Journals > Journal: Preventing Child Maltreatment > Article: Prevention and the Child Protection System
Journal Issue: Preventing Child Maltreatment Volume 19 Number 2 Fall 2009
Prevention Efforts for Cases Opened for Ongoing Services with CPS
Figure 1 illustrates the flow of families (and children) into the CPS system, using data from the most recent report on child maltreatment issued by the U.S. Department of Health and Human Services (DHHS).1 Of the 6 million children (representing some 3.3 million families) reported to CPS agencies nationwide in 2006, about 60 percent were screened in for investigation or assessment and about 30 percent of those cases (roughly 20 percent of the families originally reported) were ultimately substantiated for abuse or neglect. The majority of families whose cases are substantiated (about 60 percent in 2006) go on to receive post-investigation services, whose main focus is on preventing further maltreatment, whether the family remains intact (about two-thirds of cases) or the child is placed out-of-home with kin, in foster care, or in group care (just over a third of cases).
As figure 1 shows, some 380,000 children were provided with in-home services in 2006 as a result of their cases having been reported, investigated, and substantiated by CPS that year (that number excludes children whose cases were opened for services before 2006 and who continue to receive services from CPS). An even larger number of children—roughly 650,000—was provided with in-home services by CPS as a result of their cases having been reported and investigated but not substantiated by CPS (again, that number excludes children whose cases were opened for services before 2006). At first glance it may seem surprising that more unsubstantiated than substantiated cases were kept open for in-home services. But so many more cases are unsubstantiated than are substantiated that even though the unsubstantiated cases receive services at a lower rate, the total number receiving services is larger. It is also important to note that some children whose cases are not substantiated have in fact been maltreated. Following the differential response systems put in place over the past decade by many states, some CPS agencies now provide a family “assessment,” in place of an investigation, for low- and moderate-risk cases. In these assessments the focus is on developing a service plan for the family, rather than identifying a perpetrator and producing a substantiation decision.2
The services delivered to intact families typically include case management and supervision by a CPS worker (or perhaps a worker from an agency under contract with CPS), often supplemented by one or more other preventive services. The specific services delivered to any given family depend on the family’s assessed need, the willingness of family members to engage in and accept particular services, and the availability of services in their area. According to DHHS, post-investigation services may include “individual counseling, case management, family-based services (services provided to the entire family such as counseling or family support), [and other] in-home services” as well as “foster care services, and court services.” Intact families may also receive what DHHS categorizes as preventive services, which may include “respite care, parenting education, housing assistance, substance abuse treatment, daycare, home visits, individual and family counseling, and home maker help.”3
Researchers know remarkably little about how effective post-investigation and preventive services are in stopping maltreatment among the families whose cases are opened for services with CPS. Although a few studies have found that maltreatment is less likely to recur in open cases that receive services than in those that do not, most studies find that, if anything, families that receive services are more likely to be re-reported and substantiated subsequently.4 For example, analyses of data on 1.4 million children from nine states from the National Child Abuse and Neglect Data System (NCANDS) find that one-third of the children were re-reported within five years. Children who received post-investigation services were more likely to be re-reported than those who did not receive services. This finding applied alike to children whose cases had and had not been substantiated (and in fact was more pronounced for those who had not been substantiated initially).5 Similarly, analyses of data on roughly 3,000 children from the National Survey of Child and Adolescent Well-Being (NSCAW), a nationally representative sample of children reported to CPS, find that nearly a quarter of the children whose cases were opened for in-home services were re-reported within eighteen months, and that children were more likely to be re-reported if their families received parenting services.6
Such findings are the opposite of what one would expect if post-investigation services were effective at preventing maltreatment. But the findings may be misleading for several reasons. One problem is selection bias. If CPS systems are operating efficiently, the families who receive services should be the ones whose children are at highest risk of maltreatment and hence whose cases are at highest risk of being re-reported or re-substantiated. Estimates that do not take selection bias into account may erroneously interpret a recurrence of maltreatment after service receipt as an effect of service receipt. Another potential source of bias is the “surveillance effect.”7 Clients whose cases are opened for services may be at higher risk of being reported because they have more frequent contact with CPS workers and service providers rather than because they have higher levels of maltreatment.
Because existing research is not designed to address these two potential sources of bias, it is not possible to conclude that the links it finds between service delivery and heightened risk of reporting or substantiation are causal. But neither does the research provide much evidence that services provided by CPS reduce the risk of subsequent maltreatment.
Why are CPS services for families in open cases not more effective in promoting child safety and preventing future maltreatment? Recent analyses of data from the National Survey of Child and Adolescent Well-Being (NSCAW) and its companion survey, Caring for Children in Child Welfare (CCCW), provide some clues. One possible explanation is that many families receive few services beyond periodic visits by usually over-burdened caseworkers.8 Another possible explanation is that services are poor in quality and insufficient in quantity. For example, although rigorous research has proved several parent training programs effective, fewer than half of families whose cases are opened for services receive any parent training at all. Those who do get training typically receive only fifteen or fewer hours of training from a program that has not been proven effective. Nor is the training they receive monitored to ensure that it is being implemented as intended.9
Given the poor overall track record of today’s preventive services, the question arises whether other types of services are or could be more effective in reducing the risk of maltreatment. To date, however, evidence on that question is quite limited.
One indirect way to answer the question is to extrapolate from the characteristics of families whose children are known to be at high risk of recurring maltreatment. For instance, studies have found that families in which parents have substance abuse, domestic violence, or mental health problems are more likely than others to be re-reported, suggesting that developing and delivering more effective treatment services for such parents (as discussed in other articles in this volume) could help prevent further maltreatment.10
Young children are also at high risk for repeated maltreatment. For example, both the NCANDS and NSCAW studies discussed above found that the risk of re-reporting was highest for the youngest children (in particular, infants and toddlers) and decreased sharply with age. That pattern suggests a potentially important role for services such as child care. Although research on how child care functions within CPS is limited, the broader evidence base on child care suggests that it could be important in reducing the risk of maltreatment.
Child care has long been a core service provided to open CPS cases with the explicit intent of helping to prevent maltreatment.11 The Alaska CPS agency, for instance, explains that “protective day care services provide day care to children of families where the children are at risk of being abused or neglected. The services are designed to lessen that risk by providing child care relief, offering support to both the child and parents, monitoring for occurring and reoccurring maltreatment, and providing role models to families.”12 Such care is also expected to enhance the development of children who might otherwise be at risk for poor outcomes. The Illinois CPS agency, for instance, says: “Day care services are provided to high-risk families whose children are in open … cases; they are used to prevent and reduce parental stress that may lead to child abuse or neglect. The services also help children to develop properly and enable families to remain together.”13
The developmental benefits of child care are well documented. High-quality care has been shown to improve the cognitive development of disadvantaged children and may also improve their social functioning.14 Researchers have not yet conducted formal evaluations of whether child care prevents maltreatment among families whose cases are open with CPS.15 But studies of Head Start and other child care programs suggest that child care services can help reduce maltreatment.
Head Start, a compensatory early education program for low-income children, has been in operation since 1965 and now serves nearly 1 million preschool-aged children annually (including about 62,000 children under age three in the Early Head Start program, begun in 1994).16 Head Start was recently the subject of a randomized study that evaluated, among other outcomes, its effect on parenting and discipline. The findings indicated that parents of three-year-olds who had been randomly assigned to Head Start were less likely than control group parents to report spanking their child in the previous week and also reported spanking less frequently, with particularly pronounced effects for teen mothers (though there were no significant effects for parents of four-year-olds).17 Although using spanking as a marker for potential child maltreatment requires caution, these findings are nevertheless promising.
Another randomized study found that Early Head Start improved parenting and reduced spanking by both mothers and fathers.18 Parents of children assigned to Early Head Start were less likely than control group parents to have spanked their child in the previous week. The share of mothers spanking fell most (10 percent) among children in center-based programs but also fell (5 percent) among those in home-based programs.
Similarly, a random-assignment study of the Infant Health and Development Program (IHDP), an early child care program for low-birth-weight children, found reduced spanking by mothers in the previous week, although the effect was confined to boys.19
Also suggestive of a potentially protective role of Head Start and other formal child care is evidence from an observational study of children from the Early Childhood Longitudinal Study-Kindergarten (ECLS-K) cohort, a large nationally representative sample of children entering kindergarten in the fall of 1998.20 In that study, parents of disadvantaged children who had attended Head Start before kindergarten were more likely to report that they never used spanking, and also reported less domestic violence in their home, than parents of children who had not attended child care. Parents whose children had attended Head Start or other center-based child care were also more likely to say they would not use spanking in a hypothetical situation. The study’s authors speculated that having a child attend Head Start or other center-based child care may have reduced parents’ use of physical discipline by relieving parental stress, by exposing parents to alternative forms of discipline, and by making the children more visible to potential reporters (for example, child care providers) who would be aware if they were being maltreated.
As noted, measuring the effects of child care on spanking is not the same as measuring its effects on maltreatment. One quasi-experimental evaluation of the Chicago Child-Parent Centers, however, addresses maltreatment directly. The study found that children in the program, which provides care to children from disadvantaged neighborhoods during the two years before kindergarten, had only half as many court petitions related to maltreatment as did children in similar neighborhoods that did not have the program.21
Another potentially promising approach to prevention is “differential response,” which, as noted, entails greater CPS flexibility in responding to allegations of abuse. States are increasingly coming to believe that they can effect more lasting change in lower-risk cases by providing services that are engaging for families and attentive to their needs rather than by using a more traditional adversarial investigative response.22 What does the evidence show?
A recent review of the as-yet limited research base suggests the promise of a differential response approach in preventing future maltreatment.23 The strongest evidence comes from a random-assignment study in Minnesota that found that cases assigned to the alternative response track were less likely to be re-reported subsequently than cases assigned to the investigative track, a finding that was linked to the alternative response track’s provision of increased services to families.24 The evaluation and an accompanying process study provided many indications that families were more engaged. For example, workers delivering an alternative response reported that only 2 percent of caregivers were uncooperative at initial contact, as compared with 44 percent of those in investigation track cases.
Minnesota is exceptional in that funding from the McKnight Foundation allowed it to expand services to low-risk families. Families receiving the alternative response were more likely to have their cases opened for services (36 percent vs. 15 percent). They were more likely to receive not only the types of services, such as counseling, that are traditionally prescribed and paid for by CPS, but also services, such as assistance with employment, welfare programs, and child care, from other community resources not funded by CPS.
At the one-year follow-up, families in Minnesota’s alternative response group reported less financial stress and stress associated with relationships with other adults, as well as fewer problems with drug abuse and less domestic violence. Effects on other outcomes for the children and families, however, were few.
It should be noted that the study does not establish which of the Minnesota results were due to the added funding. Most states using differential response have not had extra resources. And the reforms in those other states, while yielding some promising evidence, have not been subject to a random-assignment evaluation.
In addition to altering service delivery for cases opened with CPS, differential response reforms also increase the likelihood that CPS will refer to community-based agencies the cases that are not opened. An explicit part of the alternative assessment approach is working with families to identify their service needs and to make appropriate referrals.
Some differential response models also explicitly set out a preventive track for reports that should be handled by community-based agencies instead of CPS right from the outset. A further impetus to such referrals was the 2003 Child Abuse Prevention and Treatment Act (CAPTA) requirement that states develop the ability to refer children who are not at imminent risk of harm to community organizations or voluntary child protective services. Both differential response and the new CAPTA requirement, then, are likely to have increased the number of lower-risk families receiving some kind of preventive services from community-based agencies, without being open for services with CPS. I turn to this group of families next.
