Journals > Journal: Preventing Child Maltreatment > Article: Prevention and the Child Protection System
Journal Issue: Preventing Child Maltreatment Volume 19 Number 2 Fall 2009
Looking Ahead: Suggestions for Further Research and Policy
It is now widely accepted that CPS has an important role to play in preventing maltreatment not just among the relatively high-risk cases opened for services, but also among the lower-risk families who come to its attention but do not meet the thresholds for case opening or continuing service delivery. Failing to prevent maltreatment among open cases is a signal that CPS intervention has failed in its primary role of promoting child safety and well-being among the most vulnerable group of children. And failing to refer lower-risk families for effective preventive services represents a missed opportunity to intervene before the risk of maltreatment escalates into full-blown abuse or neglect, saving children needless suffering while also saving CPS and other agencies the costs that would be entailed by a subsequent report, investigation, and ongoing service delivery.
How well are CPS agencies doing at prevention? We know from the federal Child and Family Services Reviews that in 2005, 6.6 percent of open CPS cases nationally experienced a new incident of substantiated maltreatment within six months of being opened.37 That rate, although somewhat lower than it was a few years previously, still exceeds the 6 percent target set by the Child and Family Service Reviews, and state CPS agencies are actively trying to lower it. But existing research sheds little light on what types of services might be most effective in meeting that goal. As other analysts have noted, CPS agencies provide “a somewhat haphazard set of services that aim to help abusive families and their children … [with] a shortage of effective intervention programs to provide needed services [and] a dearth of prevention services.”38
Program data—and common sense—suggest that any intervention that aims to prevent maltreatment must be intensive, and its frontline staff must be able to engage with families. But beyond that, researchers have much more to learn about what types of services should be expanded if CPS agencies are to do a better job of preventing maltreatment among their open cases. The demographics of recurrence suggest that some families, especially those with mental health, substance abuse, and domestic violence problems, are at higher risk than others, pointing to issues that services will need to address effectively if they are to reduce the risk of maltreatment. The demographics of recurrence also point to young children as being particularly at risk, suggesting a potentially important role for such services as child care. Indeed, child care is one area where the evidence base is reasonably strong in pointing to a potential preventive role. This is certainly an area where further experimentation would be worthwhile.
With regard to the lower-risk cases not open for services with CPS but referred to preventive services, the good news is that such services seem to be much more widespread today than in the past, reflecting the expanded availability of federal and other funds as well as the increased recognition that a one-size-fits-all investigative response will not meet the needs of all families referred to CPS. Nevertheless, challenges remain. Analysts have much to learn about what CPS agencies can do to support and monitor preventive programs to ensure that they are delivering effective services.39 They also have much to learn about coordinating services across the many types of community agencies that may play a role in prevention.40
Although the evidence base on preventive programs for lower-risk families remains fairly thin, with a few exceptions such as the results from randomized studies of the Nurse-Family Partnership program, programs and evaluations in this area are expanding rapidly. Both DHHS and the federal Centers for Disease Control and Prevention are actively reviewing program effectiveness and spurring states to commission and participate in program evaluations. It seems the nation may be on the threshold of an exciting new era in the provision of prevention programs. To take fullest advantage of the opportunities this expansion of interest is likely to offer, it is worth keeping a few principles in mind. The first is that if studies are to yield reliable evidence documenting that programs successfully prevent maltreatment, they must use randomized designs whenever possible and must measure maltreatment outcomes. The second is that policy makers must keep in mind the lessons learned from past efforts, in particular, the importance of dosage and family engagement. As tempting as it may be to cut corners and save dollars, there is no substitute for systematically implementing and evaluating promising interventions. If not, we could well find ourselves a decade from now with no more evidence on prevention in CPS than we have today.
