Tag: plans of safe care

A Fatal Collision: The Opioid Epidemic and the Dismantling of Child Protection Services in Washington State

by Marie Cohen

“B.B.” was born in 2022 and died of fentanyl poisoning in March 2023. During the ten years before B.B.’s death, DCYF had received 30 reports on B.B.’s family (many before B.B. was born) for issues including use of heroin, marijuana and alcohol in the home; lack of supervision of the children; domestic violence; an unsafe caregiver living with the family; an unsafe and unclean living environment unsecured guns in the home “out-of-control” behaviors by B.B.’s older siblings at school, with the mother described as “out-of-it” and unresponsive to school concerns; concerns about the children’s hygiene; and the mother driving under the influence of marijuana. An in-home services case that had been open since January 2023 was closed days before B.B.’s death. 

On August 24, 2024, the Washington Department of Children, Youth and Families (DCYF) proudly announced in a press statement that it had reduced the number of children in out-of-home care by nearly half since 2018. Specifically, the number of children in foster care had fallen from 9,171 in 2018 to 4,971 as of August 14, 2024. “Outcomes like this demonstrate our agency’s commitment to keeping families together and children and youth safe,” DCYF Secretary Ross Hunter said. “Although the number of reports we are receiving remain [sic] consistent, we are seeing fewer children and youth in out-of-home care as families are being referred to support services rather than having children removed from their homes. Indeed, “safely reduce the number of children and youth in out of home care by half” (without a baseline date from which this can be measured) is one of DCYF’s six strategic priorities. But treating the decline in foster care (the direct result of government actions) as a desirable outcome in itself can contribute to a disregard of actual child welfare outcomes like safety and permanency.

How did DCYF reduce foster care by nearly 50 percent?

How did DCYF manage to slash its foster care rolls so radically in such a short time? Without providing specifics, the press release cites DCYF’s implementation of the Family First Prevention Services Act (FFPSA) and its emphasis on “supporting and collaborating with families by providing access to services and programs.” A DCYF spokesperson told the Seattle Times that the department was using services to avoid removing children or to reunite families sooner, citing efforts to connect parents to substance use or mental health treatment programs, bring a social worker into the home to “problem solve,” or “offer practical items, like diapers, car seats and beds.”

Apparently not satisfied with the changes implemented by DCYF, the Washington legislature in 2021 passed the Keeping Families Together Act (KFTA, also known as HB 1227), which took effect on July 1, 2023. Among other provisions, KFTA increased the standard for the court to order removal of a child from the home, which previously required the agency to demonstrate that “reasonable grounds that the child’s “health safety or welfare will be seriously endangered if not taken into custody and that at least one of the grounds set forth demonstrates a risk of imminent harm to the child.” As amended by KFTA, the law now requires the agency to demonstrate “that removal is necessary to prevent imminent physical harm to the child due to child abuse or neglect.” The petition for removal is required to contain “a clear and specific statement as to the harm that will occur if the child remains in the care of the parent, guardian or custodian, and the facts that support the conclusion.” Moreover, the court must consider whether participation by the parents or guardians in “any prevention services” would eliminate the need for removal. If so, they must ask the parent whether they are willing to participate in such services and shall place the child with the parent if the parent agrees.

On a page dedicated to KFTA implementation, DCYF explains that it has implemented the law by adopting new policies and procedures to determine whether to remove a child and by training and supporting staff to implement the new procedures and determine whether there is an imminent risk of serious harm to the child. DCYF reports that internal reviews show that staff are “taking additional steps to prevent removal of a child and to support a safety plan for the family.” 

Shortly before KFTA took effect, DCYF, along with the Department of Health, the Health Care Authority, and the Washington State Hospital Association issued new guidelines to birthing hospitals and mandatory reporters. These guidelines stated that infants born substance exposed, but for whom there are no other safety concerns, can receive “voluntary wrap-around services from a community organization” without being reported to CPS. These voluntary services are being provided through federally-mandated “Plans of Safe Care (POSC).” Healthcare providers identifying a substance-exposed infant are instructed to access an online portal where they are directed  to call DCYF if safety concerns are identified and to complete a POSC referral if not.

DCYF has been issuing quarterly data updates to assess the impacts of the KFTA. According to the most recent (October 2024) update, the law is having the intended impact of further reducing removals to foster care. DCYF reports a 16 percent decrease in the number of children removed in the July through September quarter of 2024 compared to the same quarter of 2022, before passage of KFTA. However, comparing foster entries for all ages in July through September 2024 to those in the same quarter of the previous year, the data indicate that foster care entries actually increased! Will this be the beginning of the end of the foster care reductions? That remains to be seen.

A longer-term view raises questions about the difference KFTA made, compared to the previous and ongoing efforts by DCYF to reduce foster care placements.  Entries into foster care in Washington have decreased annually from 2017 to 2024, as shown in the chart below. The rate of decrease remained about the same between 2019 and 2024, while KFTA was not implemented until July 2023. Perhaps more children would have entered care if not for KFTA, but there is no way to assess the impact of KFTA as compared with DCYF’s ongoing effort to reduce removals. 

Source: DCYF, Child Welfare Agency Performance Dashboard, Children Entering Care in SFY, https://dcyf.wa.gov/practice/oiaa/agency-performance/reduce-out-of-home-care/cw-dashboard

The reduction in foster care placements was supposed to be accompanied (and made possible) by an increase in in-home services (which DCYF calls Family Voluntary Services or FVS), and DCYF reports that the number of cases receiving FVS increased by nine percent from 1,809 in SFY2023 to 1,994 in SFY2024. This increase in FVS cases cannot be compared to the 17-percent decrease in children placed in foster care over the same period, as the unit of analysis is different (families rather than children). But the key question is the nature and intensity of these services and whether they really kept the children safe. 

The cost of foster care reductions

The purpose of foster care is to keep children safe when they cannot be protected at home. So the essential question is whether the reduction in foster care placements has occurred without any cost to children. Trends in child fatalities and “near fatalities”1 due to child abuse or neglect can provide a clue. These deaths and serious injuries are the tip of the iceberg of abuse and neglect. For each child who dies or is seriously injured, there are many more that are living in fear, pain, or hunger, and incurring lifelong cognitive, emotional, and physical damage. There are troubling signs of an increase in child fatalities and near fatalities over the past several years. In its most recent quarterly update, DCYF reports on the number of “critical events” or child fatalities and near fatalities that met its criteria for receiving an “executive review.” These include the deaths of any minor that had been in DCYF custody or received services within a year of the death that were suspected to be caused by child abuse or neglect.2 They also include near fatality cases in which the child has been in the care of or received services from DCYF within three months preceding the near fatality or was the subject of an investigation for possible abuse or neglect. DCYF reports that the number critical events it reviewed increased from 23 in 2019 to 51 in 2023 and projects that it will increase to 61 in 2024.3

Source: DCYF, Keeping Families Together Act Quarterly Date Update, October 2024, https://dcyf.wa.gov/sites/default/files/pdf/DataUpdate_HB1227_October2024.pdf


The increase in critical events reflects, in part, the growing opioid crisis in Washington, as well as decisions Washington has made regarding how it intervenes to protect children.  Opioid related emergencies have “dramatically increased for the entire population (adults and children) in Washington,” and children have not been immune. Fentanyl is particularly dangerous to young children because it takes only a tiny amount to kill a baby or toddler, who can mistake the pills for candy or put straws or foil meant for smoking the drug in their mouths. The number of fatalities and near fatalities reviewed by DCYF that involved fentanyl climbed from four in 2019 to a projected 35 in 2024. Since 2018, Washington’s Office of the Family and Children’s Ombuds (has observed an annual increase in child fatalities and near fatalities involving accidental ingestions and overdoses. Fifty-seven (or 85 percent) of the 67 incidents examined in 2023 involved fentanyl. Over half of these incidents involved children under three years old and a shocking 14 out of the 85 infants were 12 months old or less.  As Dee Wilson and Toni Sebastian point out, the limited mobility and motor skills of infants suggests that some of these infants may have been given a small amount of fentanyl as a means of sedation.

The Washington Legislature was concerned enough about the possibility that KFTA is contributing to an increase in child fatalities and near fatalities in the context of the fentanyl epidemic that it passed a new law (SB 6109) in 2024. The law provides that a court must give “great weight” to the “lethality of high-potency synthetic opioids.….in determining whether removal is necessary to prevent imminent physical harm to the child due to child abuse or neglect.” However, it appears that there is confusion about exactly what that means.

Has DCYF given up on protecting children?

“We know that supporting and collaborating with families by providing access to services and programs increases their number of protective factors, leading to better outcomes,” said DCYF Assistant Secretary Natalie Green. “Giving families the tools they need to thrive and safely parent means more children and youth remain safely at home.”

DCYF, Washington Reduces the Number of Children in Out-Of-Home Care by Nearly Half, August 14, 2024.

But the work of DCYF’s own analysts, in their quarterly KFTA updates, raises doubts about whether DCYF is adequately performing its child protection function. These updates  acknowledge that the agency is not removing as many children with a high risk of future encounters with child welfare (in other words, those who have a high risk of being harmed). And they also report that the department has seen “an increasing percentage of moderately high to high risk cases being re-referred to CPS within 90 days of the risk assessment. DCYF also reports that the overlap between KFTA and Plan of Safe Care (POSC)  is resulting in fewer screened-in intakes involving substance-exposed newborns because these infants are now being referred to voluntary services under POSC.

There has been a chorus of voices alleging that DCYF is abdicating its child protection responsibilities. One foster parent told the Seattle Times that “she and other foster parents are finding children who now come into their care are in worse shape than they used to be, with more serious mental health conditions or greater exposure to lethal drugs like fentanyl.” She contends they’ve been left too long in unsafe conditions because of the heightened legal standard for removal. In The Erosion of Child Protection in Washington State, Toni Sebastian and Dee Wilson have cited the weakness of the management of Family Voluntary Services, which is often employed as an alternative to foster care. 

A survey of executive reviews of 2023 and 2024 child maltreatment child fatalities with DCYF involvement within a year provided examples of problems with screening, investigations, and case management, including the following:

  • Hotline issues. Reviews documented multiple intakes screened out on the same family even when the family had been the subject of multiple calls. The reviews also suggest that too many cases may be assigned to the Family Assessment Response (FAR) pathway, an alternative to a traditional investigation designed for lower-risk cases. In FAR cases, a social worker assesses the family and refers it to voluntary services. There is no finding about whether maltreatment has occurred and no child removal unless the case is transferred to the investigative track.
  • Premature closure of FAR cases. Reviewers noted instances in which FAR cases were closed after parents failed to cooperate, without caseworkers considering a transfer to the investigative track or before determining that the parent had followed through with services.
  • Assessment failures: Reviewers noted multiple failures to adequately assess parents for domestic violence, mental health, and substance abuse; failures to contact collaterals (relatives and friends) and instead relying on parental self-reports; lack of recognition of chronic maltreatment; ignoring evidence of past problems if not included in the current allegation; and failing to anticipate future behavior based on historical patterns.4
  • Inadequate understanding of substance abuse: Reviewers noted the failure to conduct a full assessment of substance abuse including history, behavioral observations, and collateral contacts; disregarding the unique danger to children posed by fentanyl; downplaying the significance of marijuana use, particularly as an indicator of relapse from harder drugs; and disregarding alcohol abuse because it is legal.
  • Failure to obtain information from treatment and service providers. The failure to communicate with service providers about clients’ participation in services like drug treatment and relying on clients’ self-reports was noted by more than one review team. Sometimes the providers refused to cooperate.  Staff told the team reviewing one case about a substance abuse treatment provider that routinely refuses to cooperate, even when parents sign release forms, and routinely tells clients not to cooperate with DCYF.
  • Lack of subject matter expertise. Reviewers pointed to the lack of deep knowledge about domestic violence, substance use disorder, and mental health among staff doing investigations, assessments, and case management and the need to provide access to subject matter experts when needed.
  • Failure to remove a child despite safety threats. The team reviewing the case of a four-year-old who died after ingesting fentanyl reported that there were at least two different times where an active safety threat was present that would have justified filing a petition in court to place the child in foster care. However, the staff believed, based on past experience, that the court would have denied the petition and therefore did not file. 
  • Delayed Reunifications: “P.L,.” a toddler allegedly beaten to death by his mother, was in foster care for over three years but his mother’s rights were never terminated. He was on a trial return to his mother for just over five months when he was found dead with bruises and burns all over his body. 

Staff shortages and high turnover were mentioned as contributing to the observed deficiencies in case practice in almost every fatality review. In B.B.’s case, the reviewers noted that the office had been functioning with a 50 percent vacancy rate for the last several years, stating that such a vacancy rate leads to high turnover, high caseloads, caseworkers with little experience, and supervisors forced to carry cases rather than support their caseworkers. Even caseloads that comply with state standards may be too high. The standard of 20 families per caseworker in FVS was noted to be unmanageable by one review panel, which noted that FVS cases are often discussed as high risk cases and require multiple contacts per month with family members, services providers, and safety plan participants. As Dee Wilson and Toni Sebastian put it,  “[b]etting young endangered children’s lives on in-home safety plans developed and implemented by inexperienced and overwhelmed caseworkers is reckless, ill-advised public policy.”

Conclusions and Recommendations

Treating the decline in foster care as a desirable outcome in itself, as Washington and other states have done, is both disingenuous and dangerous. Any government can slash the foster care rolls reducing or ending child removals, as many “child welfare abolitionists” recommend. The central purpose of child welfare services, including foster care, is to protect children from child abuse and neglect. A reduction in foster care placements that results in the failure to protect children is no kind of success. 

DCYF told King5 that “the increase in child fatalities and near fatalities in Washington is not being driven by the change in removal standards under House Bill 1227 or the reduction in the number of children in foster care. It is being driven by the increased availability of a highly addictive and hazardous drug and a lack of substance use disorder treatment in our communities.” But whether the agency’s policy or the drug epidemic is more at fault is not the right question. It is DCYF’s job to protect children given the circumstances that exist, including the drug epidemic and the lack of sufficient treatment, keeping in mind that treatment often does not work the first, second, third or subsequent times. 

What can be done? DCYF needs to address the workforce crisis, which will probably require increasing pay and improving working conditions, or even possibly relaxing requirements for employment as a caseworker in investigations, assessment, and FVS. DCYF should consider policy and practice changes such as reducing the FVS caseload cap from 20 cases per worker; Instituting a chronic neglect unit, with expert caseworkers and even lower caseloads, for chronic cases; finding a way to limit the use of FAR to cases that are truly low-risk; and promoting the use of dependency petitions for court supervision when children remain in the home, as suggested by two fatality review committees.5 DCYF should request and the legislature should fund a variety of ancillary services for families, starting with therapeutic childcare for all preschool aged children with FVS cases as well as those who have been reunited with their parents. Such childcare would give parents a break and parenting support, keep children safe for a large part of the day, and ensure another set of eyes on the child, among other benefits. Also needed are more residential drug treatment centers where parents can live with their children. 

Finally, more transparency is needed so that legislators, advocates and the public have access to the findings of DCYF’s executive review teams.  Washington deserves credit for sharing its executive child fatality reviews. But there is no reason that the DCYF should not share its near-fatality reviews as well. We know something about how DCYF failed B.B. and the other children who died. But the public needs access to the reviews of those children who narrowly escaped death as well as those who did not. It is only through such transparency that the public can see the actual impact of all the self-congratulatory proclamations about “safely reducing the number of children in out-of-home care.”

Notes

  1. A “near fatality” is defined by state law as “an act that, as certified by a physician, places the child in serious or critical condition.”
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  2. DCYF relies on the Office of the Family and Children’s Ombuds (OFCO) to determine whether the fatality appears to have been caused by abuse or neglect, therefore requiring DCYF to conduct a review.
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  3. Data collected by OFCO are more confusing. OFCO reviews all fatalities and near fatalities in which the child’s family was involved in Washington’s child welfare system within 12 months of the fatality. There number of near-fatalities reviewed by OCFO increased annually from 21 in 2018 to 70 in 2023, according to its most recent annual report on Child Fatalities and Near Fatalities in Washington State. But fatalities reviewed by OFCO did not show the same pattern. They reached a peak of 87 in 2018 and fell sharply in 2019, then rose yearly until they reached 85 in 2022 and then dropped to 79 in 2023. Nevertheless, adding fatalities and near fatalities together shows an alarming increase in critical incidents from 108 in 2018 to 149 in 2023.
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  4. For example, in the case of “R.W.,” a child who died at age four after ingesting fentanyl, an investigation was closed because the children were staying with relatives, despite the mother’s history of repeatedly removing the children from relatives with whom she had left them. A month later the child was found dead at a motel in the custody of the parents. 
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  5. See https://dcyf.wa.gov/sites/default/files/pdf/reports/mk-cfr-final-redacted.pdf and https://dcyf.wa.gov/sites/default/files/pdf/reports/ecfr-os-24.pdf ↩︎

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. ↩