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Prevention and the Child Protection System
Jane Waldfogel
Summary
The nation’s child protection system (CPS) has historically focused on preventing maltreatment
in high-risk families, whose children have already been maltreated. But, as Jane Waldfogel
explains, it has also begun developing prevention procedures for children at lower risk—those
who are referred to CPS but whose cases do not meet the criteria for ongoing services.
Preventive services delivered by CPS to high-risk families, says Waldfogel, typically include
case management and supervision. The families may also receive one or more other preventive
services, including individual and family counseling, respite care, parenting education, hous-
ing assistance, substance abuse treatment, child care, and home visits. Researchers generally
find little evidence, however, that these services reduce the risk of subsequent maltreatment,
although there is some promising evidence on the role of child care. Many families receive few
services beyond periodic visits by usually overburdened caseworkers, and the services they do
receive are often poor in quality.
Preventive services for lower-risk families often focus on increasing parents’ understanding
of the developmental stages of childhood and on improving their child-rearing competencies.
The evidence base on the effectiveness of these services remains thin. Most research focuses
on home-visiting and parent education programs. Studies of home visiting have provided some
promising evidence. Little is as yet known about the effects of parent education.
Waldfogel concludes that researchers have much more to learn about what services CPS agen-
cies should expand to do a better job of preventing maltreatment. Some families, especially
those with mental health, substance abuse, and domestic violence problems, are at especially
high risk, which suggests that more effective treatment services for such parents could help.
Very young children, too, are at high risk, suggesting a potentially important role for child
care—one area where the evidence base is reasonably strong in pointing to a potential preven-
tive role. Although preventive services for the lower-risk cases not open for services with CPS
are much more widespread today than in the past, analysts must explore what CPS agencies can
do in this area too to ensure that they are delivering effective services.
www.futureofchildren.org
Jane Waldfogel is a professor of social work and public affairs at the Columbia University School of Social Work.
VOL. 19 / NO. 2 / FALL 2009 195
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Jane Waldfogel
very state in the United States to be screened in, substantiated, or kept open
has a public child protection for ongoing protective services with CPS but
system (commonly known whose children nevertheless are at risk of
by the acronym CPS) that becoming victims of abuse or neglect. Such
E
receives and responds to services may be delivered by the CPS agency
reports of child abuse and neglect. Funding (with the case kept open on a voluntary or
for CPS agencies comes from federal, state, preventive basis) but are more commonly
and sometimes county or local sources. delivered by community-based agencies.
Although these state systems vary consider- Indeed, since the reauthorization of the
ably, they do share some common elements. federal Child Abuse Prevention and
In particular, all CPS agencies have staff and Treatment Act (CAPTA) in 2003, CPS
procedures in place to respond to reports of agencies have been required to develop
suspected child abuse and neglect, with some procedures to refer children in lower-risk
agencies also accepting other types of refer- families to community-based agencies or
rals or applications for services. Although voluntary preventive services.
CPS agencies work in partnership with other
state agencies as well as community-based In this article I examine the effectiveness of
agencies, some core functions—in particular, both types of prevention efforts. For those
receiving and responding to reports of abuse focusing on families whose cases are opened
or neglect—are carried out mainly by CPS for ongoing services with CPS, I describe the
agency staff, while other functions—such as services provided, explore their effectiveness
services for families or foster or group care— in preventing repeat maltreatment, and ask
may be contracted out or purchased from whether other approaches might do a better
other agencies. job. For efforts focused on lower-risk families
whose cases are not opened or kept open
Historically, the child protection system for services by CPS, I consider what types
has focused most of its limited resources of services are provided and to what types of
on preventing maltreatment and promoting families, how widespread the services are,
permanency and well-being among children how the services are funded and delivered,
who are identified as having already been the and how effective they are in preventing
victims of abuse or neglect. A sizable share maltreatment. I conclude with suggestions
(more than a third) of families who come to for further research and policy.
the attention of CPS are screened out at the
time of the initial referral, while others have Prevention Efforts for Cases
their cases closed after an investigation. The Opened for Ongoing Services
cases that receive services from CPS on an with CPS
ongoing basis constitute a minority of those Figure 1 illustrates the flow of families (and
referred—a minority made up of families children) into the CPS system, using data
who are judged to be at highest risk. from the most recent report on child mal-
treatment issued by the U.S. Department of
States and localities, however, also invest 1
Health and Human Services (DHHS). Of
some resources into services to prevent the 6 million children (representing some 3.3
maltreatment among lower-risk families— million families) reported to CPS agencies
families whose cases do not meet the criteria nationwide in 2006, about 60 percent were
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Prevention and the Child Protection System
Figure 1. Pathways for Children Reported to CPS in 2006
Cases of children reported to CPS
(6 million)
60 percent 40 percent
screened in screened out
(3.5 million) (2.4 million)
30 percent 70 percent
substantiated not substantiated
(1.0 million) (2.5 million)
60 percent 40 percent not 30 percent 70 percent not
open for services open for services open for services open for services
(600,000) (400,000) (750,000) (1.75 million)
37 percent placed 63 percent 13 percent placed 87 percent
out-of-home in-home out-of-home in-home
(220,000) (380,000) (100,000) (650,000)
Source: U.S. Department of Health and Human Services, Child Maltreatment 2006 (Washington: U.S. Government Printing Office, 2008).
screened in for investigation or assessment of children—roughly 650,000—was provided
and about 30 percent of those cases (roughly with in-home services by CPS as a result of
20 percent of the families originally reported) their cases having been reported and investi-
were ultimately substantiated for abuse or gated but not substantiated by CPS (again,
neglect. The majority of families whose cases that number excludes children whose cases
are substantiated (about 60 percent in 2006) were opened for services before 2006). At
go on to receive post-investigation services, first glance it may seem surprising that more
whose main focus is on preventing further unsubstantiated than substantiated cases
maltreatment, whether the family remains were kept open for in-home services. But so
intact (about two-thirds of cases) or the child many more cases are unsubstantiated than
is placed out-of-home with kin, in foster care, are substantiated that even though the
or in group care (just over a third of cases). unsubstantiated cases receive services at a
lower rate, the total number receiving
As figure 1 shows, some 380,000 children services is larger. It is also important to note
were provided with in-home services in 2006 that some children whose cases are not
as a result of their cases having been substantiated have in fact been maltreated.
reported, investigated, and substantiated by Following the differential response systems
CPS that year (that number excludes chil- put in place over the past decade by many
dren whose cases were opened for services states, some CPS agencies now provide a
before 2006 and who continue to receive family “assessment,” in place of an investiga-
services from CPS). An even larger number tion, for low- and moderate-risk cases. In
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Jane Waldfogel
these assessments the focus is on developing one-third of the children were re-reported
a service plan for the family, rather than within five years. Children who received
identifying a perpetrator and producing a post-investigation services were more likely
substantiation decision.2 to be re-reported than those who did not
receive services. This finding applied alike to
The services delivered to intact families children whose cases had and had not been
typically include case management and substantiated (and in fact was more pro-
supervision by a CPS worker (or perhaps a nounced for those who had not been substan-
worker from an agency under contract with 5
tiated initially). Similarly, analyses of data
CPS), often supplemented by one or more on roughly 3,000 children from the National
other preventive services. The specific Survey of Child and Adolescent Well-Being
services delivered to any given family depend (NSCAW), a nationally representative
on the family’s assessed need, the willingness sample of children reported to CPS, find
of family members to engage in and accept that nearly a quarter of the children whose
particular services, and the availability of cases were opened for in-home services were
services in their area. According to DHHS, re-reported within eighteen months, and that
post-investigation services may include children were more likely to be re-reported if
“individual counseling, case management, their families received parenting services.6
family-based services (services provided to
the entire family such as counseling or family Such findings are the opposite of what one
support), [and other] in-home services” as would expect if post-investigation services
well as “foster care services, and court were effective at preventing maltreatment.
services.” Intact families may also receive But the findings may be misleading for
what DHHS categorizes as preventive several reasons. One problem is selection
services, which may include “respite care, bias. If CPS systems are operating efficiently,
parenting education, housing assistance, the families who receive services should be
substance abuse treatment, daycare, home the ones whose children are at highest risk
visits, individual and family counseling, and of maltreatment and hence whose cases
home maker help.” 3 are at highest risk of being re-reported or
re-substantiated. Estimates that do not take
Researchers know remarkably little about selection bias into account may erroneously
how effective post-investigation and preven- interpret a recurrence of maltreatment after
tive services are in stopping maltreatment service receipt as an effect of service receipt.
among the families whose cases are opened Another potential source of bias is the “sur-
for services with CPS. Although a few studies 7
veillance effect.” Clients whose cases are
have found that maltreatment is less likely to opened for services may be at higher risk
recur in open cases that receive services than of being reported because they have more
in those that do not, most studies find that, frequent contact with CPS workers and ser-
if anything, families that receive services are vice providers rather than because they have
more likely to be re-reported and substanti- higher levels of maltreatment.
4
ated subsequently. For example, analyses
of data on 1.4 million children from nine Because existing research is not designed to
states from the National Child Abuse and address these two potential sources of bias,
Neglect Data System (NCANDS) find that it is not possible to conclude that the links it
198 THE FUTURE OF CHILDREN
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Prevention and the Child Protection System
finds between service delivery and height- suggesting that developing and delivering
ened risk of reporting or substantiation are more effective treatment services for such
causal. But neither does the research provide parents (as discussed in other articles in this
much evidence that services provided by CPS volume) could help prevent further
reduce the risk of subsequent maltreatment. maltreatment.10
Why are CPS services for families in open Young children are also at high risk for
cases not more effective in promoting child repeated maltreatment. For example, both
safety and preventing future maltreatment? the NCANDS and NSCAW studies discussed
Recent analyses of data from the National above found that the risk of re-reporting was
Survey of Child and Adolescent Well-Being highest for the youngest children (in par-
(NSCAW) and its companion survey, Caring ticular, infants and toddlers) and decreased
for Children in Child Welfare (CCCW), sharply with age. That pattern suggests a
provide some clues. One possible explanation potentially important role for services such as
is that many families receive few services child care. Although research on how child
beyond periodic visits by usually over-burdened care functions within CPS is limited, the
8
caseworkers. Another possible explanation is broader evidence base on child care suggests
that services are poor in quality and insuffi-
that it could be important in reducing the risk
cient in quantity. For example, although of maltreatment.
rigorous research has proved several parent
training programs effective, fewer than half of
Child care has long been a core service
families whose cases are opened for services
provided to open CPS cases with the explicit
receive any parent training at all. Those who 11
intent of helping to prevent maltreatment.
do get training typically receive only fifteen or
The Alaska CPS agency, for instance, explains
fewer hours of training from a program that
that “protective day care services provide day
has not been proven effective. Nor is the
care to children of families where the chil-
training they receive monitored to ensure that
9 dren are at risk of being abused or neglected.
it is being implemented as intended.
The services are designed to lessen that risk
Given the poor overall track record of today’s by providing child care relief, offering
preventive services, the question arises support to both the child and parents,
whether other types of services are or could monitoring for occurring and reoccurring
be more effective in reducing the risk of maltreatment, and providing role models to
maltreatment. To date, however, evidence on families.”12 Such care is also expected to
that question is quite limited. enhance the development of children who
might otherwise be at risk for poor outcomes.
One indirect way to answer the question is to The Illinois CPS agency, for instance, says:
extrapolate from the characteristics of “Day care services are provided to high-risk
families whose children are known to be at families whose children are in open … cases;
high risk of recurring maltreatment. For they are used to prevent and reduce parental
instance, studies have found that families in stress that may lead to child abuse or neglect.
which parents have substance abuse, domes- The services also help children to develop
tic violence, or mental health problems are properly and enable families to remain
more likely than others to be re-reported, together.” 13
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Jane Waldfogel
The developmental benefits of child care based programs but also fell (5 percent)
are well documented. High-quality care among those in home-based programs.
has been shown to improve the cognitive
development of disadvantaged children and Similarly, a random-assignment study of the
may also improve their social functioning.14 Infant Health and Development Program
Researchers have not yet conducted formal (IHDP), an early child care program for
evaluations of whether child care prevents low-birth-weight children, found reduced
maltreatment among families whose cases spanking by mothers in the previous week,
are open with CPS.15 But studies of Head although the effect was confined to boys.19
Start and other child care programs sug-
gest that child care services can help reduce
maltreatment. Studies of Head Start and
Head Start, a compensatory early education other child care programs
program for low-income children, has been suggest that child care
in operation since 1965 and now serves nearly
1 million preschool-aged children annually services can help reduce
(including about 62,000 children under age maltreatment.
three in the Early Head Start program, begun
in 1994).16 Head Start was recently the
subject of a randomized study that evaluated, Also suggestive of a potentially protective role
among other outcomes, its effect on parent- of Head Start and other formal child care is
ing and discipline. The findings indicated that evidence from an observational study of chil-
parents of three-year-olds who had been dren from the Early Childhood Longitudinal
randomly assigned to Head Start were less Study-Kindergarten (ECLS-K) cohort, a large
likely than control group parents to report nationally representative sample of children
spanking their child in the previous week and entering kindergarten in the fall of 1998.20 In
also reported spanking less frequently, with that study, parents of disadvantaged children
particularly pronounced effects for teen who had attended Head Start before kinder-
mothers (though there were no significant garten were more likely to report that they
effects for parents of four-year-olds).17 never used spanking, and also reported less
Although using spanking as a marker for domestic violence in their home, than parents
potential child maltreatment requires of children who had not attended child care.
caution, these findings are nevertheless Parents whose children had attended Head
promising. Start or other center-based child care were
also more likely to say they would not use
Another randomized study found that Early spanking in a hypothetical situation. The
Head Start improved parenting and reduced study’s authors speculated that having a child
spanking by both mothers and fathers.18 attend Head Start or other center-based child
Parents of children assigned to Early Head care may have reduced parents’ use of physi-
Start were less likely than control group par- cal discipline by relieving parental stress,
ents to have spanked their child in the previ- by exposing parents to alternative forms of
ous week. The share of mothers spanking fell discipline, and by making the children more
most (10 percent) among children in center- visible to potential reporters (for example,
200 THE FUTURE OF CHILDREN
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Prevention and the Child Protection System
child care providers) who would be aware if reported that only 2 percent of caregivers
they were being maltreated. were uncooperative at initial contact, as com-
pared with 44 percent of those in investiga-
As noted, measuring the effects of child tion track cases.
care on spanking is not the same as measur-
ing its effects on maltreatment. One quasi- Minnesota is exceptional in that funding from
experimental evaluation of the Chicago the McKnight Foundation allowed it to
Child-Parent Centers, however, addresses expand services to low-risk families. Families
maltreatment directly. The study found that receiving the alternative response were more
children in the program, which provides care likely to have their cases opened for services
to children from disadvantaged neighbor- (36 percent vs. 15 percent). They were more
hoods during the two years before kinder- likely to receive not only the types of services,
garten, had only half as many court petitions such as counseling, that are traditionally
related to maltreatment as did children in prescribed and paid for by CPS, but also
similar neighborhoods that did not have the services, such as assistance with employment,
21
program. welfare programs, and child care, from other
community resources not funded by CPS.
Another potentially promising approach to
prevention is “differential response,” which, At the one-year follow-up, families in
as noted, entails greater CPS flexibility in Minnesota’s alternative response group
responding to allegations of abuse. States are reported less financial stress and stress associ-
increasingly coming to believe that they can ated with relationships with other adults, as
effect more lasting change in lower-risk cases well as fewer problems with drug abuse and
by providing services that are engaging for less domestic violence. Effects on other out-
families and attentive to their needs rather comes for the children and families, however,
than by using a more traditional adversarial were few.
investigative response.22 What does the evi-
dence show? It should be noted that the study does not
establish which of the Minnesota results
A recent review of the as-yet limited research were due to the added funding. Most states
base suggests the promise of a differential using differential response have not had
response approach in preventing future extra resources. And the reforms in those
maltreatment.23 The strongest evidence other states, while yielding some promising
comes from a random-assignment study in evidence, have not been subject to a random-
Minnesota that found that cases assigned to assignment evaluation.
the alternative response track were less likely
to be re-reported subsequently than cases In addition to altering service delivery for
assigned to the investigative track, a finding cases opened with CPS, differential response
that was linked to the alternative response reforms also increase the likelihood that CPS
track’s provision of increased services to fami- will refer to community-based agencies the
lies.24 The evaluation and an accompanying cases that are not opened. An explicit part of
process study provided many indications that the alternative assessment approach is
families were more engaged. For example, working with families to identify their service
workers delivering an alternative response needs and to make appropriate referrals.
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Jane Waldfogel
Some differential response models also referrals” because they do not need to be
explicitly set out a preventive track for reports referred by CPS to be served and funded).
that should be handled by community-based
agencies instead of CPS right from the outset. The federal Department of Health and
A further impetus to such referrals was the Human Services, in its annual report on child
2003 Child Abuse Prevention and Treatment maltreatment, distinguishes between children
Act (CAPTA) requirement that states develop receiving preventive services and those
the ability to refer children who are not at receiving post-investigative services. The
imminent risk of harm to community organi- distinction perhaps suggests that their data on
zations or voluntary child protective services. children receiving preventive services mainly
Both differential response and the new capture children from the above groups—
CAPTA requirement, then, are likely to have children receiving preventive services funded
increased the number of lower-risk families by CPS even though their cases are not open
receiving some kind of preventive services for services with CPS (while post-investigative
from community-based agencies, without services would refer to children whose cases
being open for services with CPS. I turn to were substantiated and kept open for ser-
this group of families next. vices). In 2006, state CPS agencies reported a
total of 3.8 million children receiving preven-
Prevention Efforts for Lower-Risk tive services.25 Some of these children were
Families Not Opened or Kept referred to CPS in 2006; others were referred
Open for Services with CPS earlier; and still others were served without
Figure 1 highlights (in italics) three groups of having been referred to CPS at all (the
children in lower-risk cases not opened or so-called “open referrals”).
kept open for services with CPS. The three
groups are: the 2.4 million children annually According to DHHS, preventive services
reported to CPS but screened out; the “are designed to increase parents’ and other
roughly 1.75 million children annually whose caregivers’ understanding of the developmen-
cases are reported to CPS and screened in tal stages of childhood and to improve their
but not substantiated and not kept open for child-rearing competencies.” As noted, exam-
services with CPS; and the roughly 400,000 ples of preventive services include “respite
children annually whose cases are substanti- care, parenting education, housing assistance,
ated but not kept open for services with CPS. substance abuse treatment, daycare, home
Some of these children receive preventive visits, individual and family counseling, and
services from community-based agencies home maker help.” 26
(which may or may not be funded by CPS),
but data are not available on precisely how Funding for preventive services for lower-risk
many children from each group do so. cases comes from several different sources.27
Another group—not shown in the figure— The most common source reported by states
that receives preventive services from in 2006—covering nearly 30 percent of
community-based agencies consists of children receiving preventive services
children who are not reported to CPS but nationwide—was Promoting Safe and Stable
whose families apply voluntarily or are Families funding under Title IV-B of the
advised to do so by someone in the commu- Social Security Act. The second most com-
nity (these cases are sometimes called “open mon source—covering nearly 20 percent
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Prevention and the Child Protection System
Table 1. Federal Funding for Preventive Services for Children Whose Cases Are Not Open with CPS,
2006
Source Amount
Promoting Safe and Stable Families (Title IV-B of the Social Security Act) $250 million
Social Services Block Grant (Title XX of the Social Security Act) $340 million
Community-Based Child Abuse Prevention (Title II of the Child Abuse Prevention and Treatment Act) $ 42 million
Source: Author’s calculations based on data in 2004 and 2008 Green Book.
nationally—was the Social Services Block of the $1.7 billion allocated in 2006, or about
Grant (SSBG) under Title XX of the Social $340 million, was devoted to preventive ser-
Security Act. Community-Based Child Abuse vices (about 13 percent was devoted to child
Prevention (CBCAP) grants under Title II of welfare services other than foster care, with
the Child Abuse Prevention and Treatment another 8 percent devoted to child care).31
Act (CAPTA) covered roughly 15 percent, With regard to the CBCAP program, here we
while funds from the Basic State Grant under can assume that most (if not all) of the total
Title I of CAPTA covered just over 5 percent. $42 million available in 2006 went to preven-
Other federal or state programs funded the tive services, because that is the main focus
remaining 30 percent of preventive services of the program. (These estimates are summa-
for children.28 States vary considerably in the rized in table 1.)
funding sources they use. New York, for
example, relied on SSBG funding for 85 Little information is available about spending
percent of its preventive services in 2006, on specific types of preventive service
while Texas relied exclusively on Promoting programs, such as respite care and parent
Safe and Stable Families funding. education. One exception is home-visiting
programs, which have been a subject of
DHHS does not track total dollars spent increased interest in Congress and which
on these preventive services for lower-risk received an additional $10 million in federal
families, but it is possible to create some funding in 2008, under an initiative designed
rough estimates using other data.29 Thus, to expand support for empirically validated
of the $410 million appropriated in 2006 models of home visiting such as the Nurse-
for the Promoting Safe and Stable Families Family Partnership.32
program (the single largest source of funding
for preventive services nationally, as noted), a The above data on spending for prevention
reasonable estimate is that about 60 percent, refer only to federal funding and do not
or roughly $250 million, went for preven- include funding from state and local sources.
tive services such as family support and Federal dollars represent only half the funds
prevention and family preservation (with the spent on overall child welfare services and a
remainder going for other services such as much smaller share of funding for preventive
reunification and adoption planning).30 With services, which are more likely than other
regard to the SSBG (the second largest fund- types of child welfare services to rely on state
ing source for preventive services nationally), and local funding.33 In 2004, states spent a
program data indicate that roughly one-fifth total of $9 billion on child welfare services,
VOL. 19 / NO. 2 / FALL 2009 203
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Jane Waldfogel
while localities spent at least $2.5 billion.34 significant effects on protective and risk
Most of these state and local dollars, however, factors for child abuse and neglect. Two other
went for services such as foster care, with programs were reported to be effective,
only a small portion going for preventive although they lacked a random-assignment
services. evaluation. Both deliver augmented parent-
ing and family support services in child care
Although prevention programs have settings. One is the Circle of Security parent-
expanded rapidly and now exist in all fifty ing program in Head Start and Early Head
states, researchers still know little about their Start in Spokane, Washington; the other is
effectiveness. In 2003, a review conducted the Families and Centers Empowered
by DHHS noted that most of the research Together (FACET) family support program
focused on just two types of prevention in child care centers in high-risk neighbor-
programs—home visiting and parent educa- hoods in Wilmington, Delaware. Given the
tion.35 The evidence base on home visiting promising evidence on the role of child care
programs, as discussed in other articles in this in preventing maltreatment reviewed above,
volume, is promising. Although not all home these programs—which explicitly aim to
visiting programs have been demonstrated increase the protective role of child care
to be effective, randomized evaluations of settings—are potentially promising and worth
the Nurse-Family Partnership program have close attention.
found decreased rates of child maltreat-
ment among the group randomly assigned
to receive home visits. Regarding parent
education programs, perhaps the most com- Although prevention
monly provided type of prevention services, programs have expanded
the DHHS review concluded: “The record
is neither rich nor, on the whole, particularly rapidly and now exist in
compelling. However, a few studies have all fifty states, researchers
demonstrated positive findings. Many of the
existing studies in this area rely on outcomes still know little about their
that do not include actual maltreatment effectiveness.
reports, but focus on short-term gains in
knowledge, skills, or abilities. Thus, taken as
a whole, little is known about the impact of
these programs on child maltreatment in the The DHHS review also highlights two
long term.” 36 essential characteristics of effective preven-
tion programs—of whatever type. The first is
When the same DHHS review invited that the program be delivered in sufficient
nominations for effective programs, only dosage. In the prevention area, as in other
one—the University of Maryland’s Family areas of social policy, successful programs are
Connections program for at-risk families with often implemented with less intensity or for a
children aged five to eleven—met their two shorter time than the original model specifies,
standards for effectiveness: having been thus diluting the effectiveness of the program
evaluated by a study using a random- and leading to disappointing results. The
assignment design and having demonstrated second essential characteristic is the ability of
204 THE FUTURE OF CHILDREN
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Prevention and the Child Protection System
frontline staff to engage with families to existing research sheds little light on what
encourage them to agree to participate in types of services might be most effective in
services and to continue participating. But meeting that goal. As other analysts have
engaging families is also extremely difficult noted, CPS agencies provide “a somewhat
because many of the target families are haphazard set of services that aim to help
socially isolated and may distrust helping abusive families and their children … [with]
professionals, however well-intentioned. a shortage of effective intervention programs
Thus, recruiting and training effective to provide needed services [and] a dearth of
prevention staff is a common challenge. prevention services.”38
Looking Ahead: Suggestions for Program data—and common sense—suggest
Further Research and Policy that any intervention that aims to prevent
It is now widely accepted that CPS has an maltreatment must be intensive, and its
important role to play in preventing maltreat- frontline staff must be able to engage with
ment not just among the relatively high-risk families. But beyond that, researchers have
cases opened for services, but also among the much more to learn about what types of
lower-risk families who come to its attention services should be expanded if CPS agencies
but do not meet the thresholds for case open- are to do a better job of preventing maltreat-
ing or continuing service delivery. Failing to ment among their open cases. The demo-
prevent maltreatment among open cases is a graphics of recurrence suggest that some
signal that CPS intervention has failed in its families, especially those with mental health,
primary role of promoting child safety and substance abuse, and domestic violence prob-
well-being among the most vulnerable group lems, are at higher risk than others, pointing
of children. And failing to refer lower-risk to issues that services will need to address
families for effective preventive services effectively if they are to reduce the risk of
represents a missed opportunity to intervene maltreatment. The demographics of recur-
before the risk of maltreatment escalates into rence also point to young children as being
full-blown abuse or neglect, saving children particularly at risk, suggesting a potentially
needless suffering while also saving CPS important role for such services as child care.
and other agencies the costs that would be Indeed, child care is one area where the
entailed by a subsequent report, investiga- evidence base is reasonably strong in pointing
tion, and ongoing service delivery. to a potential preventive role. This is certainly
an area where further experimentation would
How well are CPS agencies doing at pre- be worthwhile.
vention? We know from the federal Child
and Family Services Reviews that in 2005, With regard to the lower-risk cases not
6.6 percent of open CPS cases nationally open for services with CPS but referred to
experienced a new incident of substantiated preventive services, the good news is that
maltreatment within six months of being such services seem to be much more wide-
opened.37 That rate, although somewhat spread today than in the past, reflecting the
lower than it was a few years previously, still expanded availability of federal and other
exceeds the 6 percent target set by the Child funds as well as the increased recognition
and Family Service Reviews, and state CPS that a one-size-fits-all investigative response
agencies are actively trying to lower it. But will not meet the needs of all families
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referred to CPS. Nevertheless, challenges be on the threshold of an exciting new era
remain. Analysts have much to learn about in the provision of prevention programs. To
what CPS agencies can do to support and take fullest advantage of the opportunities
monitor preventive programs to ensure that this expansion of interest is likely to offer, it
they are delivering effective services.39 They is worth keeping a few principles in mind.
also have much to learn about coordinating The first is that if studies are to yield reliable
services across the many types of community evidence documenting that programs suc-
agencies that may play a role in prevention.40 cessfully prevent maltreatment, they must
use randomized designs whenever possible
Although the evidence base on preventive and must measure maltreatment outcomes.
programs for lower-risk families remains The second is that policy makers must keep
fairly thin, with a few exceptions such as the in mind the lessons learned from past efforts,
results from randomized studies of the Nurse- in particular, the importance of dosage and
Family Partnership program, programs and family engagement. As tempting as it may
evaluations in this area are expanding rapidly. be to cut corners and save dollars, there is
Both DHHS and the federal Centers for no substitute for systematically implement-
Disease Control and Prevention are actively ing and evaluating promising interventions.
reviewing program effectiveness and spur- If not, we could well find ourselves a decade
ring states to commission and participate in from now with no more evidence on preven-
program evaluations. It seems the nation may tion in CPS than we have today.
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Endnotes
1. All statistics in this paragraph are from U.S. Department of Health and Human Services, Administration on
Children, Youth, and Families, Child Maltreatment 2006 (Washington: U.S. Government Printing Office,
2008) (www.acf.hhs.gov/programs/cb/pubs/cm06/cm06.pdf [accessed July 29, 2008]).
2. For an overview of alternative response systems, see Jane Waldfogel, “Differential Response,” in Community
Prevention of Child Maltreatment, edited by Kenneth Dodge (New York: Guilford Press, 2009).
3. U.S. Department of Health and Human Services, Child Maltreatment 2006 (see note 1), p. 83.
4. These studies are reviewed by John D. Fluke and Dana Hollinshead, “Child Maltreatment Recurrence,”
report prepared for the National Resource Center on Child Maltreatment (Duluth, Ga.: NRCCM, 2003)
(www.nrccps.org/PDF/MaltreatmentRecurrence.pdf) [accessed April 1, 2009]), and by John D. Fluke and
others, “Reporting and Recurrence of Child Maltreatment: Findings from NCANDS,” report prepared for
the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and
Evaluation (DHHS, 2005) (www.aspe.hhs.gov [accessed August 1, 2008]). See also Jessica Kahn, “Child
Welfare Recidivism,” doctoral dissertation, Columbia University School of Social Work, 2006. These
reviews cite only a few studies that find that families who received services had a lower likelihood of being
re-reported. See Brett Drake and others, “Substantiation and Recidivism,” Child Maltreatment 4, no. 4
(2003): 297–307; M. J. Camasso and R. Jagannathan, “Modeling the Reliability and Predictive Validity of
Risk Assessment in Child Protective Services,” Children and Youth Services Review 22, no. 11/12 (2000):
873–96; T. L. Fuller, S. J. Wells, and E. E. Cotton, “Predictors of Maltreatment Recurrence at Two
Milestones in the Life of a Case,” Children and Youth Services Review 23, no. 1 (2001): 49–78; and Diane
DePanfilis and Susan J. Zuravin, “The Effect of Services on the Recurrence of Child Maltreatment,” Child
Abuse and Neglect 26, no. 2 (2002): 187–205.
5. Fluke and others, “Reporting and Recurrence of Child Maltreatment” (see note 4). The study also found
that among children who had initially been substantiated, about 17 percent were the subject of another
substantiated investigation over the next five years. Nationally, data compiled for the Child and Family
Services Reviews indicate that in 2005, 6.6 percent of substantiated victims were the subject of another
substantiated investigation in the next six months, an improvement over the rate of 7.5 percent in 2002;
see U.S. Department of Health and Human Services, Administration for Children and Families, “Child
Welfare Outcomes 2002–2005: Report to Congress” (DHHS, 2008) (www.acf.dhhs.gov/programs/cb/pubs/
cwo05/chapters/executive.htm [accessed September 12, 2008]).
6. Patricia Kohl and Richard Barth, “Child Maltreatment Recurrence among Children Remaining In-Home:
Predictors of Re-Reports,” in Child Protection: Using Research to Improve Policy and Practice, edited by
Ron Haskins, Fred Wulczyn, and Mary Bruce Webb (Washington: Brookings Institution Press, 2007).
7. The “surveillance effect” is discussed on p. 13 of Fluke and Hollinshead, “Child Maltreatment Recurrence”
(see note 4).
8. Ron Haskins, Fred Wulczyn, and Mary Bruce Webb, “Using High-Quality Research to Improve Child
Protection Practice: An Overview,” in Child Protection: Using Research to Improve Policy and Practice,
edited by Haskins, Wulczyn, and Webb (see note 6).
9. Michael Hurlburt and others, “Building on Strengths: Current Status and Opportunities for Improvement
of Parent Training for Families in Child Welfare,” in Child Protection: Using Research to Improve Policy
and Practice, edited by Haskins, Wulczyn, and Webb (see note 6).
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Jane Waldfogel
10. See reviews by Fluke and Hollinshead, “Child Maltreatment Recurrence” (see note 4), and Fluke and
others, “Reporting and Recurrence of Child Maltreatment (see note 4); and Nick Hindley, Paul G.
Ramchandani, and David P. H. Jones, “Risk Factors for Recurrence of Maltreatment: A Systematic
Review,” Archives of Disease in Childhood 91, no. 9 (2006): 744–52.
11. See, for example, Martha G. Roditti, “Child Day Care: A Key Building Block of Family Support and Family
Preservation Programs,” in Child Day Care, edited by Bruce Hershfield and Karen Selman (Edison, N.J.:
Transaction Publishers, 1997).
12. State of Alaska, Office of Children’s Services (OCS), “OCS Family Preservation” (OCS, 2008) (www.hss.
state.ak.us/ocs/services.htm [accessed July 10, 2008]).
13. Illinois Department of Children and Family Services, “Day Care and Early Childhood”(DCFS, 2008)
(www.state.il.us/dcfs/daycare/index.shtml [accessed July 10, 2008]).
14. Regarding cognitive development, see, for example, Margaret O’Brien Caughy, Janet A. DiPietro, and
Donna M. Strobino, “Day-Care Participation as a Protective Factor in the Cognitive Development of Low-
Income Children,” Child Development 65, no. 2 (1994): 457–71. Regarding social development, see, for
example, Sylvana Cote and others, “The Role of Maternal Education and Nonmaternal Care Services in the
Prevention of Children’s Physical Aggression Problems,” Archives of General Psychiatry 64, no. 11 (2007):
1305–12.
15. Although a small-scale study (of twenty-two children) found that infants placed into protective day care
were more likely than other infants to be removed from their families subsequently, this appears to be
an isolated finding. See Patricia M. Crittenden, “The Effect of Mandatory Protective Daycare on Mutual
Attachment in Maltreating Mother-Infant Dyads,” Child Abuse and Neglect 7, no. 3 (1983): 297–300.
16. Information on Head Start from the U.S. House of Representatives, Committee on Ways and Means, 2008
Green Book (www.waysandmeans.house.gov/Documents.asp?section=2168 [accessed August 1, 2008]).
17. U.S. Department of Health and Human Services, Administration for Children and Families, “Head Start
Impact Study: First Year Findings” (Washington: DHHS, 2005) (www.acf.hhs.gov/programs/opre/hs/
impact_study [accessed August 6, 2008]).
18. John M. Love and others, “Making a Difference in the Lives of Infants and Toddlers and Their Families:
The Impacts of Early Head Start. Final Technical Report” (Princeton, N.J.: Mathematica Policy Research,
2002).
19. Judith R. Smith and Jeanne Brooks-Gunn, “Correlates and Consequences of Mothers’ Harsh Discipline
with Young Children,” Archives of Pediatric and Adolescent Medicine 151 (1997): 777–86.
20. Katherine Magnuson and Jane Waldfogel, “Pre-School Enrollment and Parents’ Use of Physical Discipline,”
Infant and Child Development 14, no. 2 (2005): 177–98.
21. Arthur J. Reynolds and D. Robertson, “School-Based Early Intervention and Later Child Maltreatment in
the Chicago Longitudinal Study,” Child Development 74 (2003): 3–26.
22. Differential response reforms in many states have complicated efforts to measure the effectiveness of
services provided by CPS in preventing future maltreatment, because states now differ sharply in how
they define reports and substantiated cases. For a discussion of the origins and rationale for differential
response, see Jane Waldfogel, The Future of Child Protection: Breaking the Cycle of Abuse and Neglect
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Prevention and the Child Protection System
(Harvard University Press, 1998), and Jane Waldfogel, “The Future of Child Protection Revisited,” in
Child Welfare Research: Advances for Practice and Policy, edited by Duncan Lindsey and Aron Shlonsky
(Oxford University Press, 2008). For a brief overview, see U.S. Department of Health and Human Services,
Administration for Children and Families, “Differential Response to Reports of Child Abuse and Neglect,”
an issue brief prepared for the Child Welfare Information Gateway (DHHS, 2008) (www.childwelfare.gov
[accessed August 1, 2008]).
23. Waldfogel, “Differential Response” (see note 2).
24. The Minnesota results are reported in Anthony L. Loman and Gary L. Siegel, Minnesota Alternative
Response Evaluation: Final Report (St. Louis: Institute of Applied Research, 2004) (www.iarstl.org
[accessed July 24, 2006]); Anthony L. Loman and Gary L. Siegel, “Alternative Response in Minnesota:
Findings of the Program Evaluation,” Protecting Children 20, no. 2–3 (2005): 79–92; and Anthony L.
Loman and Gary L. Siegel, “Extended Follow-Up Study of Minnesota’s Family Assessment Response:
Final Report” (St. Louis: Institute of Applied Research, 2006) (www.iastl.org [accessed September 18,
2007]). Results from Minnesota as well as other states are reviewed in Waldfogel, “Differential Response”
(see note 2).
25. U.S. Department of Health and Human Services, Child Maltreatment 2006 (see note 1).
26. Ibid., p. 83.
27. All statistics in this paragraph are from U.S. Department of Health and Human Services, Child Maltreatment
2006 (see note 1).
28. These other sources of funding are quite varied and include other federal agencies such as the Centers
for Disease Control and Prevention, the Maternal and Child Health Bureau, and the U.S. Department of
Justice, as well as a variety of state and private funding sources.
29. In particular, I rely on estimates from various editions of the Green Book, published at regular intervals by
the U.S. House of Representatives, Committee on Ways and Means. As of this writing, the 2008 version of
the Green Book was being published in stages. For some sections, the 2008 version is available, while for
others, the latest release was the 2004 version. See also Emilie Stoltzfus, “Child Welfare Issues in the 110th
Congress,” CRS Report for Congress RL34388 (Congressional Research Service, 2008) (http://opencrs.
cdt.org [accessed January 15, 2009]); and Emilie Stoltzfus, “Child Welfare: Recent and Proposed Federal
Funding,” CRS Report for Congress RL34121 (Congressional Research Service, 2007) (http://opencrs.cdt.
org [accessed January 15, 2009]).
30. Data from the U.S. House of Representatives, Committee on Ways and Means, 2004 Green Book, Section
11—Child Protection, Foster Care, and Adoption Assistance (http://waysandmeans.house.gov [accessed
January 15, 2009]).
31. Data from the U.S. House of Representatives, Committee on Ways and Means, 2008 Green Book,
Section 10—Title XX Social Services Block Grant Program (http://waysandmeans.house.gov/Documents.
asp?section=2168 [accessed January 15, 2009]).
32. See Stoltzfus, “Child Welfare Issues in the 110th Congress” (see note 29), and Stoltzfus, “Child Welfare:
Recent and Proposed Federal Funding” (see note 29).
33. In 2005, federal funds were 49 percent of total child welfare spending, with state funds making up 39
percent and local funds making up 12 percent; see Cynthia Andrews Scarcella and others, “The Cost
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Jane Waldfogel
of Protecting Vulnerable Children, V: Understanding State Variation in Child Welfare Financing”
(Washington: Urban Institute, 2006).
34. Ibid.
35. David Thomas and others, “Emerging Practices in the Prevention of Child Abuse and Neglect,” report
prepared for the U.S. Department of Health and Human Services, Children’s Bureau Office on Child Abuse
and Neglect (DHHS, 2003) (www.childwelfare.gov/preventing/programs/whatworks/report [accessed July
28, 2008]). The federal Centers for Disease Control and Prevention (CDC) are also involved in reviewing
the effectiveness of prevention programs; see, for example, Centers for Disease Control and Prevention,
National Center for Injury Prevention and Control, “Using Evidence-Based Parenting Programs to Advance
CDC Efforts in Child Maltreatment Prevention” (CDC, 2004) (www.cdc.gov/ncipc/pub-res/parenting/
ChildMalT-Briefing.pdf [accessed August 3, 2008]).
36. Quote from p. 15 of Thomas and others, “Emerging Practices in the Prevention of Child Abuse and
Neglect” (see note 35).
37. See U.S. Department of Health and Human Services, Administration for Children and Families, “Child
Welfare Outcomes 2002–2005: Report to Congress” (DHHS, 2008) (www.acf.dhhs.gov/programs/cb/pubs/
cwo05/chapters/executive.htm [accessed September 12, 2008]).
38. Quote from p. 2 of Haskins, Wulczyn, and Webb, “Using High-Quality Research to Improve Child
Protection Practice” (see note 8).
39. See discussion in Fred Wulczyn, “A Community’s Concern,” Child Welfare Watch 14 (Summer 2007): 29–30.
40. The need for coordination arises, in large part, because children at risk for maltreatment often have mul-
tiple needs and thus require services that cut across agencies. See Roger Bullock and Michael Little, “The
Contribution of Children’s Services to the Protection of Children” (Dartington, England: Dartington Social
Research Unit, 2002) (www.dartington.org.uk); and Nick Axford and Michael Little, Refocusing Children’s
Services towards Prevention: Lessons from the Literature (London: Department for Education and Skills
Research Report RR10, 2004) (www.dartington.org.uk).
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