Child Protective Services Case Research Articles

A Multisystemic Approach to the Prevention and Treatment of Child Abuse and Neglect.

Families experiencing physical abuse and/or neglect are at risk of continued difficulties that may involve long-term monitoring by Child Protective Services (CPS) and perhaps even removal of the child. Interventions needed to help the family remain intact safely and reduce both the clinical challenges they are experiencing and risk of further maltreatment will need to meet the multiple needs of all family members and involve a positive, collaborative working relationship with CPS. If services that are typically provided at outpatient clinics are used, the CPS case worker may be tasked with linking the family to many providers. When the family cannot make all the appointments, they are at further risk of removal of their child. In this article we present Multisystemic Therapy for Child Abuse and Neglect (MST-CAN), an ecologically based treatment for families experiencing physical abuse and/or neglect in which research-supported mental health services are delivered in the home by one clinical team to families who have serious clinical needs. To date, MST-CAN has been implemented with families experiencing the most serious levels of risk, but application is feasible for families with lower risk levels. Among high-risk families, MST-CAN has been shown effective for reducing out-of-home placement, abusive or neglectful parent behavior, and parent and child mental health difficulties and for increasing natural social supports. Two specialty population programs based on MST-CAN are also presented. These are MST - Building Stronger Families, a specialty program for parents who are experiencing abuse or neglect co-occurring with substance abuse, and MST for Intimate Partner Violence for families experiencing abuse or neglect and intimate partner violence. All models are based on the core Standard MST model. We trace the history of model development to dissemination.

Perceptions of child protective services among pregnant or recently pregnant, opioid-using women in substance abuse treatment

Pregnant, opioid-using women represent a challenge to healthcare providers attempting to engage them in prenatal and substance abuse services. Limited, primarily international research suggests that child welfare clients have mixed feelings about Child Protective Services (CPS) and that fear of CPS may present a barrier to care. Understanding how pregnant opioid-using women in substance abuse treatment perceive CPS may be useful in encouraging substance abuse treatment initiation. Participants were currently or recently (within past 12 months) pregnant women with current or recent (within past 12 months) abuse/dependence of pharmaceutical opioids at a drug treatment facility. Participants were recruited by treatment staff to participate in a comprehensive study across multiple domains. Data for this analysis were collected using semi-structured qualitative interviews. Transcribed data were thematically analyzed using in vivo and interpretive coding by three coders for purposes of inter-rater reliability. Following 2, two-hour meetings, consensus was reached on primary themes and sub-themes. Two major themes and several sub-themes were identified: 1) Participants’ feelings and attitudes about CPS (positive and negative); 2) Interaction-based perceptions of CPS’ function and performance. Participants’ feelings toward CPS were often conditioned by their experiences with individual caseworkers. While many pregnant, opioid-using women identify legitimate, and even useful features of CPS, fear of CPS can be a barrier to care. Making substance abuse treatment accessible to this population requires recognition of their complex feelings toward CPS, and coordination among CPS case workers and substance abuse treatment providers.

Predictors of a Positive Illicit Drugs Screens for Pregnant Women in Colorado [15N

INTRODUCTION: There are no clear guidelines to determine when illicit drug screening in pregnant women is warranted. We investigated which testing indications reliably predict a positive screen. METHODS: We performed a historical cohort study of all pregnant women who underwent drug screening on labor and delivery in 2014 at a safety-net hospital in Denver, Colorado. Testing was performed at provider discretion and with patient consent. Illicit drugs were included in the urine toxicology screen; tetrahydrocannabinol was not. Chart abstraction included testing indications, demographic, reproductive, social, and substance use characteristics. We performed descriptive frequencies and used Fisher's exact tests to compare testing results. RESULTS: In 2014, 166 urine toxicology tests were performed; 14 (8.4%) were positive. Women with positive tests were more likely to have had a prior STI (83.3% vs 39.7%, p>0.01), previous child protective services case (35.7% vs 8.6% p=0.009), child removed from custody (60.0% vs 7.3%, p < 0.001), prior drug use (92.9% vs 34.2%, p < 0.001) or treatment (64.3% vs 11.2%, p < 0.001), self-reported current drug use (71.4% vs. 27.6%, p < 0.01), current tobacco use (71.4% vs 19.7%, p < 0.001), less than 5 prenatal visits (58.3% vs 28.0%, p=0.05), or outborn delivery (28.6% vs. 0.7%, p < 001). No obstetrical indications were associated. A composite variable including history of child protective services case, child removed from custody, history of drug use or treatment, and/or self-reported drug use had a PPV=100% and NPV=65%. CONCLUSION: Using a composite variable based on historical factors to determine performance of drug screening may be a strong predictor of positive tests and reduce over-testing.

Cumulative risk hypothesis: Predicting and preventing child maltreatment recidivism

Although Child Protective Services (CPS) and other child welfare agencies aim to prevent further maltreatment in cases of child abuse and neglect, recidivism is common. Having a better understanding of recidivism predictors could aid in preventing additional instances of maltreatment. A previous study identified two CPS interventions that predicted recidivism: psychotherapy for the parent, which was related to a reduced risk of recidivism, and temporary removal of the child from the parent's custody, which was related to an increased recidivism risk. However, counter to expectations, this previous study did not identify any other specific risk factors related to maltreatment recidivism. For the current study, it was hypothesized that (a) cumulative risk (i.e., the total number of risk factors) would significantly predict maltreatment recidivism above and beyond intervention variables in a sample of CPS case files and that (b) therapy for the parent would be related to a reduced likelihood of recidivism. Because it was believed that the relation between temporary removal of a child from the parent's custody and maltreatment recidivism is explained by cumulative risk, the study also hypothesized that that the relation between temporary removal of the child from the parent's custody and recidivism would be mediated by cumulative risk. After performing a hierarchical logistic regression analysis, the first two hypotheses were supported, and an additional predictor, psychotherapy for the child, also was related to reduced chances of recidivism. However, Hypothesis 3 was not supported, as risk did not significantly mediate the relation between temporary removal and recidivism.

The Influence of Transformational Leadership and Job Burnout on Child Protective Services Case Managers' Commitment and Intent to Quit

ABSTRACTJob burnout is prevalent in child welfare with turnover rates estimated between 20% and 40% nationwide. Although effective leadership has been shown to facilitate positive job attitudes and low job burnout in many industries, including healthcare organizations, limited research exists examining whether transformational leadership affects job burnout and job attitudes among child protective services (CPS) case managers. Moreover, no research exists examining whether job burnout mediates the relationships between transformational leadership and job attitudes. This study was designed to examine the relationships between transformational leadership, job burnout, and job attitudes among CPS case managers and whether job burnout mediates those relationships. Bass's theory of transformational leadership and Maslach's theory of job burnout provided the theoretical frameworks for this study. In this nonexperimental study, 197 CPS case managers (83% women) participated by completing an online survey. Results indicated that transformational leadership and job burnout correlated with each other and with job attitudes as hypothesized, and job burnout partially mediated the relationships between transformational leadership and the criterion variables. Our findings suggest that child welfare organizations should hire and/or train transformational leaders to reduce job burnout and increase job attitudes among CPS case managers. Directions for future research are discussed.

The whole picture: Child maltreatment experiences of youths who were physically abused

The purpose of the current study was to describe the maltreatment experiences of a sample of urban youths identified as physically abused using the Maltreatment Case Record Abstraction Instrument (MCRAI). The sample (n=303) of 9–12 year old youths was recruited from active child protective services (CPS) cases in 2002–2005, and five years of child protective service records were reviewed. The demographic and maltreatment experiences of MCRAI-identified youths with physical abuse were compared to maltreated youths who were not physically abused and youths who were identified as physically abused by CPS when they entered this longitudinal study. T-tests and chi-square tests were used to compare the demographics and maltreatment experiences of the sample MCRAI-identified physically abused to the sample MCRAI-identified as nonphysically abused maltreated by gender. Of the total sample, 156 (51%) were identified by MCRAI as physically abused and 96.8% of these youth also experienced other types of maltreatment. Whereas youth with the initial CPS identification of physical abuse showed little co-occurrence (37.7%) with other forms of maltreatment. The MCRAI-identified physically abused youths had a significantly higher mean number of CPS reports and higher mean number of incidents of maltreatment than MCRAI-identified nonphysically maltreated youths. Lifeline plots of case record history from the time of first report to CPS to entry into the study found substantial individual variability in maltreatment experiences for both boys and girls. Thus, obtaining maltreatment information from a single report vastly underestimates the prevalence of physical abuse and the co-occurrence of other maltreatment types.

Criminal investigations in child protective services cases: an empirical analysis.

This study analyzed the frequency and correlates of criminal investigation of child maltreatment in cases investigated by child protective service (CPS), using national probability data from the National Survey of Child and Adolescent Well-Being. Criminal investigations were conducted in slightly more than 25% of cases. Communities varied substantially in percentage criminally investigated. Sexual abuse was the most frequent type of maltreatment criminally investigated followed by physical abuse. Logistic regression results indicated that criminal investigations were more likely when caseworkers perceived greater harm and more evidence; when CPS conducted an investigation rather than an assessment; when a parent or a legal guardian reported the maltreatment; and when cases were located in communities in which CPS and police had a memorandum of understanding (MOU) governing coordination. Most variation between communities in criminal investigation remained unexplained. The findings suggest the potential of MOUs for communities wanting to increase criminal investigation.

Differential Response: A Dangerous Experiment in Child Welfare

Differential Response represents the most important child welfare initiative of the day, with Differential Response programs rapidly expanding throughout the country. It is designed to radically change our child welfare system, diverting the great majority of Child Protective Services cases to an entirely voluntary system. This Article describes the serious risks Differential Response poses for children and the flawed research being used to promote it as “evidence based.” It puts the Differential Response movement in historical context as one of a series of extreme family preservation movements supported by a corrupt merger of advocacy with research. It argues for reform that would honor children’s rights, confront the problems of poverty underlying child maltreatment in a serious way, and expand rather than reduce the capacity of Child Protective Services to address child maltreatment. It calls for a change in the dynamics of child welfare research and policy so that we can avoid endlessly repeating history in ways harmful to child interests.

The effect of parental intellectual disability status on child protection service worker decision making

There is evidence to suggest that parents with an intellectual disability (ID) constitute a higher proportion of child-protective services (CPS) cases than would be expected based on the prevalence of ID in the general population. Researchers have suggested that the stereotypic assumptions and expectations that CPS workers have about parents with an ID might influence decisions and responses made to such parents. This study examined whether parental ID (having an ID vs. not) had an effect on CPS workers' emotional reactions, attributions and decisions about risk to the child, whether to remove the child and workers' general willingness to help the parent. Two hundred and twelve CPS workers read vignettes describing parents who were labelled as either having or not having an ID. Workers responded to the vignettes by making ratings of their emotional reactions, attributions and decisions regarding risk, removal and helping. CPS workers made significantly higher ratings of pity, willingness to help and risk for parents with an ID than for parents without an ID. Lower ratings of anger and disgust were found for parents with an ID than for parents without an ID. Parents' intellectual status did not have a direct effect on workers' attributions or removal decisions. The results show evidence for the influence of stereotypes regarding parental ID due to its differential effect on CPS workers' emotional reactions and decisions about child risk and their willingness to help.

Examining racial disproportionality in child protective services case decisions

Using a national sample of 1,461 child protective services (CPS) investigations in the United States, we examine differences between black and white families with regard to caseworker ratings of risk and harm to the child, as well as the probability that a case is substantiated for maltreatment. We employ difference-in-difference methods to identify whether gaps in outcomes for black and white families are equivalent when black and white CPS workers conduct the investigation, and Blinder-Oaxaca decomposition methods to identify the portion of the black-white difference in outcomes that is attributable to differences in case characteristics (risk factors) versus differences in associations between these characteristics and the outcomes by race (differential treatment). We find no differences in outcomes by child race after adjusting for case characteristics. At the same time, we find that relative to white caseworkers, black caseworkers are more likely to rate black children at subjectively higher risk of harm than white children and are also more likely to substantiate black families for maltreatment. The decomposition results suggest that-even after accounting for caseworker race-differences in outcomes for black and white children are primarily explained by differences in family and case circumstances rather than differential treatment. Thus, our analyses suggest that interventions addressing maltreatment-related risk factors that disproportionately affect black families may have greater utility for reducing racial disparities in CPS involvement than current emphases on cultural competence training.

Making Lemonade Out of Lemons

Slightly more than 5% of women in the United States use illicit drugs during pregnancy.1 Estimates of the proportion of Child Protective Services cases that involve substance use range from 20% to 80%.2 Pregnant and parenting women who misuse substances are frequently involved with child welfare services, and this either implicitly or explicitly entails use of external pressure or coercion to promote entrance to substance abuse treatment. In this context, implicit pressure refers to the threat of child welfare intervention or fear of loss of child custody that a pregnant or parenting woman may feel, whereas explicit pressure encompasses pressure in the form of warnings, requirements, or mandates (ie, legal coercion) from external sources. External pressure in the treatment of substance misuse is controversial, and even more so when considering this specific population of substance users. Between 50% and 75% of women entering substance use treatment programs have a history of trauma.3 This mandates a thorough discussion of the most effective way to use external pressure to promote positive treatment outcomes while remaining sensitive to the unique context in which their substance use occurs, such that women are not retraumatized. Herein we present a case report of a postpartum woman with substance misuse who faced implicit and explicit pressure to enter treatment in order to regain custody of her newborn child. We follow the case presentation with a review of the literature on the use of external pressure as it pertains to perinatal and parenting women.

Variations in emotional abuse experiences among multiply maltreated young adolescents and relations with developmental outcomes

Objective Based on the data obtained through Child Protective Services (CPS) case records abstraction, this study aimed to explore patterns of overlapping types of child maltreatment in a sample of urban, ethnically diverse male and female youth ( n= 303) identified as maltreated by a large public child welfare agency. Methods A cluster analysis was conducted on data for 303 maltreated youth. The overall categorization of four types of abuse (i.e., physical, sexual, emotional abuse and neglect) was used to provide a starting point for clustering of the 303 cases and then the subtypes of emotional abuse were broken down in the clusters. The different clusters of child maltreatment were compared on the multiple outcomes such as mental health, behavior problems, self-perception, and cognitive development. Results In this study, we identified four clusters of child maltreatment experiences. Three patterns involved emotional abuse. One cluster of children experienced all four types. Different clusters were differentially associated with multiple outcome measures. In general, multiply-maltreated youth fared worst, especially when the cluster involved sexual abuse. Also, sex differences were found in these associations. Boys who experienced multiple types of maltreatment showed more difficulties than girls. Conclusion and practice implications These results reiterate the importance of creating more complex models of child maltreatment. Children who have experienced various types of maltreatment are especially in need of more attention from professionals and resources should be allocated accordingly.

An exploratory study of the range of implications of families' criminal justice system involvement in child welfare cases

This article describes findings from a review of child protective services case records that was conducted to further understanding of the relevance of families' criminal justice system involvement in child welfare cases. Records suggest there are four broad categories of scenarios in which families' criminal justice and child welfare involvement intersect. These include: (1) instances in which parental arrest and child maltreatment investigations coincide; (2) consideration of parents' criminal histories in the decision to remove children from the care of their parents; (3) consideration of relatives' criminal histories in decisions to place children in foster care; and (4) instances in which child protective services agencies become involved with children whose parents are incarcerated because of risks to children's current safety or inadequate resources. Variations within these categories are described and discussed in the context of ongoing advocacy on behalf of incarcerated parents and their children.

Predicting child fatalities among less-severe CPS investigations

This research is focused on the discovery of variables distinguishing Child Protective Services (CPS) maltreatment-related fatality cases from non-fatality CPS cases. Using only the cases that did not initially present severe features, information from CPS investigations prior to a child fatality was compared to information from investigations that did not result in a fatality. Logistic regression was used to distinguish less-severe non-fatality cases from less-severe fatality cases. Findings resulted in three categories of predictive indicators: 1) more actionable and indicative of reduced risk, 2) mostly more actionable and indicative of increased risk, and 3) less actionable and indicative of increased risk. Implications for the field in terms of risk assessment, practices, and training are discussed, as are the implications for future research.

Can Early Assessment Make a Difference in Child Protection? Results from a Pilot Study

ABSTRACT An exploratory study was conducted to examine the effectiveness of a multidisciplinary assessment and follow-up consultation on first-time substantiated child protective services cases with at least one child 7 or younger. Fifty children from families receiving the multidisciplinary assessment were matched on race, family structure, child gender, child age, and severity of maltreatment with 50 children who did not receive the assessment. Children in families who received the multidisciplinary assessment were more likely to be at home at follow-up and in permanent living situations, and less likely to be reported subsequently to child protective services and subject to termination of parental rights. However, only about half of recommendations for cases receiving the early assessment were implemented by caseworkers.

Increasing Safety for At-Risk Adults: Screening In-Home Care Providers

Years ago, the director of a program for adults with developmental disabilities asked me to teach a workshop for staff after a male aide molested a wheelchair-bound client in a bathroom. A head nurse at a hospital for frail elders asked for a workshop after a stroke patient was diagnosed with a sexually transmitted disease. Why me? I asked the people extending these generous invitations. Good question--my field is child welfare. Everybody else refused, they answered. Bad answer. From my perspective as a child welfare social worker, I see unnecessary gaps in screening and hiring practices for in-home helpers who work with dependent adults and frail elders. I have heard the justifications for the status quo from consumers, client advocates, and agency directors and find them unpersuasive and unnecessarily dangerous. PREREQUISITES FOR WORK WITH MINORS People wishing to work with children in health and mental health programs, schools, child care, foster care, group homes, and residential programs must submit fingerprints to their prospective employer who, in turn, sends them to the state's Department of Justice for clearance. The clearance includes juvenile court and child protective services cases as well as criminal convictions (Goldman & Salus, 2003; Howell, 1993; Lockyer, 2000). The former may be more relevant than a Department of Motor Vehicles (DMV) or criminal background check because the triggers (for example, crying, enuresis, defiance, and temper tantrums) that lead a parent to abuse a child are apt to abound in work with children. Once hired, employees must be informed of their responsibilities under the child abuse reporting laws and agree to report reasonable suspicions of abuse or neglect promptly to the appropriate protective agency. They must sign a statement saying they know they are mandated by law to report suspected child abuse and neglect, understand what constitutes abuse and neglect, and know how and when to report their reasonable suspicions. The employer must keep the fingerprint clearance and this signed statement in the employee's personnel file. Most states require more extensive training for those applying for social work, marriage and family therapy, and clinical psychology licenses (Goldman & Salus, 2003; Howell, 1993). Whenever there is a question about omissive or comissive behavior by an employee or an agency, an investigator's first move is to check the personnel files for fingerprint clearances and reporting law agreements. That is not to say that people seeking to victimize children do not scale these hurdles--far too many do--but, as hurdles go, they are good deterrents. Prospective employees must be fingerprinted and pay the nominal fee the police, sheriff, and DMV charge, usually about $15. Each state's Department of Justice charges the employer approximately $75 to $85 per candidate to run the scans. Agencies, even child care agencies operating on shoestring budgets, are expected to include this expense in their budgets as a reasonable and necessary cost of doing business. Child welfare is committed to preserving family ties for at-risk children (National Council of Juvenile and Family Court Judges, Child Welfare League of America, Youth Law Center, & National Center for Youth Law, n.d.) and waives many requirements for relatives providing child and foster care that would be mandatory for nonrelatives doing the same work. This double standard aims to keep families together with minimal assurances of safety and raises the bar considerably for nonrelatives wishing to become foster parents or to work with children in day care centers, schools, and therapeutic programs. WORKING WITH AT-RISK ADULTS In adult services, the landscape is very different. Some people contact an agency for helpers and generally rely on the agency to screen staff. Many agencies have improved their screening in the past several years, but consumers cannot assume that agencies do more than contact references and perhaps the DMV. …

Ecological Correlates of Neglect in Infants and Toddlers

Infants and toddlers are more likely to be victims of neglect than any other form of maltreatment. Infants and toddlers are at highest risk of fatality because of maltreatment and experience behavioral, social, academic, medical, and cognitive consequences of neglect during their most formative years. Within an ecological framework, this study examines the correlates of the substantiation of neglect in children 0 to 36 months of age. Using an ex post facto design and a random sample of 148 child protective services cases, bivariate analysis revealed significant differences in families who were substantiated for neglect in the areas of child characteristics, home environment, social environment, caregiver, and maltreatment situations. Multivariate analysis found children who were substantiated for neglect were exposed to greater environmental dangers and had caregivers who had poor parenting skills. Implications for practice and future research are discussed.

Police Involvement in Child Protective Services Investigations: Literature Review and Secondary Data Analysis

This article examines the relationship of police and child protective services (CPS) coinvolvement to the outcomes of child maltreatment investigations. It reviews practice and empirical literature and conducts a secondary analysis of a national CPS data set. Most sources argue that coordination of the two agencies improves investigations and benefits children and families. Yet, sources also report friction between these agencies, interference with each other's job, and concerns that police involvement increases child removal. In the CPS case data, allegations were more likely to be judged credible when police also investigated and families were also more likely to receive various services. For neglect cases, multi-disciplinary decision making, but not police involvement per se, was linked to child removal. Across studies, police do not appear to hinder CPS effectiveness and may actually promote it. Their investigations should be coordinated in every community.

The use of risk assessment instruments in child protective services case planning and closures

This exploratory study examined variables expected to predict which caretakers are most likely to reabuse children under child protective services (CPS) supervision. Caretaker variables related to poverty, mental health problems, history as a victim of abuse, substance abuse, and prior CPS reports were evaluated to determine their effectiveness in predicting which children remain at risk of maltreatment. Method: Using a pretested instrument, data were collected from case records of 447 randomly selected children supervised by CPS while residing with parents or relatives for a minimum of six months. These children, in contrast to those in foster family care, were selected because of their more likely exposure to initial abusers. Results: This study offered little support for using variables employed by risk assessment instruments to predict which caretakers were most likely to reabuse because reabusers and non-reabusers shared many features. Importantly, findings in this study indicate that children residing in kinship care are not at significant risk for future maltreatment.

The treating expert: A hybrid role with firm boundaries.

Ongoing or impending litigation may have a substantial impact on treatment, affecting parents' and children's interactions with the therapist and the structure and content of treatment. Psychologists must be prepared to think forensically as well as clinically and have the requisite expertise to support children's needs, accomplish interventions, and. if appropriate, provide information to the forensic evaluator or the court. S. Greenberg and D. Shuman's (1997) conceptualization of the treating expert is expanded and applied to the child custody or dependency case, with an emphasis on role boundaries, standards of expertise, and suggestions for professional practice. Although mental health professionals are often involved with families in crisis, they are often poorly prepared for the impact that the family's involvement with a court process has on treatment. Divorce and child protective services (CPS) cases focus on highintensity issues such as whether either parent poses a risk to the child's safety and which parent is best suited to have primary custody. Such disputes may impact on core emotional issues for parents and children, such as the children's attachment to and relationships with their parents, parents' self-esteem, or the conflicts that led to the marital dissolution. Divorcing parents frequently have concerns about each others' parenting. Such concerns may be based on behavior witnessed during the marriage (e.g., abuse of the parent or child, substance abuse, etc.), or they may derive primarily from the parent's feelings about the other parent. A parent fighting for custody may go to considerable lengths to prevail in the conflict, recruiting extended family members and friends to assist in the parent's cause. Johnston and Roseby (1997) coined the term tribal warfare to describe the alignment of a parent with his or her family of origin against the other parent and his or her family of origin. The impact of tribal warfare on family conflict may be even more intense when there is an allegation of abuse or the CPS system becomes involved.