Report of Maltreatment: a major risk factor for child mortality

When I joined the District of Columbia’s Child Fatality Review Committee, I was expecting to review many deaths of children due to child abuse and neglect. Thankfully, that was not the case–or at least there were few cases that were clearly due to maltreatment. But over time I learned that the relationship between child maltreatment and child fatalities was more complicated. I was shocked to discover how many children who died of of natural causes, accident, homicide, or suicide came from families that had previously reported to Child Protective Services (CPS). There has been a spate of new research demonstrating that children who have been the subject of a child abuse or neglect report are more likely to die from many major causes than other children, even when confounding factors are controlled. This increasing body of evidence has major policy implications, including the need to intervene with high-risk infants at or before birth.

Many of the new studies come from California, where researchers linked prior CPS reports with birth and death records. The size of California, with its more than 10 million children, allowed the researchers to obtain statistically significant results despite the relative rarity of child fatalities. Moreover, the researchers could adjust for sociodemographic factors including birth payment method (public vs. private insurance), maternal age, maternal education, race and paternity establishment, birth order, child gender, and child health risk indicators (low birth weight and birth abnormalities). The researchers chose to focus on children with any maltreatment allegation, rather than only substantiated ones, because of the literature suggesting the difficulty of making an accurate finding of past maltreatment, as well as the absence of differences in subsequent outcomes between children with substantiated and unsubstantiated allegations.

In the first study using this approach, Emily Putnam-Hornstein of the University of California Berkeley sought to establish whether children reported for maltreatment were at higher risk of death by intentional and unintentional injury during their first five years of life. She linked CPS, birth and death records for over 4.3 million children born in California between 1999 and 2006. And what she found was striking: after adjusting for socioeconomic and other risk factors at birth, children with a prior report to CPS died of intentional injuries at a rate that was 5.9 times greater than children who were not reported. More surprisingly perhaps, these children died of unintentional injuries at a rate that was twice as high as that for unreported children. In total, children with a prior allegation of child abuse or neglect were fatally injured at a rate 2.5 times higher than children without a prior allegation. Putnam-Hornstein found that a prior report to CPS was the strongest independent risk factor for injury mortality in the first five years of life out of all the risk factors studied. The existence of more unintentional injuries among children with prior CPS reports may reflect the lack of age-appropriate supervision by parents, as Putnam-Hornstein suggests, given that these parents have already been the subject of CPS reports. But she also notes the probability that some of the injuries classified as unintentional may have actually been intentional injuries that were misclassified on death certificates.*

Putnam-Hornstein and colleagues, using the same dataset, also studied how the risk of fatal injury varies by the type of maltreatment allegation, adjusting for baseline risk factors. They found that children with a previous allegation of physical abuse died from injuries at a rate 1.7 times higher than children referred from neglect. Moreover, these children died from intentional injuries at a rate five times higher than children with an allegation of neglect. Yet, these children had a significantly lower risk of unintentional injuries than children with an allegation of neglect. They point out that these findings are consistent with the general conceptual understanding that abuse is an act of commission, while neglect is an act of omission.

In the next California birth cohort study to be published, Putnam-Hornstein and her colleagues sought to establish whether infants previously reported for maltreatment face a heightened risk of Sudden Unexpected Infant Death (SUID), a term that refers to children who die in the first 12 months of life with no immediately identifiable cause or explanation.** They started with the same dataset of all children born in California between 1999 and 2006 with corresponding CPS and death records through each child’s first birthday. Adjusting for risk factors at birth (including low birth weight and late or absent prenatal care), they found the rate of SUID was more than three times greater among infants who had been previously reported for past maltreatment than among infants who had not been reported. The authors suggest several possible explanations for this finding. The existence of a previous CPS report may indicate the presence of risk factors the researchers were not able to measure, such as maternal substance abuse, which has been found to be associated with SUID. In addition, families reported to CPS may be less likely to adhere to safe sleeping guidelines due to the stressors they face and the fact that they have not yet been reached or convinced by public health messaging around safe sleep practices.

To complement the first two studies, which focused on injury deaths and unexplained non-injury deaths, Schneiderman, Prindle and Putnam-Hornstein looked at non-injury, medically-caused deaths of infants in the first year of life. In this study, the researchers used records for the more than 3.4 million children born in California between 2010 and 2016. They found that after adjusting for baseline risk factors (including low birth-weight and preterm birth), infants with one CPS report were almost twice as likely to die of medical causes than infants with no CPS reports; infants with more than one CPS report were more than three times more likely to die of medical causes than those without a CPS report. The researchers also found that among infants reported for maltreatment, periods of foster care placement reduced the risk of death from medical causes by roughly half. The authors speculate that the higher risk of death from medical causes among infants in families with CPS reports is related to these families’ challenges around mental health, substance abuse, and extreme poverty, as well as their lack of social support. Medical neglect may also be more likely in these families given their CPS history. And unfortunately, as described by child welfare analyst Dee Wilson, there is a strong correlation between medical fragility and parental incapacity to care for a child, as parents with little or no prenatal care and those who abuse drugs are most likely to have babies with low birth weight and birth abnormalities. The protective effect of foster care suggests that many foster parents are better equipped to meet the medical needs of fragile infants than the families from which they have been removed.

But it is not just infants and young children previously reported to CPS who are more likely to die of non-maltreatment causes than their non-reported peers. In a newly published article, Palmer, Prindle and Putnam-Hornstein report on their study of CPS history and risk of suicide. Using linked birth, death and CPS records, they followed all children born in California in 1999 and 2000 and all death records through 2017. Using a “case-control design,” they matched each suicide case to four living controls based on demographic characteristics including sex, year of birth, maternal race and ethnicity, maternal age at birth, maternal education, and insurance type at birth. They found that over half (56.5 percent) of children who died by suicide had a history of past allegations of abuse or neglect, as compared to 30.4 percent of the control youth. Children with any CPS history were three times as likely to end their own lives than children without such a history. In a second study, they compared suicide victims with CPS involvement to a matched group of living adolescents with CPS involvement to determine if the nature of the allegation or the child welfare response affected suicide risk. In that study, they found that teens with one or more substantiated allegations were no more likely to die of suicide than teens with allegations that were not substantiated. Moreover, they found no difference in suicide risk between teens who were placed in foster care and those who were never removed from home. They did find increased odds of suicide among teens with more recent CPS reports, allegations of physical abuse, and allegations of sexual abuse.

As I stated in the top of this column, I have observed that many victims of homicide cases reviewed by the District of Columbia’s Child Fatality Review Committee had a history of CPS reports. Their families had long histories of calls to CPS alleging both abuse and neglect, with school absenteeism being one of the most frequent allegations. Eventually, these young people became involved in violent and illegal activities, ultimately leading to their deaths. There is some relevant evidence from an older study of Washington State children born between 1973 and 1986 who were reported to the state child abuse registry. Matching each reported child to three other children of the same sex, county of birth, and year of birth, the researchers found that children reported to the registry were almost 20 times more likely than the comparison population to die from homicide. These researchers were not able to to control for other variables that might affect homicide risk, including poverty and maternal education, so the differences may be exaggerated but are likely real.

The studies reviewed here show that children who are reported as possible victims of abuse and neglect are at risk for more than “just” further abuse and neglect, but for other bad outcomes, including a sudden infant death and for deaths due to injuries (intentional or unintentional), medical causes, suicide, and homicide. While different factors may come into play for different causes and manners of death, maltreatment allegations generally suggest parents who, even if not actually abusive or neglectful, are not well equipped to protect and nurture their children. As Putnam-Hornstein puts it in her article about injury deaths, these data confirm that “children reported for maltreatment have a truly distinctive risk profile defined by much more than just birth into poverty.”

The research described above suggests that youths who previously reported for abuse or neglect are more likely to die due to their own self-harming behaviors, not just directly through acts of commission or omission by their parents. This is not surprising, as a large body of research links child maltreatment and wide variety of adverse outcomes, including, diminished cognitive and executive function, poor mental and emotional health, attachment and social difficulties, post-traumatic stress, juvenile delinquency, and substance abuse. In a recent commentary, Dee Wilson describes specific pathways by which childhood abuse and neglect lead to early-onset mental health conditions, which in turn result in higher rates of suicide, substance abuse and lethal violence in adolescence and young adulthood.

The growing body of research linking child abuse reports with mortality from causes other than child maltreatment itself has important implications for policy. More intensive supports should be put in place for all children remaining at home after a CPS report, especially infants and young children, who are most vulnerable and whose development is most affected by maltreatment. Such intensive approaches could include supportive housing, residential drug treatment programs where children can stay with their mothers, and high-quality early care and education programs. Older children who are the subject of a report should receive a mental health assessment and access to activities and services that provide them with nurturing relationships and opportunities to develop talents and skills, as Dee Wilson describes in his commentary.

But while one can argue for more intensive services for children with substantiated allegations, the idea of mandating services when allegations are not substantiated is a non-starter at a time when the conversation is about restricting the role of CPS, not expanding it. But the research described above also lends support to the growing chorus of voices that is calling for putting more resources into programs that prevent the occurrence of child abuse and neglect, rather than responding to its occurrence. There is a growing interest in “targeted universal prevention programs,” like Hello Baby in Allegheny County Pennsylvania and Family Connects in North Carolina and Oregon, which reach out to all families but provide a more intensive intervention to the families of children who are most at risk of being abused or neglected. Family Connects has already shown some promising results, reducing CPS referrals and emergency room visits among infants receiving the intervention.

It is important to note that mortality is not the only outcome that matters. Because the definition of death is unambiguous, and death data are collected everywhere, death rates are a good way to calculate risk differentials between groups. But for every child who dies as a direct or indirect consequence of abuse or neglect, there are many more who are seriously disabled or injured or suffering from the kinds of adverse outcomes mentioned above, including poor mental and emotional health, juvenile delinquency, and substance abuse. We need a stronger response to reports of child maltreatment, whether or not they are substantiated or the child is placed in foster care. And we must intervene as early as possible to protect high-risk children, rather than waiting for them to be the subject of a child maltreatment report.

*It should be noted that evidence cited by Putnam-Hornstein shows that death certificates “severely” undercount the number of deaths due to child maltreatment and inflicted injuries, and it is likely that over half of fatalities due to maltreatment may be incorrectly classified as due to accidents, natural causes, or undetermined.

**Ultimately about half of these deaths are classified as caused by sudden infant death syndrome (SIDS), a term which connotes a death that remains unexplained following an in-depth investigation.

***Emily Putnam-Hornstein and colleagues found that in California, 82 percent of infants remained at home following their first CPS report. Of these infants remaining at home, only one in ten of their parents received services through an open case, and 60.7 percent were re-reported within five years. Those who did not receive services through an in-home case may have received community-based services but that information is not available.

Child Neglect: a misused and misunderstood term

There is much confusion around child neglect. Opponents of the current child welfare system are fond of stating that most children reported to child protective services (CPS) are suffering from neglect, not abuse, that neglect is synonymous with poverty, and therefore that children are commonly being removed from home because of poverty. While neglect is clearly related to poverty, the facts suggest that the removal of children due to poverty alone is rare. To know more about this most common form of maltreatment, it is necessary to collect more specific data on the types of child neglect that are found when a neglect allegation is substantiated. Nevertheless, child welfare must recognize the important role of poverty in promoting child neglect and the role of poverty alleviation programs in child neglect prevention.

A useful way to distinguish between abuse and neglect of children is that abuse is generally an act of commission, while neglect is an act of omission. According to the Child Welfare Information Gateway, neglect is “commonly defined in state law as the failure of a parent or other person with responsibility for the child to provide needed food, clothing, shelter, medical care, or supervision to the degree that the child’s health, safety and well-being are threatened with harm.” The most commonly recognized categories of neglect include physical neglect (failure to provide for basic physical needs), medical neglect, inadequate supervision, emotional neglect, and educational neglect. Some states include exemptions for certain types of neglect, like religious exemptions for medical neglect. Twelve states and the District of Columbia exclude financial ability to provide for a child from the definition of neglect.

How true are common statements about neglect?

A number of statements about neglect are are frequently made in support of various views and proposals. These are discussed below.

The national child welfare system was established to address abuse, not neglect. This is absolutely true. The discovery of “battered child syndrome” by Henry Kempe at the University of Colorado led to the passage of child protection laws in every state within a few years. On the federal level, the Child Abuse Prevention and Treatment Act (CAPTA), which established the federal role in supporting and monitoring these systems, was also focused on abuse rather than neglect. According to an oft-quoted book about the history of CAPTA, Democrats feared that President Nixon might veto CAPTA if it was viewed as an anti-poverty program, so they took pains to reiterate that child maltreatment could happen to anybody, regardless of socioeconomic status. As a result, the responses to child maltreatment focused on mental health and parent education services rather than economic supports. In his essay, Poverty, Neglect and Cultural Denial, child welfare commentator Dee Wilson recalls that when he began working as a CPS social worker in the 1970’s, all his training focused on battered children. Yet, in his work he encountered battered babies and toddlers maybe “once or twice annually out of 100 to 150 assigned cases.” Instead, he received both in Colorado and later in Washington “a steady diet of reports of child neglect and, to a lesser extent, reports of excessive punishment of children with minor injuries that did not require medical attention.” Academic literature has contributed to the problem by failing to distinguish between abuse and neglect.

Neglect is the main reason for children’s involvement with child welfare. This is also a true statement. According to the latest data collected from the states and published in Child Maltreatment 2019, three-quarters (74.9 percent) of the 656,000 children found to be victims of maltreatment in 2019, were found to be neglected, 17.5 percent were physically abused, 9.3 percent were sexually abused, and 6.8 percent were “other.” Some children were found to be victims of both neglect and another maltreatment type. These percentages should not be viewed as an exact representation of the relative importance of different types of maltreatment. As Font and Maguire-Jack point out, investigators do not have to substantiate every allegation to justify intervention. So If there is more than one type of maltreatment in the home, investigators may not substantiate all of the different types. Thus a child found to be a victim of neglect only may actually have suffered abuse as well. Comparison of substantiation data with other sources, as shown in Font and Maguire-Jack’s table listed below. suggests that “substantiations are likely to grossly understate all forms of child maltreatment, but especially physical abuse.” So neglect does appear to be more common than abuse as a reason for child welfare involvement, but abuse may be be present in a higher fraction of cases than the percentages indicate.

Source: Sarah Font and Kathryn Maguire-Jack, The Nature and Causes of Child Abuse and Neglect.
ANNALS, AAPSS, 692, November 2020. https://journals.sagepub.com/doi/abs/10.1177/0002716220969642?journalCode=anna

Child neglect is strongly related to poverty. This is also true. Research demonstrates that poverty is a major risk factor for child neglect. According to the most recent National Incidence Study of Child Abuse and Neglect, children in low socioeconomic status households experienced maltreatment at five times the rate of other children. Studies have also demonstrated that providing economic supports for families (through programs like tax credits, passing on child support, food assistance, and child care subsidies) have direct effects on child maltreatment. We do not know exactly how poverty affects child neglect but in an excellent article in a journal issue devoted to child maltreatment Feely et al provide a useful way to think about it. They posit that the inverse of neglect is what they call “safe and consistent care or SCC,” which they define as “to provide safe, consistent supervision and constantly provide for children’s basic needs.” As they describe, time and money are two core resources a family needs to provide SCC. For a poor parent, it may be very difficult to provide acceptable levels of time and money simultaneously. So a poor parent might have to choose between going to work and letting the children be unsupervised or inappropriately supervised, or losing their job and letting their children go hungry.

Most parents found to be neglectful are actually just poor. The confusion of poverty with neglect is a trope that is cited again and again by those who advocate restricting government intervention in maltreating families. For example, Jerry Millner and David Keller, the former Associate Commissioner of the Children’s Bureau and his special assistant, have written that It’s time to stop confusing poverty with neglect. They claim that many children become involved with child welfare only because their parents are poor. For example, children might be taken into care because a parent gets evicted or cannot afford childcare and leaves them alone. Despite the popularity of this belief, the evidence does not support it. It is clear that most poor parents do not neglect their children. They find a way to provide safe and consistent care, whether it means extensive research on community resources, creative use of existing supports, or delaying the next birth until adequate resources are available to care for the children they already have. Dee Wilson argues based on his decades of experience in child welfare that “a large percentage of neglect cases which receive post-investigation services, or which result in foster placement, involve a combination of economic deprivation and psychological affliction, beginning with mood disorders such as depression and PTSD,” which often lead to substance abuse as a method of self-medication.

The most serious cases of neglect are often chronic. Chronic child neglect can be defined as “a parent or caregiver’s ongoing, serious pattern of deprivation of a child’s basic physical, developmental and/or emotional needs for healthy growth and development.” Chronic neglect by a single mother often opens the door for physical or sexual abuse by her boyfriend. Children who have experienced chronic neglect may suffer “serious cognitive and social deficits because of the….lack of responsive parent-to-child interaction that is essential for healthy child development.” Chronic neglect can have effects similar to trauma, such as difficulties with emotion regulation.

Many child neglect reports are frivolous and unnecessary, cluttering up the system and making it harder to identify serious maltreatment. Many critics of mandatory reporting and CPS cite a study estimating that 37.4 percent of all U.S. children (and 53 percent of Black children) experience a CPS investigation by the age of 18. Some argue that many of these reports are the consequence of a racist system that ensnares too many poor and Black families. Some are supporting bills to end anonymous mandatory reporting in New York and Texas. Another, smaller set of reports has drawn attention, as described by Naomi Schaefer Riley in her article, Reforming Child Neglect Laws. These reports target stable, functional middle class families that have chosen to give their children more independence than many other parents in their geographic and demographic stratum. The case of the Meitiv children, who were picked up by police while walking a mile to their home in Silver Spring, Maryland and became the subject of not one but two CPS cases, drew publicity around the country.

It is clear that some reports coming into hotlines do not warrant investigation, but we do not know what proportion. Annual data submitted by states and compiled in the Child Maltreatment 2019 report shows that that 45.5 percent of referrals (for all kinds of maltreatment) in 2019 were screened out. And of all children receiving an investigation or alternative response, only 18.9 percent were found to be victims of maltreatment. However, research suggests that the likelihood of another report, a substantiated report, or a foster care placement is the same for a child who is the subject of a substantiated versus an unsubstantiated report. Chances are that many of the children with unsubstantiated reports were previously the subject of substantiated reports, or will be the subject of such reports later. Moreover, as Font and Maguire-Jack point out, “it seems unavoidable that some number of non-maltreated children will be reported to CPS if mandatory reporters are acting appropriately.” After all, they are told that they do not need to be sure the maltreatment is occurring, but to leave that decision to CPS. Changing that guidance, in my opinion, would be dangerous to children.

Should neglect be treated differently from abuse?

Even if neglect is not “just poverty,” some commentators argue that it should be treated differently from abuse. Two former directors of large child welfare systems, Tom Morton and Jess McDonald, argue that because child protective services were designed around abuse rather than neglect, they were patterned after the criminal justice system and treat all maltreatment as antisocial behavior. Morton and McDonald argue that because neglect is an act of omission rather than commission, it should be treated differently, The response to neglect should occur in a “public health framework” outside the current child protection system.

I do not agree that we need a separate system to deal with neglect. As I have discussed, many neglected children are also victims of abuse, whether or not it is substantiated by authorities, and neglect by one caregiver can pave the way for abuse by another. We already have a criminal justice system that addresses criminal abuse and neglect separately from the child welfare system. While the effect may seem punitive, the goal of CPS is to make children safe, not punish parents. Both abuse and neglect make a child unsafe, and the first mission of child welfare is to ensure child safety. Splitting this mission into two is probably not be the best way to promote children’s safety.

Even if we do not need a separate system to deal with neglect, we need to recognize the importance of anti-poverty strategies to help families provide safe and consistent care and prevent child neglect. Prevention has become a major priority of child welfare leaders and thinkers, so this is a good time to talk about incorporating poverty alleviation into child maltreatment prevention. In this new vision, as Feely et al propose and as I have discussed in an earlier post, child maltreatment (especially neglect) prevention should not be the responsibility of child welfare agencies alone. This responsibility should be shared by all the agencies responsible for alleviating poverty. The new initiatives proposed by the Biden Administration for child tax credits, universal pre-kindergarten and expanded child care assistance should be a good beginning.

Is it time to drop the term “neglect”?

In an article in The Imprint, Rebecca Masterson of Gen Justice argues correctly that the term “child neglect” has become almost meaningless because it is used so broadly and so deceptively as a symptom of poverty. Masterson argues that “neglect” needs to be replaced by more specific terms, such as abandonment or refusal of medical care. I do not agree that the term neglect should be dropped. Just as “child abuse” is an umbrella term that includes physical abuse, sexual abuse, and emotional abuse, “neglect” has value as an umbrella term that refers to acts of omission that harm children, in contrast to abuse, which is an act of commission. It makes sense to have these umbrella categories.

But the umbrella categories of “abuse” and “neglect” should not be put in the same list of categories as the specific acts (or lack thereof) underneath the umbrellas. Unfortunately, state and local data systems often list “neglect” as a category along with other more specific terms for types of neglect. This results in bizarre analyses where “neglect” is often described as the most common category of child maltreatment–more common than its subcategories–as if anything else is possible! Just as social workers do not have to check off “abuse” as well as “physical abuse,” in their agency database, they should not be asked to check off “neglect,” as well as specific types of neglect. In order to fix this problem everywhere, and to make sure we have comparable data from all states, the federal government should mandate that all states use the same subcategories of abuse and neglect, and that “abuse” and “neglect” not be among the specific categories.

In devising these alternative categories, we also must be careful to avoid confounding neglect with conditions that may cause it, such as substance abuse and mental illness. These are contributing factors that should be noted in databases and shared with the federal government but are not in themselves forms of neglect. And indeed, in some jurisdictions, like the District of Columbia, substance abuse is not considered neglect unless it is considered to impair parenting.

Child neglect is the most common form of child maltreatment, yet it received little attention in the first decades of the modern child welfare system. It took a long time for child welfare scholars and leaders to recognize the importance of neglect. Unfortunately now that they have recognized its importance, many leaders are using this new knowledge in order to support their proposals to upend child welfare in ways that may be harmful to neglected children. This misuse of the concept of neglect can be addressed by requiring that child welfare agencies collect uniform data on the types of neglect that are being found. That being said, it is important for child welfare leaders to understand the importance of poverty alleviation strategies in preventing maltreatment in general and to recognize that this job does not belong to the child welfare system.

Targeted Universalism in child maltreatment prevention: the promise and the challenge

Image: Family Connects Durham

A growing chorus of voices is calling for a shift of resources away from responding to child abuse and neglect toward preventing its occurrence. Interest is coalescing around a newer idea that would combine universal reach with a response that is targeted based on a family’s risk, sometimes called targeted universalism. Several jurisdictions are already implementing initiatives based on this approach. Governments interested in adopting such a system need to resolve a number of questions concerning the system’s entry point, goals, lead agency, program content, and how to attract and retain the families that are most at risk. But the idea of targeted universalism is worth pursuing as it combines the advantages of both approaches.

The new focus on prevention should not be confused with the changes made by the Family First “Prevention” Services Act of 2018, which allows funds under Title IV-E of the Social Security Act to be be diverted from foster care to services to help keep children with their families. Despite its name, Family First funds can be used only for services to families in which abuse or neglect has already occurred. Such services are generally considered treatment, not prevention, although public health specialists refer to them as “tertiary prevention,” which mean preventing the recurrence of a problem. But this is not the meaning of prevention to the layperson, and the placement of “prevention” in the title of the act continues to cause confusion.

Preventing a problem, if possible, is certainly preferable to addressing it after it appears. As child maltreatment prevention expert Deborah Daro states in an issue of The Future of Children devoted to universal approaches to promoting healthy development, doctors don’t send away patients with precancerous cells and tell them to come back when they have Stage 4 cancer. Yet, that is exactly what we do in child welfare. As Daro points out, “our public response lacks an adequate early assessment when people become parents, and we often offer the appropriate level of assistance only after a parent fails to meet expectations or a child is harmed.” For this reason, many child welfare thought leaders like Daro are calling for a new emphasis on preventing maltreatment before it occurs.

The consensus on prevention still leaves the question of how much to invest in universal approaches (known as primary prevention) as opposed to “secondary prevention” approaches that target families who are deemed to be at risk. Secondary prevention has a lot going for it. Targeting a program to those who need it most can be justified on grounds of efficiency. Why spend money reaching people who do not need help? But investing only in secondary prevention has drawbacks, as described by Kenneth Dodge and Benjamin Goodman in the Future of Children issue referenced above. Even the lowest-risk groups have some risk of child maltreatment. And because they are much larger than the high-risk groups, they may account for most cases of maltreatment. Moreover, interventions with targeted groups rarely reach a high proportion of that population, and thus cannot have a detectable impact on the problem overall. Finally, targeted programs are often stigmatized and not politically popular, leading to lower funding–and less participation by targeted groups.

Dodge and Goodman point out that a debate over universal vs. targeted approaches played out when public schooling was first discussed in the United States. Some advocates argued that middle and upper class families could pay for their children to be educated, and that confining public education to the poor would save taxpayers money. Of course the proponents of universalism won out. Even though affluent families continue to be able to buy a more expensive education through higher property taxes and access to private school, one can only imagine the sorry state of our public education system if at been confined to the poor.

As Dodge and Goodman point out, not all universal programs must provide the same services for everyone, and they cite pediatric care as analogy. All children are seen for well-child visits, during which pediatricians screen them for conditions that might warrant services from specialists, and refer them accordingly. Therefore, they argue that “the best strategy may be to embed targeted interventions in a universal strategy that reaches the entire population while offering intensive interventions for targeted subgroups.” This approach, which they call “targeted universalism,” involves screening all families at a single point in time, such as the birth of a child, identifying the family’s risks and needs, and connecting them with community resources for addressing those risks and needs.

This is the approach that they embedded in the Family Connects Program, starting with a home visit fro a nurse. Nurse home visiting is a popular platform for a universal program, and there is a lot of precedent for a universal nurse home visiting program. Universal nurse home visiting is used by many European countries, where it is part of a comprehensive maternal and child health system, and is also used in other parts of the world. Perhaps the best developed application of this approach in the United States is Family Connects, which Dodge and his team at Duke University initiated in Durham, North Carolina in 2008 as Durham Connects. The model is now being implemented in over two dozen communities around the country, and Oregon is rolling it out statewide. Family Connects aims to reach every family giving birth in a community, assess the parents to determine their risks and needs, and refer them to appropriate services. The program rests on three “pillars:” home visiting, community alignment and data and monitoring, as described by Dodge and Goodman.

The first pillar is home visiting by a trained public health nurse who visits the family in the hospital to welcome the baby and offer a free home visit when the baby is about three weeks old. During the home visit, the nurse uses a structured clinical interview to assess risk in 12 key domains that predict adverse outcomes among children. At the end of the interview, the nurse works with the family to develop a plan of action which may include follow-up visits, phone calls, or contact with external agencies. With parental consent, this plan is shared with the baby’s pediatrician and the mother’s primary care provider. Four weeks later, a program staff member calls the family to check on their progress and determine if the referrals were successful. If the family has not succeeded in making the connection, the program either helps the family try again or makes another referral.

The second pillar, called community alignment, is a compilation of community resources available to families at birth, including targeted home visiting programs, early care and education, and mental health. This directory is available in electronic for for nurses to use on their visits. The third pillar is an electronic data system that documents each family’s assessment, referrals, and connections with community agencies. These records, scrubbed of identifying information, are aggregated to provide information about each agency and on a community level to identify gaps between needs and services. To contain costs, Family Connects is limited to seven contacts (phone calls and visits) over the course of 12 weeks. Dodge and Goodman report that the cost of Family Connects ranges from $500 to $700 per family.

Family Connects has been evaluated with two randomized controlled trials (RCT’s) in Durham, NC and one field study in four rural counties in the state. Eighty percent of the intervention families in the first trial scheduled a visit and 86 percent completed it, for a total “completion rate” of 69 percent. In the second trial, the percentages were 77 percent scheduled and 84 percent completed for a total of 64 percent. The first and second RCT’s found 49 and 52 percent of families respectively to have moderate needs, 46 and 42 percent to have serious needs requiring referral to a community resource, and one percent with a crisis needing immediate intervention. Of the families referred to a community agency, 79 percent and 83 percent reported they had followed through and made the connection. In the first RCT, researchers found that intervention infants had 39 percent fewer referrals to Child Protective Services (CPS) than did the control infants by the age of 60 months, controlling for demographic risk factors, as well as a 33 percent decrease in emergency room use.

Nurse home visiting is not the only possible platform on which to base a targeted universal program, Other options for locating a universal service include pediatric practices. There are two different models based in pediatrician’s offices that have shown promise for preventing child maltreatment–SEEK and Healthy Steps. SEEK trains pediatric primary care providers (PCP’s) to use a questionnaire to assess for a specific set of risk factors. The PCP initially addresses identified risk factors and refers the parent to community resources, ideally with the help of a behavioral health professional. Healthy Steps, as described by Valado and coauthors in The Future of Children, functions as a targeted universal model with three tiers. All families receive screenings and access to a child development support line. Second-tier families receive short-term consultations, along with referrals, additional guidance and resources. Families classified in the highest-risk tier receive “a series of team-based well child visits incorporating a Healthy Steps specialist.”

Models based in pediatric practices have had some promising results. A study testing SEEK with a high-risk sample of patients from a pediatric primary clinic in Baltimore found a “striking” 31 percent reduction in CPS reports. The other SEEK study focused on a low-risk population and there were not enough cases of maltreatment to find impacts on abuse and neglect; however, the study found a lower rate of physical punishment and psychological maltreatment reported by participating mothers. A multisite evaluation of Healthy Steps, as described by Velado et al, showed similar effects, such as a 33 percent reduction in the use of severe physical discipline in the intervention group vs the comparison group when the child was 30-33 months of age. The philanthropic partnership Blue Meridian Partners has chosen Healthy Steps as one of five models to receive large grants to help bring them to a national scale as a potential solution to poverty and lack of economic mobility.

Neither of these primary care-based models has been used universally throughout a jurisdiction. Moreover, pediatric care based models have less reach than models based on the birth hospital. Almost all babies are born in hospitals, but fewer infants attend their regularly scheduled well-baby visits. But according to the National Survey of Children’s Health for 2019, only an estimated 89 percent of children aged 0 to five had experienced one or more preventive care visit in the past year. While hopefully the percentage is greater for infants, it is probably less than the nearly 100% who are born in hospitals.

Many questions must be answered in developing a “targeted universal” child maltreatment prevention system.

What should the entry point be, and should there be more than one? Having all families enter the program through the same portal (be it the GYN practice, birth hospital, or pediatrician’s office) would avoid overlap and inefficiency. Choosing the system that meets parents earliest–the OB-GYN office–would allow programs to make a difference at a crucial time but would also miss the children who get little or no prenatal care. The founders of Family Connects chose to use the birthing hospital because it covers the most families, even though they are missing the chance to address problems that begin prenatally. Combining two or more portals may increase a program’s reach and the opportunity to coordinate and extend services. In Guildford County, NC, Healthy Steps is being integrated with Family Connects. Michael Wald, in a forthcoming article in the Handbook of Child Maltreatment, proposes a prevention system that starts with OB-GYN’s and WIC programs in the prenatal stage and continues with universal services at birth through pediatricians, home visitors and family resource centers. All of these entry points in turn would refer families to targeted services. Using more than one portal requires linkages and procedures for hand-off or collaboration, adding complexity to the system, but increases potential coverage.

What should the goals of the system be? A basic question is whether the system would be framed as a child maltreatment prevention system or something broader. It is hard to separate the goal of preventing maltreatment from that of promoting healthy child development, and indeed most of the programs discussed above have broader goals. The mission of Family Connects is “to increase child well-being by bridging the gap between parent needs and community resources.” Healthy Steps has the goal of “promoting the health, well-being and school readiness of babies and toddlers.” Clearly it is hard to separate the goals of child maltreatment prevention and the promotion of child well-being and healthy development.

What should the lead agency be? A key question about universal prevention is which system should take the lead. Child welfare leaders like Jerry Milner, head of the Children’s Bureau under the Trump Administration, have expressed the desire to expand the role of child welfare to include primary prevention. But if the goal is the broader enhancement of child development, and if the main providers of universal services are health professionals rather than social workers, another agency like public health may be a more appropriate home. Moreover, the child welfare system is already overburdened and underfunded. The work of investigating existing abuse and neglect (which will never be totally eliminated), helping parents and children heal, and making sure children have a safe environment to thrive either temporarily or permanently, is work enough for this beleaguered system. It is interesting that many modern child welfare leaders are so discontented with their primary mission that they are crying out to take on prevention. Perhaps the answer lies in the current political climate, which disparages child protective services and foster care, rather than recognizing the crucial role these services play in protecting children from harm,

What should the targeted services be? Michael Wald raises the question of whether a limited set of evidence-based models should be supported as part of a prevention system or whether jurisdictions should be given free rein in program selection. There are arguments for both, but it may be more practical to allow local jurisdictions to choose their own programs, especially since most “evidence-based” programs have only modest effects. But there are many reasons to advocate that every family found to be high-risk receive early care and education (ECE) interventions such as Early Head Start and Educare, which reduce child maltreatment risks in so many different ways, as I argued in an earlier post. The proposed Child Care for Working Families Act should help make such quality programs more available around the country.

How can we engage the highest-risk families? This is perhaps the thorniest question of all. All of the existing and proposed programs discussed above are voluntary, and voluntary programs never succeed in involving all eligible families. Moreover, it is often hardest to enroll and retain the highest-risk families in parenting support programs. We have already seen that Durham Connects provided a home visit to only 69% and 64% of eligible families in its two RCT’s. And considering that only 79 percent and 83 percent accessed the recommended services, the actual completion rate goes down further. In a study of Durham Connects, the researchers found that parents with a higher risk based on demographic factors like age and income were more likely to agree to a home visit but less likely to follow through. They also found that infant health risk, as measured by low birth rate, birth complications, and medical diagnoses, was associated with lower levels of both initial engagement and follow-through. An HHS issue brief suggests many ways to improve a program’s performance in enrolling and engaging families in home visiting programs. Not listed is the idea of including a peer mentor in the program model, which is embedded in some newer initiatives like Hello Baby and the Detroit Prevention Project. But the fact remains that a voluntary program will leave some children unprotected until they are actually harmed by abuse or neglect. Yet, it is clear that a mandatory child abuse prevention program will not be accepted in the U.S–just look at the debate over the COVID vaccine. We can hope that If a universal, voluntary prevention program is adopted, it will gradually gain in acceptance by high-risk and low-risk parents alike as a valuable benefit. In case that does not occur, we must record identifying information about the parents who do not accept the initial offer to participate and and follow up on future outcomes for their children in order to assess the efficacy of the program at preventing maltreatment among the highest-risk groups. Moreover, CPS must have access to this information when they receive a new report on a family.

Can the system be funded by cutting child welfare budgets? Congress has an unfortunate history of cutting funds to unpopular programs prematurely with the hope of achieving savings by a new approach, rather than waiting for a new approach to yield savings. One could mention mental health deinstitutionalization but a closer analogy might be the Family First Act’s moving money away from congregate care toward family preservation services, before states have the foster homes to replace these facilities, thereby simply shifting the cost of such facilities to states. We hope that establishing a robust system of prevention may well eventually result in a reduction of calls to Child Protective Services and in the need for foster care and in-home services. But we cannot reduce funding for traditional child welfare unless and until this effect has occurred, as Brett Drake argued in in a webinar recently conducted by the American Academy of Political and Social Science (AAPSS) in conjunction with their 2020 volume on child maltreatment. Even then it may make sense to retain current funding as the system is currently stretched thin.

What about anti-poverty programs? Adopting a system of targeted universalism to prevent child maltreatment does not directly address poverty, a prime risk factor for abuse and neglect, as discussed in my last post. Targeted universal programs will not change the level of welfare benefits or housing availability. However, it is important to remember that most poor families do not neglect their children, as University of Maryland’s Brenda Jones-Harden mentioned in the AAPSS webinar. Those families that are functioning well will find a way to get the resources they need to care for their children, and the supportive services provided through targeted universalism may help the others do the same. But at the same time, prevention advocates should fight to improve economic supports so that no child is deprived of what he or she needs to grow up into a healthy and functioning adult. Some of the new programs already passed or under discussion under the Biden Administration and the new Congress, such as the expanded child tax credit and the Child Care for Working Families Act, will help make targeted interventions more effective by addressing some of the poverty-related risk factors that cannot be addressed by targeted programs.

There is a growing consensus in the child welfare world that we must focus on prevention of abuse and neglect, and there is an increasing interest in using the approach of targeted universalism. The current historic expansions of the safety net will provide the perfect backdrop for such an initiative by addressing the economic risk factors for child abuse and neglect. With the motivation to build a better society in the wake of the pandemic, the time may be right to develop a universal, targeted system to prevent child maltreatment and allow every child the conditions for optimal development.

New Jersey to foster parents: thanks but no thanks!

Foster Parents Needed As COVID-19 Pandemic Strains Families is a typical headline these days, as illustrated in an article from Illinois. The pandemic has imposed new impediments to recruiting and retaining foster parents, including fears of exposure to COVID-19, loss of employment and income, and concerns about supervising virtual schooling. But these issues do not seem to be affecting New Jersey, where prospective foster parents are told that they are not needed, thank you very much! While the state credits its efforts at child abuse prevention and family preservation for its lack of need for foster parents, the explanation seems to lie elsewhere. Over the course of five years, the state has cut in half its rate of confirming allegations of abuse and neglect–resulting in a similar fall in the number of children entering foster care. This is a big change, and one that demands explanation in order to ensure that the agency is continuing to fulfill its mission of ensuring children’s safety in New Jersey.

Would-be New Jersey foster parents who click on “Be A Foster Parent” on the website of the Department of Children and Families (DCF) are greeted with the following message: “Thank you for your interest in becoming a resource parent to children and youth in state care.  Due to the COVID19 Pandemic and its impact on operations, DCF has suspended all new inquiry submissions at this time. Please continue to check our website for any updates.” This is an odd message indeed, as it seems to imply that the pandemic has made recruitment and licensing impossible. But agencies around the country have adapted quickly to move vetting and training online in order to enable new foster parents to enter the pipeline. Not so New Jersey.

When we asked DCF why foster parents are being turned away, we received the following reply from DCF Communications Director Jason Butkowski. “[W]e did experience a 19.17% reduction in out-of-home placements from 2019 to 2020.  This is attributable both to New Jersey’s statewide prevention network and our ongoing work to preserve families and keep children and parents together in their homes while receiving services.”

Interestingly, a message sent earlier to prospective foster parents gave a different answer. In May, 2020, would-be foster parents received a message saying, “In New Jersey, the number of youth in foster care continues to be reduced each year because we are focusing first on kinship placements,” as quoted in an article by Naomi Schaefer Riley. We asked Mr. Butkowski which explanation was more accurate–prevention and family preservation or kinship placements–but received no answer.

So what is going on in New Jersey? Certainly, foster care numbers have been decreasing. According to the data portal maintained by Rutgers University, annual entries to foster care fell from 5,504 in 2013 to 2,525 in 2019, as shown in the chart below. The rate of decrease in foster care entries became even steeper between 2018 and 2019, with a decrease of 23.7 percent in the number of entries in that one year alone. The total number of children in foster care dropped from a high of 7,775 in May 2014 to 4,463 in February 2020–before the pandemic closures occurred. So what could be causing this drastic decline in foster care placements and caseloads?

Source: NJ Child Welfare Data Hub, available from https://njchilddata.rutgers.edu/portal/entering-placement-reports#

One possibility might be a decline in child abuse and neglect, which Butkowski is implicitly assuming by attributing part of the fall in foster care cases to DCF’s “statewide prevention network.” In that case, one might expect reports to child abuse hotlines to decline significantly. But according to monthly state reports, calls to child abuse hotlines hardly changed between 2014 and 2019, decreasing very slightly from 165,458 to 164,417. Of course we cannot be sure that reports are an accurate measure of child maltreatment; but one might expect a significant reduction in hotline calls if a large reduction in maltreatment were occurring.

DCF’s Butkowski also credited the agency’s work to “keep children and parents together in their homes while receiving services” as a reason for declining foster care entries. It is true that most substantiations of abuse or neglect do not result in foster care. Instead, DCF works with many families in their homes to help them avoid future maltreatment. But DCF has been emphasizing in-home services for years. Of all the children who were under DCF supervision in foster care or in-home services, the percentage receiving in-home services rather than foster care was 84.7 percent in May 2014 and 90 percent in February 2020. So children were somewhat more likely to receive in-home services in 2020 than in 2014, but the difference was small and not likely to explain the big fall in the foster care rolls.

So with hotline calls basically unchanged, and only a slight increase in the emphasis on in-home services, how did New Jersey manage to reduce its foster care entries by almost half in six years? One can think of the child welfare process as a funnel, starting with referrals, the child welfare term for hotline calls. As we discussed, those have fallen only slightly. Only some referrals are screened-in and accepted for investigation; many are rerouted or receive no action because hotline workers determine that they do not concern abuse or neglect. But a reduction in screened-in referrals is not part of the explanation for New Jersey’s drop in foster care placements. New Jersey reported that 60,934 referrals were screened in in FFY 2019, compared with 59,151 in FFY 2013–a slight increase.

The next step in the child welfare funnel is investigation, and here the count shifts from the number of referrals to the number of children. According to data submitted to New Jersey to the Administration for Children and Families (ACF) and published in Child Maltreatment 2019, the number of children receiving an investigation in New Jersey increased slightly from Federal Fiscal Year (FFY 2015) to FFY 2019–from 74,546 to 78,741. However there was a stunning drop in the proportion of these children who were found to be abused or neglected (known as “substantiation” in the child welfare world). In FFY 2015, 13.0 percent of the children who received investigations (or 9,689 children) were found to be abused or neglected. In FFY 2019, only 6.5 percent of the children receiving investigations (5,132 children) were found to be victims of maltreatment. In other words, among the children who were involved in investigations, the proportion who were found to be maltreated dropped by half. Similarly, the number of children found to be maltreatment victims dropped by 47 percent. (This is very similar to the 44.6 percent decrease in foster care entries between those years shown in the Rutgers data portal cited above).

Note: The substantiation rate is the number of children found to be maltreatment victims divided by the number of children who were the subject of CPS investigations. Data are from Child Maltreatment 2019, available at https://www.acf.hhs.gov/sites/default/files/documents/cb/cm2019.pdf

It turns out that aside from Pennsylvania, which is not comparable to other states because it does not report on most neglect allegations, New Jersey had the lowest rate of substantiation per 1,000 children of all the states in FFY 2019. Only 2.6 children per 1,000 were found to be maltreated, compared to a national rate of 8.8 children per 1,000. In FFY 2015, this rate was 4.9 per 1,000 children in New Jersey–almost twice as high.

How did the number and percent of children found to be victims of child maltreatment drop so much in New Jersey over a four-year period, despite little decline in hotline calls? We asked DCF this question but received no reply. In the notes it submitted to ACF with its 2019 data, DCF acknowledged a decrease in the number of substantiated victims of maltreatment and stated that this is consistent with a continued trend–but provides no explanation. Perhaps policy or practice has changed to make it more difficult to substantiate abuse or neglect, through a change in definitions or in the standard of proof, or perhaps in training or agency culture. But such a change was not mentioned either by Butkowski or in DCF’s submission to ACF.

Let us revisit DCF’s previous message to foster parents saying that “In New Jersey, the number of youth in foster care continues to be reduced each year because we are focusing first on kinship placements.” This is an interesting statement because it implies that these kinship placements are not through the foster care system. It is important to understand that children can be placed with relatives in two ways. A child can be found to be a victim of maltreatment and placed with a relative, who becomes licensed as a foster parent. In New Jersey, 1,619 foster children (or 41 percent of the 3,951 children in foster care) were living with licensed kinship foster parents in November 2020. But these children are included in the state’s count of children in foster care, so they cannot account for the caseload drop. DCF must have been referring to something else.

Perhaps DCF’s earlier message to foster parents referred to the agency’s increasing use of a practice called “kinship diversion.” As described in an issue brief from ChildTrends, kinship diversion is a practice that occurs during an investigation or an in-home case when social workers determine that a child cannot remain safely with the parents or guardians. Instead of taking custody of a child, the agency facilitates placing the child with a relative. If this occurs in the context of an investigation, kinship diversion may result in a finding of “unsubstantiated” even when abuse or neglect has occurred, on the grounds that the child is now safe with the relative. We have no idea how widespread this practice is in New Jersey or nationwide since neither New Jersey nor other states report the number of these cases. However, the system of informal kinship care created by diversion has been called America’s hidden foster care system and nationwide it appears to dwarf the provision of kinship care within the foster care system.

There are many concerns about kinship diversion, as described in an earlier post: caregivers may not be vetted or held to the same standards as foster parents; they and the children they are caring for do not receive case management and services; they do not receive a foster care stipend and may have to depend on much-lower public assistance payments; there is nothing preventing caregivers giving children back to the parents without any assurance of safety; and parents are not guaranteed the due process rights and help with reunification that come with having their children in foster care. Because of the various concerns around kinship diversion, litigation has been filed in several states challenging this practice.

There is one other possible explanation that comes to mind for DCF’s foster parent surplus–dropping foster care rolls due to the COVID-19 pandemic. We removed data from the time of the pandemic from the above discussion to avoid confounding its effects with those of policy and practice changes but we need to ascertain whether the pandemic’s impact on calls to the hotline has affected entries into foster care. As in most states, hotline calls in New Jersey fell sharply in the aftermath of school closures and other pandemic measures. The number of child maltreatment referrals between March (the onset of school closures and quarantines) and November 2020 (the last month for which data are available on the DCF website) was 98,306, compared to 131,344 in the same period of 2019–a drop of 25 percent, based on monthly reports from DCF. It is likely that fewer calls from teachers now teaching virtually were a major factor behind this drop in hotline calls.

Entries into foster care also fell sharply in the wake of the pandemic. Foster care entries dropped from 1,949 in March through November 2019 to only 1,211 in the same months of 2020–a drop of 37.9 percent–which may have reflected in part the reduction in hotline calls and in part the continuing decrease in foster care entries that we have described. But the number of children in care did not drop nearly as much as entries into care. Between February and November 2020, the total number of youth in care decreased only 11 percent from 4,463 to 3,951. This drop is surprisingly low–in fact it is less than the decrease in the foster care caseload during the same months of 2019 (16.1 percent). The small size of this caseload decline reflects the fact that foster care exits dropped even more than foster care entries. Exits from foster care dropped from 2,754 in March through November 2019 to 1,661 in the same months of 2020. That is a drop of over 1,093, when the drop in foster care entries was “only” 738.[1] As a result, it appears that the number of children in foster care was higher, rather than lower, due to the pandemic. Therefore, it does not appear that the pandemic contributed to the decline in demand for foster parents.

One might expect to hear expressions of concern, or at least interest, in the recent precipitous drop in the number and rate of substantiations and in the foster care caseload from the court-ordered monitor charged with ensuring that New Jersey’s child welfare system is fulfilling its mission of protecting children. Since 2006 New Jersey has been operating under a settlement agreement in a lawsuit filed in 1999. The Court Monitor is Judith Meltzer, Executive Director of the Center for the Study of Social Policy (CSSP). In its most recent report, CSSP praised DCF for maintaining its progress toward meeting all the benchmarks required to exit the lawsuit, despite the challenges posed by COVID-19. Ironically, the report mentions DCF’s progress in “Prioritizing Safety.” The report does not mention the precipitous drop in foster care entries or substantiations before the pandemic or the fact that the state is turning away prospective foster parents.

New Jersey may be the first state to have stopped accepting applications for foster parents, and the reasons cited by DCF do not seem to explain this unusual event. Careful study of DCF data shows that the rate at which allegations of abuse or neglect are substantiated has been cut in half, and that there has been a similar reduction in entries into foster care. This cut in the substantiation rate could be due to policy or practice changes making it harder to confirm child maltreatment or it could be due to an increased tendency to place children with relatives without establishing officially that maltreatment has occurred. Without an adequate explanation from the state, the extent to which either of these factors is driving these trends is unknown. It is imperative to know the explanation of this trend to ensure that DCF’s new policies and practices are not compromising its mission of keeping children safe.

[1]: Reasons for this drop in foster care exits may include court shutdowns and delays and suspension of services parents need to complete their reunification plans.

Declining child abuse? The misuse of data in child welfare

Lowest number of maltreatment victims in five years, crowed the Administration on Children and Families (ACF), summarizing its annual report, Child Maltreatment 2019. Child welfare newsletter The Imprint eagerly repeated the claim, claiming that the Number of Child Abuse and Neglect Victims Reached Record Low in 2019. The venerable Child Welfare League of America followed suit in its Children’s Monitor saying “Data Shows Decline in Child Abuse in FY2019.” It is only by reading the report that one learns that the decline was not actually in the number of victims of abuse or neglect. Instead, it was a decline in the number of children who were found by Child Protective Services (CPS) to be abused or neglected, which is not the same thing at all.

Child Maltreatment, the Children’s Bureau’s annual report on child abuse and neglect, is based on data from the states, the District of Columbia, and Puerto Rico collected through the National Child Abuse and Neglect Data System (NCANDS). Child Maltreatment 2019 is based on data from Federal Fiscal Year (FFY) 2019, which ended September 30, 2019. (Note that these data reflect the year before the inception of the coronavirus pandemic.) Displayed below is a summary of four key national rates reported by ACF between 2015 and 2019. The first indicator shown is the referral rate, which describes the number of calls and other communications describing instance of child maltreatment per 1,000 children. Next is the screened-in referrals rate, which includes referrals that are passed on for investigation or alternative response. Once screened in, only some reports are referred for investigation, and the third set of bars represents children who received an investigation per 1,000 children. The fourth group shows the rate of children found to be abused or neglected–or those who received a substantiation. Let us go over these numbers in more detail.

*Note that Investigation and Substantiation Rates are based on number of children, not referrals
Source: Child Welfare Monitor tabulation of data from Child Maltreatment 2019, available from
https://www.acf.hhs.gov/sites/default/files/documents/cb/cm2019.pdf

Total referrals: A referral is a call to the hotline or another communication alleging abuse or neglect. In 2019, agencies received an estimated total of 4.4 million referrals, including about 7.9 million children. The “referral rate” was 59.5 referrals per 1,000 children in FFY 2019. This rate has increased every year since 2015, when it was 52.3 per 1,000 children. It is worth noting that the referral rate differs greatly by state, ranging from 17.1 referrals per 1,000 children in Hawaii to 171.6 per 1,000 children in Vermont, as shown in the report’s state-by-state tables. These differences in referral rates may stem from cultural differences regarding the duty to intervene in other families, differences in publicity for child abuse hotlines and ease of reporting, or temporal factors like a recent highly-publicized recent child abuse death.

Screened-in referrals (reports): A referral can be either “screened in” or screened out because it does not meet agency criteria. In FFY 2019, agencies screened in 2.4 million referrals, or 32.2 referrals per 100,000 children. This was a decrease in the rate of screened-in referrals per 1,000 children after three straight years of increases. This percentage of referrals that were screened in varied greatly by state, ranging from 16 percent in South Dakota to 98.4 percent in Alabama. States reporting a decrease in screened-in referrals gave several reasons, such as a change in how they combine multiple reports and a decision to stop automatically screening in any referral for a child younger than three years old.

Children who received an investigation (child investigation rate): Once a report is screened in, it can receive a traditional investigation or it can be assigned to an alternative track, which is often called “alternative response” or “family assessment response.” (Two-track systems are often labeled as “differential response.”) This rate represents the number of children who received an investigation as opposed to an alternative response. Only an investigation can result in a finding of abuse or neglect; an alternative response generally results in an offer of services. Like the referral rate, the investigation rate increased from 2015 to 2018 and then decreased in 2019. This rate also varies widely between states and over time. Some states eliminated or expanded their differential response programs in 2019, resulting in more or fewer investigations, as described in the report.

Substantiation: A “victim” is defined in NCANDS as a “child for whom the state determined at least one maltreatment was substantiated or indicated; and a disposition of substantiated or indicated was assigned for a child in a report.” The report’s authors refer to the number of such children per 1,000 as the “victimization rate.” But clearly substantiation does not equal actual victimization. The difficulty of making a correct decision on whether maltreatment has occurred is well-documented. Stories of families with repeated reports that are never substantiated or not confirmed until there is a serious injury or even death are legion. So are reports of parents wrongly found to be abusive or neglectful. Therefore, we have chosen to use the term “substantiation rate” instead of ‘victimization rate.” This rate varies greatly by state, from 2.4 per 1,000 children in North Carolina to 20.1 in nearby Kentucky.[1] The national substantiation rate in FFY 2019 was 8.9 per 1,000 children, down from 9.2 per 1,000 in FFY 2019 and FFY 2015. States reported a total of 656,000 (rounded) victims of substantiated child abuse or neglect in FFY 2019–a decline of four percent since 2015.

So does this decline in the number and rate of substantiations really connote a decline in child abuse and neglect? The range in substantiation rates among states argues against this idea. Unless states differ by almost a factor of 10 in the prevalence of child abuse and neglect, these numbers must reflect factors other than the actual prevalence of maltreatment. And indeed the report’s authors acknowledge that “[s]tates have different policies about what is considered child maltreatment, the type of CPS responses (alternative and investigation), and different levels of evidence required to substantiate an abuse allegation, all or some of which may account for variations in victimization rates.” Changes in these policies and practices can account for changes in these rates over time. Moreover, changes in all the earlier stages of reporting, screening, and assignment to investigation or alternative response contribute to changes in the substantiation rate. In 2019, screened-in referrals and investigations per thousand-children both decreased, which clearly contributed to the decrease in the substantiation rate.

It is interesting to note that while referrals increased every year between FFY 2015 and FFY 2019, both screened-in referrals and investigations decreased in FFY 2019. This suggests a general tendency among states to be less aggressive in responding to allegations of maltreatment, perhaps in accord with the prevalent mindset among child welfare leaders nationally and around the country, as discussed below.

Understanding the difference between “victimization” and “substantiation” and the many possible causes of a decrease in this rate reveals the deceptiveness of ACF’s statement that “[n]ew federal child abuse and neglect data shows 2019 had the lowest number of victims who suffered maltreatment in five years.” Lynn Johnson, the HHS assistant secretary for children and families, is quoted in ACF’s press release as saying that “[t]hese new numbers show we are making significant strides in reducing victimization due to maltreatment.” Unless Johnson and the ACF leadership intended to mislead, it appears they are woefully ignorant of the meaning of these numbers.

Most regular leaders of this blog already know why ACF wants to support the narrative of declining child maltreatment. The current trend in child welfare policy, regardless of political party, is to oppose intervention in families. Republicans who oppose government spending and interference in family life have made common cause with Democrats who think they are reducing racial disparities and supporting poor poor families by allowing parents more freedom in how they raise their children, even if it means leaving children unprotected. Members of both parties came together to pass the Family First Act, which encoded this family preservation mindset into federal law.

Child Welfare Monitor has pointed out many other instances where ACF or by other members of the child welfare establishment in the interests of supporting the family preservation mindset. For example, we wrote about the Homebuilders program, which was classified by a federally-funded clearinghouse as “well-supported” despite never having been proven effective for keeping families together. In fact, Homebuilders had to be classified as well-supported because it was one of the key programs touted by ACF and others in promoting the Family First Act and other policies promoting family preservation.

So if ACF’s “victimization” data do not in fact tell us what is happening to abuse and neglect rates, what else is available? We call on Congress to pass an overdue re-authorization of the Child Abuse Prevention and Treatment Act and include a fifth National Incidence Study of Child Abuse and Neglect. Data for the last study was collected in 2005 and 2006; it is high time for an update which should put an end (at least temporarily) to the misuse of NCANDS data as an indicator of trends in child maltreatment.

President Biden has called for ending a “culture in which facts themselves are manipulated and even manufactured.” We hope that ACF under its new leadership, as well as the rest of the child welfare establishment, will take these words to heart and commit themselves to truth and transparency from now on.

[1]: Pennsylvania has a substantiation rate of 1.8, even lower than that of North Carolina, but in Pennsylvania, many of the actions or inactions categorized as “neglect” are classified as “General Protective Services” and not included in the substantiation rate, making its data not comparable to that of the other states and territories.

[2]: Massachusetts did not provide data on FFY 2019 child maltreatment fatalities.

America loses champion for a child-centered child welfare system

GellesRichard Gelles, one of the nation’s leading child welfare experts, died late in June of brain cancer, as reported by the Chronicle of Social ChangeGelles’ death deprives the nation of one of its leading child welfare scholars, and one of the few remaining spokespersons for a child centered approach to child welfare.

Richard Gelles played an important role in the passage of the Adoption and Safe Families Act (ASFA) of 1996 through the publication of  The Book of David: How Preserving Families Can Cost Children’s Lives. This book told the  story of a 15-month old boy who was murdered by his abusive mother. David’s parents had an open child welfare case when he was born, due to their severe abuse of his sister Marie when she was six weeks old that left her with lifelong disabilities.  While Marie was still in foster care, the parents were reported to the child abuse hotline twice for abusing David. In closing their investigation without removing David or opening a case, agency workers ignored two huge red flags–the grievous injury to six-week-old Marie and the failure by her parents to comply with the agency’s reunification plan, resulting in the termination of their parental rights to their daughter. Three and a half months after the case was closed, David was dead.

According to Gelles, David’s death could be traced to the doctrine requiring that agencies make “reasonable efforts” to keep or reunite abused and neglected children with their parents. Without any definition or timeframe, efforts to keep children like David with their birth parents often cross the line separating reasonable from unreasonable. Gelles argued that David’s death could also be traced to “the larger ideology behind ‘reasonable efforts,’ ‘the sacrosanct belief that children always (or nearly always) are better off with their biological parents.”

In his testimony at a 1995 Congressional hearing, Gelles argued that the current obsession with family preservation should be replaced for a “child centered child welfare system” where abused and neglected children would longer remain for years in abusive homes, nor would they languish for years in foster care. Instead, the goal of a child-centered child welfare system would be “to terminate parental rights, when appropriate, quickly enough so that (1) children are not permanently harmed, physically or psychologically, and {2) make children available for adoption earlier enough in their lives so that they are ‘adoptable.'”

Gelles’ perspective was incorporated into several changes made by ASFA, as described by  former Hill staffer Cassie Statuto Bevan in an Urban Institute compilation on ASFA ten years after its passage. The requirement for “reasonable efforts” was moderated by requiring that such efforts must maintain the child’s health and safety as the “paramount concern.” Moreover, a  deadline was placed on reunification efforts, requiring a state to file for termination of parental rights after a child had been in foster care for 15 of the previous 22 months. ASFA also allowed states to bypass reasonable efforts altogether in extraordinary cases, such as when parents have committed a felony assault resulting in serious injury to the child or another child–clearly an exception that could have been applied in David’s case.

While it appears that ASFA has resulted in shorter stays in foster care as Gelles hoped, the impact of the provisions designed to protect children from dangerous parents appears to have been less than their authors hoped. Agencies make frequent use allowable exceptions to the 15-month time limit for termination of parental rights and rarely use the provisions that allow them to forego reunification plans. In order to make the system more child-centered, these provisions should be strengthened. Unfortunately, we seem to be going in the opposite direction.

There is a groundswell of attacks against ASFA,  with critics claiming that 15 months is not enough time for with problems like drug addiction to address them, especially if services are not immediately available. Some critics even denounce the law as racist because they say it penalizes black parents, ignoring the needs of black children for safety and permanency. Contrary to the child-centered perspective Gelles promoted, these advocates prioritize parents’ rights over children’s needs to be placed in a loving home quickly enough to avoid permanent damage and early enough in their lives to be likely to be adopted.

In The Book of David and in his testimony, Gelles also criticized the investment of a billion dollars in unproven “intensive family preservation programs” to keep families together. These new programs, such as the well-publicized Homebuilders, were intensive, short term, crisis intervention services designed to address parental behaviors that are putting their children at risk. Gelles pointed out that there was no research evidence to support the success of intensive family preservation programs at preventing foster care placements, let alone keeping children safe–which was not even evaluated. And from a theoretical perspective, Gelles pointed out that intensive family preservation programs would be effective for only those families with a low level of risk and a high level of readiness to change. To assume that these services could work for all maltreating families was unrealistic. 

Sadly, the same programs that were supported without evidence in the 1980’s are being supported again with more baseless claims of research support. As reported in a recent post, Homebuilders is once again being promoted as effective in keeping families together, although the research is no more convincing than that of the 1980s. Recently Homebuilders was approved as a best practice that can be funded by the Family First Act, based on only two studies. One of the studies focused on a program that did not follow the Homebuilders model and worked only to reunify families already separated by foster care—not prevent foster care placement which is the main purpose of Family first. The second was a study of Homebuilders family preservation programs and according to its authors failed to demonstrate any favorable program impacts. 

Why invest in a program that has failed to document success over several decades of research? The renewed push for family preservation has once again taken over the child welfare world. With the passage of the Family First Act, allowing billions in funding for programs that keep families together, there is a desperate need for programs to spend that money on. The federal clearinghouse established to approve programs for this purpose has demonstrated that its standards for calling a program “well-supported by the evidence” are low indeed. And that is not surprising, since there are few such programs that have been shown to be effective in helping abusive and neglectful parents change longstanding and often intergenerational patterns. And so the story starts again.

As we face increased backlash against ASFA and increased incentives to spend billions of dollars on unproven family preservation programs, Richard Gelles’ keen analysis and advocacy for children will be greatly missed.

 

 

When social distancing can kill: child protection during a pandemic


NJbridgethegapSocial distancing is essential to break the back of  the coronavirus pandemic. But for children who are at risk of abuse and neglect, social distancing means social isolation and the loss of any hope of rescue from their desperate circumstances. It is important for child welfare agencies to reach out to the general public and those workers still seeing children with special messages about warning signs of maltreatment and how to get help.

For children living in abusive or neglectful homes, the pandemic is a perfect storm. On one hand, abuse and neglect are likely to increase due to parental stress and more time spent together in close quarters due to social distancing. Research suggests that child abuse increases in times of economic or natural disasters.

At the same time as families are under increased stress and spending more time together, children are not being seen by mandated reporters, especially teachers and school staff.  One in five reports comes from education personnel, according to the most recent federal data; hence the annual summer falloff in reports and the uptick every October. Today, almost every school building in the country is closed. While many schools are conducting online classes, the New York Times has reported that fewer than half of students are participating in some schools. Absence from virtual classrooms seems to be especially high in schools with many low-income students, who often lack access to computers and the internet. Some students and parents have completely fallen out of touch with their schools. And these are precisely the students who are more likely to be abused or neglected.

Reports about declines in hotline calls have appeared from almost every state, with calls in dropping often by half and in some jurisdictions by as much as 70 percent since schools shut their doors.1 School closures cannot explain this entire decline. Clearly other possible abuse reporters, such as law enforcement, health personnel, neighbors, and family members are seeing less of children as well.

At the same time, there is reason to think that child abuse is increasing during the pandemic.  A three-year-old Fort Worth boy who died from “severe child abuse” on Easter morning was the third child in less than a month to die at Cook Children’s Hospital, according to the hospital. Since March 13, eight children have been admitted to the hospital for severe child abuse and three have died. The hospital normally sees six child abuse deaths in an entire year. The Arnold Palmer Children’s Hospital in Orlando, has seen a spike in child abuse cases. According to the medical director, the hospital normally sees one or two trauma cases a month. But in the last few weeks, eight children were brought to the hospital with severe injuries due to abuse. At Children’s National Medical Center in Washington DC, 86 percent of children coming to the Emergency Room with injuries suggesting child abuse between March 15 and April 20 had to be hospitalized compared to 50 percent in the same period of last year.

Ironically, April is Child Abuse Prevention month, when government and nonprofit agencies work to increase public awareness about child abuse and neglect and the need to report it. Unfortunately, a recent study casts doubt on the effectiveness of public education efforts to date. A nationwide survey conducted during the pandemic found that a large majority of Americans are not willing to report excessive physical punishment to the police or CPS. The New York Society for the Prevention of Cruelty to Children (NYSPCC)  surveyed 1,004 adults nationwide on March 27 to 29, in the midst of the crisis. They found that only 19% of adults say they are “very likely” to report a parent who is “excessively spanking or physically punishing their child” to child protective services. Only 36 percent of adults say they are very likely to contact the police if they see a stranger doing the same thing. Among the reasons given for their unwillingness to report, 68 percent of respondents cite that it might make things worse for the child, 35 percent cite the risk to their own family, and 30 percent say it is “none of my business.”

These survey results, with or without a pandemic, are frightening.  As Mary Pulido of NYSPCC puts it, “If what you see in public is enough to even make you think about calling the authorities, think of what that child could be enduring at home, behind closed doors.” But these results should not be surprising to those who are aware of past cases of egregious child abuse which were not reported despite obvious red flags.  For example, the media has reported on the failure of family and neighbors to report major concerns about treatment of the 13 Turpin children, who were imprisoned, starved, and physically abused by their parents over many years. 

What we know about the reluctance of people to report their concerns about children’s treatment suggests the need for a much more concerted effort for the long-term. Such an effort should be led by the federal government and implemented at the state and local levels. It should aim to increase knowledge of the signs of child abuse and neglect and convince citizens that it is their obligation to report, as described in an earlier post. Such a campaign would be more powerful if all citizens were required to report when they fear that a child is being harmed.

For this time of pandemic, we cannot hope for an immediate sea-change in attitudes, but governments can integrate messaging about child abuse and neglect into their communications with the public about the pandemic. Special efforts should be made to encourage teachers who are interacting with students online and other essential workers who have contact with children and families. Sadly, the federal Children’s Bureau has not issued any guidance to states and and counties resources and suggestions for how to do this. Such leadership has been left to state and local governments and nonprofits.

In a Call to Action for State Governors, CHILD USA, a national think tank focused on child protection, suggests that Governors should add to all their COVID updates a reference to the need for all adults to be alert for signs of abuse and neglect, along with how to reach the child abuse hotline. Special campaigns such as  #bridgethegap in New Jersey, may be helpful as well. As shown in the poster above, the public is reminded that “It IS your business. Everyone in New Jersey is a mandated reporter.” Readers should reach out to their government executives to urge them to incorporate such messages into their communications with the public. 

Special materials targeted to teachers and other staff may be helpful as well. New Jersey has produced a special message for education personnel asking them to “try to get ‘eyes on’ every child at least once a week.” Maine’s Office of Child and Family Services, in partnership with the Department of Education, has also issued guidance for educators, health care providers and community members for spotting and responding to signs of child maltreatment.

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CHILD USA has issued a list of Tips for Teachers on Child Welfare and Online Safety during COVID-19. This helpful document lists questions to ask students at the elementary, middle, and high school levels to assess their physical safety, online safety, and whether they are getting enough to eat. It also lists key items for teachers to look for when seeing their students online, such as the appearance of the student and the home, and things that the student might say.  And it suggests special efforts to monitor students with issues with drug abuse, mental illness or domestic abuse in their families. All child welfare agencies should ensure that their local school systems distribute this checklist to their teachers.

The document from CHILD USA does not say what teachers should do when they are unable to reach a child and their family, which is probably the case for many of the children most at-risk of maltreatment. Jurisdictions should consider the possibility of treating the inability to reach a child and family after several tries over several days as grounds for a teacher to call the child abuse hotline.

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States and counties might also try to enlist the only people who are seeing children regularly other than their immediate families–grocery and pharmacy workers and mail carriers. A representative of the Allegheny County Department of Children Youth and Families told a reporter that the agency “plans to pivot its awareness campaign” to focus on these workers. They plan to make sure the workers get the message that “if you see something, say something.” A grassroots campaign run by former child welfare workers in Arizona is also trying to contact the people who are still seeing children, including grocery workers, delivery services, and food banks.

As Angelina Jolie wrote in Time Magazine, “We were underprepared for this moment because we have yet to take the protection of children seriously enough as a society.” This is a major problem which needs to be addressed for the long term, so that next time there is a crisis, we will have a society that is ready to keep its children safe in spite of physical isolation.

This post is being updated daily during the coronavirus crisis include new information.

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Child Maltreatment 2018: Almost one in 100 children found to be maltreated, but great variation among states and populations

The federal Children’s Bureau (CB) has released its annual Child Maltreatment report, containing data provided by the states from Federal Fiscal Year 2018.  The high rate of maltreatment victimization and the contrasting numbers and rates between states and populations are two of the major takeaways of the report. A common theme across the report is that differences between states and populations and over time can reflect differences in levels of maltreatment,  policy or practice, or even how states collect data.

CB’s annual maltreatment reports use data from the National Child Abuse and Neglect Data System (NCANDS),  which is a federal effort that collects and analyzes child welfare data provided voluntarily by the states plus the District of Columbia and Puerto Rico. The data follow children and families from referrals to reports, dispositions and services. One of the most helpful resources is exhibit 2, reproduced below, a flow chart that follows families and children through the process from referral to services. (All tables in this post are reproduced from the report).

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Referrals and Reports

During FY 2018, states reported receiving a total of 4.3 million “referrals” (calls to a hotline or other communications alleging abuse or neglect) regarding approximately 7.8 million children.  The number of referrals per 1,000 children varied wildly between states, from a low of 15.7 in Hawaii to a high of 167.9 in Vermont.  The different referral rates between states may reflect different levels of knowledge about and comfort with child maltreatment reporting, different rates of underlying maltreatment, or even different state practices in defining the term “referrals.” Vermont explains that its high referral rate is the result of its practice of treating all calls to the child abuse hotline as referrals.

The rate of referrals has increased from 50 per 1,000 children in 2014 to 58.5 referrals per 1,000 children in 2018. Differences over time within a state may due to changes in state policy or practice or events in a particular state. For example, Alabama reported that it implemented online mandatory reporter training in 2014, resulting in an increase in referrals. Rhode Island reported a large increase in referrals due to the public trial of a school official for failure to report child abuse, resulting in more than a doubling of hotline calls from school staff.

A referral may be screened in or out by the child welfare agency depending on whether it meets agency criteria. Referrals may be screened out because they do not meet the definition of child abuse and neglect, there is inadequate information, or for other reasons. Screened-in referrals are called “reports” and receive a traditional CPS investigation or an “alternative response” (often called an “assessment”) in states that have two-track or “differential response systems.” These alternative responses, usually reserved for the less serious cases, do not result in an allegation of abuse or neglect but rather are aimed at connecting families with services they might need. Of the 4.3 million referrals, states screened in 2.4 million for an investigation or assessment. The rate of screened-in referrals (known as “reports”) has increased from 29.1 per 1,000 children in 2014 to 32.5  in 2018. The highest number of reports came from education personnel (20.5%), legal and law enforcement personnel (18.7%), and social services personnel (10.7%). Parents, other relatives, friends and neighbors submit the remaining reports.

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Substantiations

A total of 3.5 million children received an investigation or alternative response, and states found approximately 678,000 (16.8%) to be victims of child maltreatment; in other words the allegation was “substantiated.” Another 14% received an alternative response rather than an investigation, which meant there was no determination of whether maltreatment occurred. Reports involving 56.3% of these children were unsubstantiated, which meant there was not sufficient evidence to conclude that maltreatment took place.

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The 678,000 children who were found to be victims of maltreatment equates to a national rate of 9.2  victims per thousand children in the population, or almost one out of every 100 children. This rate varies greatly by state, from 2.7 in Washington 1 to 23.5 in Kentucky. A lower child victimization rate might reflect less child maltreatment or a system less likely to respond to existing maltreatment or that makes greater use of differential response. Kentucky had the highest proportion of children found to be victims (23.5 per 1000 children or over one in every 50 children) followed by West Virginia, Rhode Island, Massachusetts and Michigan. The ongoing crisis involving opioid and methamphetamine addiction has been blamed for an increase in maltreatment in many states. And indeed, all of the states with the highest rates have been hard-hit by the opioid epidemic and had among the highest opioid overdose death rates in the country in 2017.

The national proportion of children found to be victims of maltreatment has fluctuated since 2014, increasing slightly between 2014 and 2018 from 9.1 to 9.2 per thousand. This small national increase masks large changes in the numbers of victims in certain states, from a 50% decrease in Georgia to a 216% increase in Montana. In their written submissions, the states attribute these diverse trends to changes in child welfare law, policy and practice as well as increases in parental drug abuse and even severe weather events such as Hurricane Maria in Puerto Rico.2  Georgia reports a policy change that resulted in a large increase the proportion of cases assigned to the alternative response track, perhaps one reason for the decrease in substantiations. Montana has experienced a surge in children entering foster care due to parental drug abuse, especially methamphetamine, which probably contributed to the increase in children found to be victims.

The disparity in the proportion of children found to be maltreatment victims across states is consistent with the belief that there is no foolproof method of assessing the truth of an allegation and that substantiation may not be a very good indicator of whether maltreatment has taken place. Research has found little or no difference in future reports of maltreatment of children who were the subject of substantiated or unsubstantiated reports.

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Victim Demographics

The proportion of children found to be victims of maltreatment decreases as age increases. The rate of substantiated victimization for babies under a year old is 26.7 per thousand. This rate falls to 11.8 percent for children aged one to two and decreases gradually as age increases. This age effect reflects the greater fragility and helplessness of younger children and also the fact that they are less likely to spend time away from their parents (the primary maltreaters). That is one reason why many child advocates support making early care and education available to all children at risk for maltreatment and particularly to those already involved with the child welfare system.

Screen Shot 2020-01-31 at 9.30.35 AMThe rate of children found to be victims of maltreatment  varies considerably between racial and ethnic groups. The highest rate is for Native American or Alaska Native children, who were found to be victims at a rate of 15.2 per thousand, followed by African-American children, with a rate of 14 per thousand, compared to  8.2 per thousand for White children,  and 1.6 per thousand for Asian children. It is 8.1 per thousand for Hispanic children, who can be of any race. The higher rate of substantiated victimization among African-American and Native American children is a subject of controversy. Some believe it reflects greater tendency of African-American and Native parents to be reported to CPS and later substantiated as perpetrators due to racism. But these differences might also reflect a greater poverty rate for Black and Native children, or cultural factors, such as a preference for corporal punishment in the Black community, or substance abuse in the Native American community.

Maltreatment Types

Neglect continues to be the predominant type of maltreatment. The data shows 60.8% of children were found to be victims of neglect only, 10.7% victims of physical abuse only, and 7.0% to be sexually abused only, with 15.5% suffering from multiple types of maltreatment, mostly commonly neglect and physical abuse. It is important to understand that a given child may be found to have suffered one type of maltreatment when other types are also present. For example, abuse can be hard to substantiate when the parent and child give contradictory accounts, or the child recants, and such children may be substantiated for neglect only when abuse is also present.

For the first time, 18 states reported on victims of sex trafficking. These states reported a total of 339 victims. While one case would be too much, it is encouraging that the scope of the problem is so small compared to other types of maltreatment. This suggests that sex trafficking as a type of child maltreatment is much less widespread than one might have thought given the amount of attention recently attached to this topic through legislation, training, and policy.

There is wide variation among states in the prevalence of different types of substantiated maltreatment. Some of this variation may be due to real underlying differences in parental behavior and some may be due to varying laws, policies and practices. Of particular interest are the states that have much higher percentages of abuse than the national average. While nationally only 10.7% of victims are found to have experienced abuse only, that percentage was 55.3% in Vermont, 48.2% in Alabama, and 39.7% in Pennsylvania. It is known that corporal punishment, which may escalate to abuse, is more popular in Southern states, like Tennessee and Alabama. Vermont’s  and Pennsylvania’s high rates of abuse may be due to the assignment of many less-serious cases to an alternative track where there is no disposition (in Vermont) or the disposition is not reported (in Pennsylvania).3 Alabamans are aware of their state’s high abuse rate, which was covered in an excellent story by Al.com that cites the state’s acceptance of corporal punishment as one underlying factor.

Substance Abuse

For the FY 2018 report, the researchers analyzed three years of data on the presence of alcohol or drug abuse among caregivers. They found that the national percentage of substantiated victims with a caregiver identified as a drug abuser was 30.7%  in 2018. Alcohol as a caregiver risk factor was 12.3%. Both of these percentages increased slightly from 2016. As is often the case, there was an astonishing diversity among states, ranging from 2.2% to 45.5% for alcohol abuse, and from 3.1% to 61.5% for drug abuse. This diversity, especially the very low rates in some states,  raises concerns about whether they are accurately capturing these factors.

Perpetrators

The data show that 90.7% of the victims were maltreated by one or both of their parents. That includes nearly 40% who were maltreated by their mother acting alone and 21.5% by their father acting alone. Relatives (4.7%) and unmarried partners of parents (2.8%) are the largest remaining categories of maltreaters.

Fatalities

There is no standard, mandatory system for reporting child abuse and neglect deaths and it is often extremely difficult to determine where a death was caused by abuse or neglect rather than natural causes. Based on data from all states except Massachusetts, the researchers estimated that 1,770 children died from abuse or neglect in 2018, which is a rate of 2.39 per 100,000 children in the population. That is an 11.3% increase over the estimate for 2014 but this change may reflect data quality rather than a real change in maltreatment deaths. State rates range from 0 (Nebraska) to 6.6 (Arkansas) per 100,000 children but it is hard to know how much of the variation reflects differences in capturing actual child fatality rates.  NCANDS maltreatment data are generally viewed as underestimates because, among other factors, many maltreatment fatalities may be unknown to any system or impossible to prove and some states do not report on deaths of children not known to the Child Protective Services Agency.  In contrast, the Commission on Child Abuse and Neglect Fatalities reported that the most recent National Incidence Study (where data is collected directly by ACF) reported 2,400 deaths compared to 1,530 deaths in the Child Maltreatment report for a similar period. The  CAPTA reauthorization bill which was passed by the House would require the Secretary of the Department of Health and Human Services establish uniform standards for the tracking and reporting of child fatalities and near-fatalities related to maltreatment.  This requirement is badly needed.

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Like child maltreatment itself, child maltreatment fatalities are more likely occur to the youngest children. Infants under one year old were the most likely to die, at a rate of 22.77 per 100,000. The rate decreases to 6.3 per 100,000 one-year-olds and continues to fall with age. Nearly half of the children who died were younger than one and 70.6% were younger than three. This illustrates again why it is so important to ensure that all children at risk of severe abuse or neglect must be in early care or education.

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The child fatality rate for African American children (5.8 per 100,000 children)  is over 2.8 times the rates for White children. Mixed-race children had the second highest rate of 3.2, followed by Native American children at 3.12. As discussed above, we do not understand these disparities. They could be due to cultural factors, economic factors, racism in reporting and substantiation, or other factors. The child maltreatment fatality rate for Black children is more than twice that for White children (5.48 vs. 1.94 per 100,000). This is an even greater disparity than  the difference in child maltreatment rates (14.2 per 1000 for black children vs. 8.2 per 1000 for white children).   Perhaps many Black parents’ embrace of corporal punishment, as described by author Stacey Patton in her important book, Spare the Kids, while not much different in terms of overall percentages from that of White parents, countenances more severe discipline than among other racial and ethnic groups. These disparate child maltreatment death rates should give pause to those self-described anti-racists who want to equalize the rates of investigations, substantiations, and child removals of Black and White children. Such a policy would very likely lead to increased deaths of Black children–hardly an outcome they should welcome.

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Of the children who died from maltreatment in 2018, 72.8 percent suffered neglect and 46.1 percent suffered physical abuse, including some children who suffered more than one type of maltreatment. Eighty percent of the deaths were caused by parents or caregivers acting alone or with other individuals. Based on reports from 24 states, 20.3% of the children who died had received family preservation services in the previous five years. And 2.5%  had been reunified with their families in the previous five years after being removed.

Services

Approximately 1.3 million children (a duplicated count4) received services at home or in foster care as the result of an investigation or alternative response. This includes 60.7% of the children who were found to be victims of maltreatment and 20.9 percent of the non-victims. It is concerning that such a low percentage of the victims received services. But not every state reports data for every in-home service (especially those provided by other agencies or contractors), so the actual proportion receiving services other than foster care may be higher. Sadly, according to reports from 26 states, only 21.9% of the victims received court-appointed representatives.

About a fifth of the children found to be maltreatment victims (22.5%) and 1.9% of those not found to be victims5 were placed in foster care. It is worth noting that less than half of the maltreatment victims who received services (146,706 out of 391,661) were placed in foster care. The others received family preservation services while remaining at home. Many news reporters and child welfare commentators have incorrectly suggested that no services other than foster care were available to abused or neglected children before the implementation of the Family First Prevention Services Act. This data shows the incorrectness of that assumption.

Infants with prenatal substance exposure

For FFY 2018, States were required  to report for the first time on infants exposed prenatally to drugs and alcohol. Forty-five states reported that they had been informed of 27,709 infants born exposed to substances. Nearly 88% of these infants were screened in as appropriate for an investigation or alternative response. It is somewhat concerning that the others were not, given the possible serious effects of prenatal and postnatal substance abuse.  Of those screened in, 75.5% had a caregiver identified as a drug abuser, 11.7% had a caregiver identified as a drug and alcohol abuse, and less than one percent had a caregiver identified as abusing alcohol only. The 24,342 children who were screened in in 42 states constituted a shockingly high 10.8 percent of children under one in those states. Of the screened in reports, 68.3 percent were substantiated as victims or abuse or neglect. Nine percent received an alternative response and nine percent were unsubstantiated. The report’s authors caution against comparing states because this was the first year of reporting.  The wild disparity between states in the proportions identified suggests they are right to be cautious and that the national figures have a wide margin of error as a result.

The Child Abuse Prevention and Treatment Act (CAPTA) as amended by the Comprehensive Addiction and Recovery Act (CARA) in 2016,  requires that all infants “affected by a substance abuse or withdrawal symptoms resulting from prenatal drug exposure, or a Fetal Alcohol Spectrum Disorder” receive a “plan of safe care…addressing the health and substance use disorder treatment needs of the infant and affected family or caregiver.” Thirteen responding states reported that 64% of infants with prenatal substance exposure had a plan of safe care. A separate CAPTA provision requires states to report how many infants had a “referral to appropriate services,” and fourteen states reported that only 42.6% of infants had such a referral. The difference between these two percentages is due to California, which provided data on referrals and not plans of safe care. Only 12.7% of California’s substance-exposed infants had referrals to appropriate services. Since the California’s population is larger, and the percentage receiving referrals was low, the overall percentage was reduced significantly by adding California but the two percentages were the same in the other responding states.

Plans of safe care and referrals are voluntary and do not mean much unless they are followed by the families, providers, and agencies. It would be better to know how many of these infants received foster care and other services after an investigation or family assessment. That would probably require opening a services case for all these families. Congress should consider requiring this, as it would be the only way to follow up on what services these families actually receive.

The fact that almost one in 100 children is found to be a victim of child maltreatment should be of concern to all child advocates, especially because it is likely that many other victims were never reported or found to be victimized. It is hard to interpret comparative data between states, populations, and years because of the difficulty in disentangling the amount of actual maltreatment given the variety of  policies and practices in how it is defined and reported. Analysis of the report suggests changes in CAPTA that would make it more useful. For example, Congress should to set uniform standards for reporting child maltreatment fatalities by passing the CAPTA reauthorization bill in 2020. And the new version of CAPTA should be further strengthened to replace the plans of state care with a more substantial response to infant substance exposure.


  1. Pennsylvania’s victimization rate was actually the lowest at 1.8% but this low rate reflects the state’s unusual child protective services structure. Allegations that do not concern abuse or specific very serious types of neglect are labeled as General Protective Services and not counted as referrals or reports for federal reporting. 
  2. Puerto Rico had a 43% decline in children found to be maltreatment victims between 2014 and 2018. The territory’s commentary explains that its child population was already decreasing due to emigration even before Hurricane Maria struck in October 2017 and then further declined due to emigration. 
  3. Vermont’s extremely high abuse rate rate may be due to the fact that about 40% of its cases are assigned to the alternative response track, which does not result in a disposition, and another sizeable group are assigned to a pathway outside CPS, called family assessment. The cases assigned to these alternative tracks are expected to be less serious and more likely to involve neglect rather than abuse. A similar phenomenon likely occurs in Pennsylvania where most neglect allegation are assigned to General Protective Services and not reported to the federal government. 
  4. Individual children were counted more than once if they were involved in more than one CPS case. 
  5. Many of these children were probably siblings of children who were found to be victims of maltreatment. 

Illinois’ Intact Family Services: What happens when family preservation trumps child safety?

ChapinHallIllinois’ child welfare services to families that are allowed to keep their children have major systemic flaws that put children at risk. Most importantly, there is extreme reluctance to remove children from their homes and place them in foster care. Those are the findings of a review from Chapin Hall at the University of Chicago that was commissioned by the Governor in the wake of several deaths of children whose families were being supervised by the state.

This report follows an earlier one, discussed in a  previous post,  by the Inspector General (OIG) for the Illinois Department of Children and Family Services (DCFS) stating that child safety and well-being are no longer priorities for the agency.  One problem area identified in that report was Intact Family Services, which are the services provided to families in order to prevent further abuse or neglect without removing the child. OIG’s 2018 annual report included an eight-year retrospective on the deaths of children in Intact Family Services cases, which concluded that in many of these cases the children remained in danger during the life of the case due to violence in their homes, when DCFS should have either removed the children or at least sought court involvement to enforce participation in services,

Increasingly, child welfare systems around the country have been relying on services to intact families (often called in-home or intact family services) in order to avoid placing children into foster care. In 2017, according to federal data, only 15% of children who received services after an investigation or assessment were placed in foster care; the other 85% were provided with services in their homes. These services may become even more predominant with implementation of the Family First Prevention Services Act, which allows federal Title IV-E funds to reimburse jurisdictions for the cost of such services.

It is important for child welfare agencies to be able to work with families that remain intact. This allows the agency to monitor the children’s safety and avoid the trauma of placement in foster care while working to ameliorate the conditions that might lead to a foster care placement. But agencies must be cognizant that not every family can be helped this way, keep a close watch what is going on in the home, and be ready to remove children when necessary to ensure their safety. The deaths of children who have received Intact Family Services in Illinois have raised questions about whether the agency is accomplishing these tasks.

In Illinois, Intact Family Services (referred to below as “Intact”)  are provided mostly by private agencies under contract with DCFS. The Chapin Hall  report found systemic issues that create barriers to effectively serving intact families.

Avoiding foster care placement: Perhaps the most important issue observed by the researchers was the high priority that Illinois places on avoiding placement of children in foster care. As a result of many years of such efforts, Illinois now has the lowest rate of child removal in the country. Intact staff expressed the belief that “recommendations to remove children based on case complexity, severity, or chronicity will not be heard by the Division of Child Protection (DCP) or the Court.” As a result, Intact supervisors are reluctant to reject referrals of families even when they believe a family cannot be served safely in the home.  They are also reluctant to elevate cases for supervisory review when they have not been able to engage a high risk family.

Supervisory Misalignment: In the past, negotiations between DCP and Intact over the appropriateness of a referral occurred on a supervisor-to-supervisor level, allowing Intact to push back against unsuitable referrals. An administrative realignment that placed investigators and Intact under different administrations eliminated this ability of Intact to contest inappropriate referrals. According to the researchers, this resulted in the opening of Intact cases for families with “extensive histories of physical abuse” that Intact staff believed they could not serve effectively.

High Risk Case Closures:  Intact service agencies are expected to work with a family for six months and then close the case with no further involvement by DCFS. The researchers learned that there was no clear pathway for intact staff to express concerns when they been unable to engage a family. As a result, some providers told the researcher that they may simply close the case when a family will not engage.

Staffing Issues: Caseload, capacity and turnover.  The researchers found that DCP investigators are overwhelmed with their high caseloads and are desperate to make referrals to Intact to get families off their caseload as soon as possible. The prescribed caseload limit of 15 cases per worker is very hard to manage, and some workers carry even more cases. Moreover, DCP workers tend to stop managing safety plans and assessments as soon as a referral is made to Intact, which leaves children in limbo until services begin. For their part, Intact workers’ caseloads are often over the prescribed limits and are not adjusted for travel time or case complexity. Moreover, the difficulty of their clientele makes the current caseload of 10:1 difficult to manage. High turnover among Intact workers, investigators and other staff can also contribute to the information gaps and knowledge deficits mentioned below.

Role Confusion: DCP workers and Intact workers seem to have different views of the role of the DCP worker, according to the researchers. DCP workers view their role as making and justifying the decisions about whether to substantiate the referral and remove the child. However, the Intact Family Services policy calls upon them to engage the family and transmit all necessary information to the Intact staff. Cultural differences between the two sets of workers compound the problems.

Information Gaps: Because of the role ambiguity mentioned above, investigators often fail to pass on crucial information to Intact workers. Yet, these workers often cannot access investigators notes or key features of the case history. Moreover Chapin Hall’s reviews of the two recent deaths of toddlers in intact cases found that much of the family’s history was inaccessible because cases were expunged or purged. DCFS expunges most unsubstantiated reports and shreds investigators files and appears to be more aggressive about such expungements than most other states, according to a previous DCFS Director, George Sheldon.

Service Gaps: The researchers also mentioned gaps in service availability, especially long waiting lists for substance abuse prevention, which make it very difficult to engage families as well as providers.

The authors made a number of recommendations for addressing these problems they identified.  These include:

  • Work with courts and State’s attorneys to refine the criteria for child removal in complex and chronic family cases;
  • Develop and refine protocol for closing Intact cases;
  • Direct attention to cases at greatest risk for severe harm; revisit the use of predictive models which should be transparent, based on broad input and be supported by ethical safeguards’
  • Clarify goals and expectations across staff roles;
  • Utilize evidence-based approaches to preventive case work;
  • Improve the quality of supervision;
  • Adjust the preventive services offered through Intact to meet the needs of the population;
  • Restructure Intact Services to address the supervisory mismatch with DCP; and
  • Redesign the assessment and intake process to reduce redundant information, improve accuracy or assessments to support decision-making and improve communication across child serving systems.

We would have liked to see a recommendation to modify Illinois’ policy of expunging and purging all unsubstantiated investigations. At a hearing in May, 2017, the DCFS Director, George Sheldon, expressed his support for allowing DCFS to keep records of all investigations, even if they are unsubstantiated. Research suggests that it is very difficult to make accurate decisions about whether maltreatment has occurred; moreover, unsubstantiated reports are as good as substantiated ones in predicting future maltreatment. Examples of children killed after families have had multiple unsubstantiated reports have been observed all over the country.

This report should be a must-read for all child welfare agencies.  Children in many states have died of abuse or neglect after intact cases have been opened for their families. (Think about Zymere Perkins in New York or Anthony Avalos and Gabriel Fernandez in Los Angeles.) Many of the issues identified by the Chapin-Hall report may have contributed to these deaths as well, particularly the extreme avoidance of child removals that has condemned so many innocent children to death ever since the widespread push to reduce the foster care rolls, supported by a coalition of wealthy and powerful foundations and advocacy groups.

 

Inspector General: Child safety and well-being no longer priorities for Illinois Department of Child and Family Services

SemajCrosby
Semaj Crosby: wtvr.com

DCFS has lost focus on ensuring the safety and well-being of children as a priority. This is evidenced by several recent cases and the clear lack of attention to assuring children and families receive adequate, thorough, and timely responses and needed services. Investigators, caseworkers and supervisors are unmanaged, and unsupported. Children are dying, children are being left lingering in care, children are being left in in psychiatric hospitals beyond medical necessity causing them to lose hope. This is not just unacceptable it is HARMFUL

That startling statement was made by the Acting Inspector General (IG) for Illinois Department of Children and Families to News Channel 20 about its most recent annual report. During FY 2018, the Office of Inspector General (OIG) reviewed 97 deaths and one serious injury of children whose families were involved in the child welfare system within the preceding 12 months. Of the 98 families involved, at least 52 were the subject of of a completed child abuse or neglect investigation during the previous 12 months; fully 37 of these investigations failed to find any abuse or neglect and were closed without any action to protect the child. Twelve of the 98 families were the subject of an open investigation when the child died, eight were involved in an open family service case, and three had had a family case closed within a year of the death. (See the full count of deaths by case status at the bottom of this article.)

Not all of the deaths or serious injuries can be attributed to DCFS failure to protect a child. Twenty-seven deaths were ruled natural; most of the children involved had serious medical issues. Some of the deaths (including most the 16 youths in foster care)1 were sadly due to violence, car accidents, drug abuse by older youths and other circumstances not under the Department’s control. Heartbreakingly, two older teens in foster care died of abuse that was inflicted on them as infants and left them medically compromised.

However, many of the case reviews suggest DCFS missed danger signs and opportunities to save vulnerable children. Thirteen children were killed by a parent, step parent, parent’s paramour, another relative or unknown perpetrator within a year of an open investigation or service case.  These children were beaten, starved, stabbed, and shot to death. The cause of 23 deaths of children in families that recently interacted with DCFS is still undetermined; many are currently being investigated. Most of these children were infants; many of the deaths appeared to be linked to unsafe sleep practices and at least four raised concerns of abuse. The deaths of 24 children with an open or recently open case were classified as accidental. Fourteen of these deaths were attributed to asphyxia, suffocation, or sleep related causes; there were also two accidental drownings, an accidental hanging, and an accidental shooting of a three-year-old by an 11-year-old, as described below.

 The OIG completed “full investigations” of four cases  that have drawn extensive media attention:

  • Seventeen-month-old Semaj Crosby was found dead under a couch in her home 30 hours after being reported missing. There was both an open in-home case and a pending child protection investigation of the family at the time Semaj was reported missing. The family had been the subject of 11 investigations during the two years before her death. The mother received SSI for cognitive delays but was never assessed to determine her ability to keep her children safe. Semaj’s seven-year-old brother was psychiatrically hospitalized three times for threatening to kill himself during the time the family’s case was open. A family service caseworker visited the home the day before the toddler was reported missing, and a child protection investigator had been to the house the day the report was made. No immediate safety concerns were reported by this investigator, even though the health department deemed the apartment uninhabitable after the body was found. Criminal and child neglect investigations are pending.
  • Four-year-old Manual Aguilar was killed, apparently  starved to death, and his body was burned post-mortem. Four years before his death, Manual and his three siblings were removed  from their mother’s custody after she left the three older children in a car overnight at temperatures hovering around freezing, while Manual was left in a stranger’s care. The children were returned home a year before Manual’s death despite the mother’s failure to progress in therapy and an unfounded investigation stemming from bruises to one child that his older siblings reported were inflicted by the mother during an overnight visit. Five months before Manual’s death, the two older siblings texted to their former foster parent that their mother was beating them, but the investigation was unfounded when they recanted. The mother has been charged with murder.
  • A daycare center reported that a two-and-a-half-year-old appeared to have cigarette burns on both hands. The reporter also said the child’s face had been swollen on two prior occasions, and an unknown male accompanying the mother was seen to hit the child across the face a week before. The investigator closed the case without investigating adequately either the child’s burns or the family’s allegation that they occurred at the daycare. Two days following the investigation’s closure, the child experienced cardiac arrest and died four days later. The autopsy concluded that the manner of death was undetermined and suspicious, but a child protection investigation did not find evidence to find anyone responsible for the death.
  • An eleven-year-old girl accidentally shot her three-year-old brother in the head while playing at home. This child survived and and this appears to be the only non-fatal case reviewed. The parents had left four of their children, of which the eleven-year-old was the oldest, at home alone.  The father had eight drug convictions and had been arrested multiple times for physically assaulting the mother. The investigation of the shooting was the eleventh investigation of this family since 2008. One investigation had occurred when the father barricaded himself in the home with the mother, who was eight months pregnant, and the screaming and crying children. The children’s eight-year-old sibling was in residential care in the custody of DCFS at the time of the shooting and the agency was required to monitor the at-home siblings as well. Nevertheless no visits by case managers to the home were documented in the 45 months before the shooting with one exception. A case manager attempted to visit the home 21 days before the shooting but was not allowed in. . 

The acting Inspector General told a reporter that understaffing may have contributed to the state’s inability to prevent child deaths. Following the death of Semaj Crosby, the OIG investigated a media report that child protection workers in the local office were offered incentives for early case closure. The IG found that while Semaj’s family was involved with DCFS, the entire region was understaffed (at times as low as 66% of staff needed), resulting in excessive caseloads for investigators. In December 2016, the field office administrator offered a $100 gift card to the investigator who could close the most cases in January. The IG found similar incentive programs for early case closure around the state.

The OIG also found that “a large contributing factor to the caseload problem was that the previous director had several management initiatives that seemed to take priority” over any attempt to redistribute caseloads. One of these initiatives, Rapid Safety Feedback, received some media attention last year. DCFS awarded a multimillion-dollar contract to two out-of-state firms using a “propriety algorithm to identify cases most likely to result in death or serious injury.” There were concerns that this contract was one of several no-bid contracts given to a circle of former associates of the previous director, as described by the Chicago Tribune. The contract was terminated after 25 to 50 percent of cases were flagged as having a a greater than 90% probability of death or serious injury in the next two years, alarming and overwhelming social workers. At the same time, the algorithm failed to predict the death of Semaj Crosby and other children who were killed while under supervision by DCFS. 

The OIG report identified two areas of “chronic misfeasance,” or conduct that is lawful but inappropriate or incorrect. One of these areas is “intact family services,” which is DCFS-speak for the services provided to families to prevent further abuse or neglect without removing the child. OIG’s 2018 annual report included an eight-year retrospective on the deaths of children in intact family services cases. The OIG concluded that in many of these cases the children remained in danger during the life of the case due to violence in their homes, when DCFS should have either removed the children or at least sought court involvement to enforce participation in services.

A second area of “chronic misfeasance” identified in the 2019 report which has also drawn media coverage is the practice of leaving foster children in psychiatric hospitals “beyond medical necessity,” or after they are stable enough to be cared for outside that setting because there is no appropriate placement. OIG reported that the number of such episodes increased from 273 in FY 2017 to 329 in 2018. “The availability of community-based services and resources for youth with significant mental and behavioral needs continues to be at crisis levels.”

The OIG’s overall conclusion–that child safety and well-being are no longer priorities for DCFS–is sobering. But even more alarming is the fact that this description could be applied to many or even most other states.  Although we don’t have numbers for most states, every year brings stories from around the country of children killed after long histories of contact with child welfare authorities. Twenty-seven percent of the fatality cases analyzed by the Administration on Children and Families for its Child Maltreatment report had at least one Child Protective Services contact within the past three years.  State child welfare agencies tend to hide behind strict privacy protections in order to avoid releasing information on child protection failures, even though the case information could be released without including the names of the families involved. As a member of the District of Columbia’s Child Fatality Review Commission, I hear at almost every monthly meeting about one or more children who died after the family was called to the attention of CPS multiple times. And yet, I am not allowed to share any information about these cases with anyone, including legislators.

At least in Illinois, thanks to the DCFS Inspector General, the public and its elected representatives are given the opportunity to learn about failures to protect children while in the custody of their parents as well as those the custody of DCFS. This information helps make the case for change. The OIG report was the subject of a hearing in Springfield. The Governor has already requested an increase of more than $70 million for 126 new staff and technology upgrades.

Unfortunately, most states do not have an independent agency like the Illinois OIG to look out for children who are served by the agency both at home and in care. In a report issued on April 4, 2018, the National Council of State Legislators found that only 11 states have “an independent and autonomous agencies with oversight specific to child welfare,” although they seem to have missed Illinois. All states need such an autonomous agency. Somebody needs to reveal the truth about how we fail our most vulnerable children–and what it would take to do better.

Number of Child Deaths by Case Status from OIG Report

Case Status*                                                    Number of deaths or serious injuries

Pending Investigation at time of child’s death………………………………………………………12

Unfounded Investigation** within a year of child’s death……………………………………37

“Indicated” Investigation*** within a year of child’s death…………………………………..15

Youth in care………………………………………………………………………………………………………………16

Open Placement/Split custody****……………………………………………………………………………..3

Open Intact Case*****………………………………………………………………………………………………….8

Closed Intact Case within a year of child’s death……………………………………………………….3

Child of Youth in Care……………………………………………………………………………………………………1

Child Welfare Services Referral (no allegation of abuse or neglect)………………………….2

Preventive services to assist family but not as result of indicated investigation………1

Total……………………………………………………………………………………………………………………………….98

*When more than one reason existed for the OIG investigation, the death was categorized based on “primary reason.”

**An investigation in which the agency was unable to verify that abuse or neglect occurred. 

***An investigation in which abuse or neglect by the parent was found to have occurred.

****Child was in home with siblings in foster care

****A case in which the family was receiving services while the child remained in the home. 


  1. Of the 16 children who died while in foster care, a 14-year-old and an 18-year-old died of gunshots by unrelated perpetrators, two died as a consequence of abuse by their parents in infancy, three were infants in care of relatives and cause of death was undetermined for two and suffocation for one, two died of methadone or opioid intoxication, one 18-year-old died in a car accident and five died of natural causes.