported as a result of their own parenting behaviors, but also as a result of parents' involvement with professionals and within social systems that are charged with providing assistance to struggling families. For instance, some parents perceived professionals to be shaming, social services to be harmful and legal proceedings stigmatizing. Parents' reported reactions to morally injurious events included lasting feelings of guilt, shame and anger; and loss of trust in professionals. These responses impeded their perceived abilities to fully engage in services. If involvement in CPS places parents at increased risk of moral injury, then moral injury is a critically important construct for child welfare policy makers and workers to understand and address in the conduct of effective, ethical child welfare practice.

Moral injury among Child Protection Professionals: Implications for the ethical treatment and retention of workers

This study considers any “moral injury” occurring among professionals working within the Child Protection System (CPS). Moral injury refers to the lasting psychological, spiritual and social harm caused by one's own or another's actions in high-stakes situations that transgress deeply held moral beliefs and expectations. We administered a modified version of the Moral Injury Events Scale (MIES) (Nash et al., 2013) to 38 CPS professionals. We then conducted in-depth, semi-structured, audio-recorded individual interviews with them to elaborate their responses to the MIES. Professionals' MIES scores and descriptions of their responses suggest that some professionals do experience moral injury as a result of their CPS involvement. Similar to parents involved with CPS, professionals described harm to themselves occurring through under-resourced systems, problematic professionals, unfair laws and policies, abusive parents, an adversarial system, systemic biases, harm to children by the system and poor-quality services. They also communicated feelings associated with moral injury such as anger and sadness, emotional numbing, and guilt and shame. These feelings have been reported by CPS-involved parents and are described in the existing moral injury literature. Many also described troubling, existential issues including their ability to function in an ethical and moral manner within a system they viewed as deeply flawed, and in an unsupportive working environment steeped in human misery. Nearly a third of all professionals described themselves or colleagues as actively seeking employment elsewhere. We discuss implications for the related issues of the ethical treatment and retention of professionals working within CPS.

Youth with disabilities in the United States Child Welfare System

Existing literature suggests that youth with disabilities are known to be at increased risk of maltreatment in the form of abuse and/or neglect. Little is known, however, about the experiences of youth with disabilities who are living in foster care or who are supervised by child protection authorities. This study establishes a baseline estimate of the prevalence of youth with disabilities living in foster care, documents reasons for child protection system involvement, identifies placement types while youth are in care and explores case outcomes. This cross-sectional, exploratory study draws on data from the 2012 Adoption and Foster Care Reporting System (AFCARS) for foster youth in 50 states, the District of Columbia and Puerto Rico. A sample of youth with disabilities (N=36.492) and a comparison group without disabilities (N=601.539) were identified. Findings about demographics, reasons for child removal, foster care placements, permanency planning goals and case outcomes are presented. Findings have implications for the prevention the removal of youth from caregivers, the need for family supports to prevent foster care involvement, the promotion of community inclusion of foster youth while in foster care and the need for inter-system collaboration at the transitional age stage.