Child Welfare: Overview
Abstract and Keywords
The mission of child welfare is multifaceted and includes: (a) responding to the needs of children reported to public child-protection agencies as being abused, neglected, or at risk of child maltreatment; (b) providing children placed in out-of-home care with developmentally appropriate services; and (c) helping children find permanent homes in the least-restrictive living situations possible; and (d) providing “post-permanency” services to children so they do not return to foster care. This section describes the mission, scope, and selected issues of major child-welfare-program areas.
Child Protective Services
Child maltreatment is the primary reason that parents and children are referred or reported to child welfare agencies for service. Approximately 3.4 million reports of child maltreatment were made to child welfare agencies in 2011 in the United States. The victimization rate for FFY 2011 was 9.1 per 1,000 children (U.S. Department of Health and Human Services’ [DHHS] Administration for Children and Families, Children’s Bureau, 2012a). Of those 676,569 substantiated (unduplicated count) victims, an estimated 1,570 children died from abuse and neglect during federal fiscal year 2011 (U.S. DHHS Administration for Children and Families, Children’s Bureau, 2012a, pp. ix, 56).
Many public and private child welfare programs and staffs are concerned with protecting children from some form of abuse or neglect by strengthening the ability of families to protect their children or providing an alternative safe family for the child. Child protective services staff (and in a few communities, law enforcement) investigate reports of child maltreatment and provide families with a range of clinical and “concrete” services to address family needs or problems as a way of preventing or treating child maltreatment (National Association of Public Child Welfare Administrators, 2009).
Family Support, Preservation, and Reunification Services
Although “family support” is sometimes used as an umbrella term for an array of child-maltreatment interventions, it more often refers to community-based services broadly intended to promote family and child wellness and stability (but not necessarily designed to prevent child maltreatment). Support services that are available to anyone qualify as “universal” prevention programs, whereas family support services aimed at families considered challenged or at risk, such as poor families, qualify as “selected” prevention (National Research Council and the Institute of Medicine, 2009).
“Family preservation,” or “family-based services,” as a distinct child welfare intervention targets families that are at relatively high risk of removal of the child or children (or families who need support for reunification with a child removed already). Child maltreatment or severe child emotional or behavioral problems have been identified in these families, and the goal is to prevent child-maltreatment reoccurrence or injury to the child or others. Case management, counseling, therapy, education, skill-building, advocacy, and concrete services—such as assistance in obtaining food, transportation, or safe housing—are provided (Allen & Tracy, 2009; Bagdasaryan, 2005; Nelson, Walters, Schweitzer, Blythe, & Pecora 2008; Walton, Sandau-Beckler, & Mannes, 2001). Most programs—such as Boys Town’s home-based services, Homebuilders, and Youth Villages Intercept program—are found in child welfare agencies, but these services are also provided in mental health centers and juvenile-justice programs (Henggeler & Sheidow, 2003; Pope, Williams, Sirles, & Lally, 2005; Walton, Sandau-Beckler, & Mannes, 2001).
As a result of child maltreatment or to help families address child behavioral problems that are severely disrupting family functioning, about 660,000 children every year are served in the U.S. foster-care system in family and nonfamily settings, with about 400,000 served on any given day. The number of children in foster care has been steadily decreasing since around 2010 (U.S. DHHS Administration for Children and Families, Children’s Bureau, 2012c).
Social workers are involved in all the major functions of out-of-home care, including emergency protection, crisis intervention, assessment and case planning, reunification, preparation for adoption, and preparation for independent living. To implement such functions and to meet the unique needs of different children on the basis of such factors as the nature of the problem, the age of the child, the reason for referral, the situation of the parents, and the intensity and length of service required, diverse forms of out-of-home care are required, including emergency foster care, kinship foster care, placement with unrelated foster families, treatment foster care, foster care for medically fragile children, shared-family foster care, and family group homes (Curtis, Grady, & Kendall, 1999; Pecora, Whittaker, Maluccio, Barth, & DePanfilis, 2009; Wulczyn, Barth, Yuan, Jones-Harden, & Landsverk, 2005).
Of the children in out-of-home care in 2011 with court-approved case plans (about 95% at any time), most have a plan for reunification with their parents (52%) or discharge to the care of other relatives (3%). The second-most-common plan is adoption (25%), followed by emancipation to independent living (5%) and guardianship (4%). In addition, long-term foster care is an option for a small number of youths (6%) for whom reunification with family and adoption are not viable permanency-planning options (U.S. DHHS Administration for Children and Families, Children’s Bureau, 2012c). Statistics on the characteristics of children in out-of-home care in the United States in 2011 reflect preliminary estimates for the out-of-home-care population as of July 2012, from the Adoption and Foster Care Analysis and Reporting System (U.S. DHHS Administration for Children and Families, Children’s Bureau, 2012c).
Family Foster Care
Traditional family-foster-home care, in which children are cared for by adults who are not related to them, remains the most common form of out-of-home care in the United States. In September 2011, 47% of children in out-of-home care (188,222) were living in nonrelative foster-family care. Family foster care meets the needs of children and youths of all ages and with a wide variety of needs. Since the late 1970s, specialized family-foster-care programs, such as treatment foster care, have been developed for children and youths with special needs in such areas as emotional disturbance, behavioral problems, and scholastic underachievement. These programs employ specially trained foster parents and caseworkers with lower caseloads than traditional family foster care (for example, Chamberlain, 2003; Foster Family Based Treatment Association, 2012).
Kinship Foster Care
Care of children by extended family members is quite common; in 2006, more than 6.1 million children in the United States lived in households headed by relatives other than their parents, who provided full-time care, nurturing, and protection (U.S. Census Bureau, 2006). In 2009 four percent of all children in the United States aged 0–17 lived without their parents, with the greatest proportion of caregiver’s being grandparents (59.4%), other relatives (18.1%), foster parents (8.9%), non-relatives (8.7%), and other relatives and non-relatives (4.3%) In 2009, a large number of children (2.5 million) were cared for by their grandparents (U.S. Census Bureau, 2011, p. 4), and the vast majority of these children lived with kin as a result of voluntary arrangements made by their families. Beginning in the 1980s, however, when federal reimbursement for out-of-home placement of children with kin was made comparable to reimbursement for nonkin placements, states began to use kinship foster care as a placement option for children in court-ordered out-of-home care (Hegar & Scannapieco, 1998).
In 2011, kinship foster homes provided care for 107,995 (27%) of the children in out-of-home care, making kinship care the second-most-common placement (U.S. DHHS Administration for Children and Families, Children’s Bureau, 2012b). Research has generally shown that children placed with kin experience greater placement stability than children in nonfamily settings but that they also spend longer time in care (Wulczyn, Kogan, & Harden, 2002; Wulczyn et al., 2005). Much remains to be learned about the best ways to support kinship foster parents and ensure the success of kinship-care placements for children, as some concerns have been raised about the child well-being outcomes of youths placed in kinship care (Geen, 2003; Hegar & Scannapieco, 1998; National Committee of Grandparents for Children’s Rights and the Empire Justice Center, 2011).
Residential Group Care
According to the Child Welfare League of America, the primary purpose of residential treatment services “is to provide specialized therapeutic services in a structured environment for children with special developmental, therapeutic, physical, or emotional needs” (Child Welfare League of America [CWLA], 2004, p. 20). Residential treatment centers and group homes are generally reserved for children and youths who are perceived as in need of services that cannot be provided in a family setting, though residential-care providers increasingly work directly with the families of children in their care (CWLA, 2004). Programs and services are provided in a wide range of settings, including community-based apartments, group homes, campus-based facilities, other self-contained facilities, and secure units. Two of the most dominant forms of residential care include campus-based residential treatment centers and community-based group homes. Youths placed in group care (group homes and residential treatment centers) comprised about 15% of those in out-of-home care in the United States, as of September 30, 2011. Specifically, 23,624 (6%) were placed in group homes and 34,656 (9%) were placed in institutions of some kind (U.S. DHHS Administration for Children and Families, Children’s Bureau, 2012c). Within these settings, children and families obtain a mix of services, including counseling, education, recreation, health, nutrition, daily living experiences, independent-living skills, reunification services, and aftercare services (Braziel, 1996).
Continuing the historical debate over the proper place of residential and family-based out-of-home care, recent critics have argued that there is little evidence that residential care is a superior alternative to foster care, particularly for children and youths with serious behavioral and mental health problems, and that it may be harmful to many (Noonan & Menashi, 2010; Poulin, Dishion, & Burraston, 2001). The group-care field responded by improving many aspects of intervention design, implementation, staff development, and evaluation (Courtney & Iwaniec, 2009; Noonan & Menashi, 2010; Whittaker, 2012; The American Association of Children’s Residential Care Agencies, 2011). In particular, the group-care field has made efforts to shorten the length of stay for youths in care, to involve family members more extensively in treatment, to help youths learn skills that they can use in the community (for example, how to manage their emotions and behaviors), and to conduct more extensive evaluation studies (Barth, 2005; Jenson & Whittaker, 1987; Kerman, Maluccio, & Freundlich, 2009; Pecora et al., 2009). As residential programs move forward to adopt and adapt many of the family-focused practice innovations incorporated in treatment foster care, wraparound services, and multisystemic treatment, it is critical that these efforts be accompanied by rigorous evaluations to ensure their relationship to the ultimate outcomes of interest: community adjustment and integration for children and youths returning home from care (Whittaker, 2006).
Independent Living Services
Each year, about 26,000 youths leave foster care through legal emancipation rather than through reunification with their families or adoption (U.S. DHHS Administration for Children and Families, Children’s Bureau, 2012c). In order to comply with the provisions of the John Chafee Foster Care Independence Program, states are required to provide foster youths with a written transitional independent-living plan. They can use the funds they receive through the program to provide a variety of services to foster youths in transition, including outreach programs to attract eligible youths, training in daily living skills, education and employment assistance, counseling, case management, and written transitional independent-living plans.
States can also use some of the Chafee Program funds for room and board, and in recent years, they have been able to support post-secondary education for youths through the Chafee education-and-training voucher program. In spite of these services, research on outcomes for foster youths making the transition to adulthood shows that too many still experience unfavorable outcomes, including limited educational attainment, unemployment, poverty, homelessness, mental illness, crime, and victimization (Courtney, Dworsky, Lee, & Raap, 2009; Pecora et al., 2010).
Adoption is a “social and legal process whereby a parent-child relationship is established between persons not so related by birth” (Costin, 1972). It provides an opportunity for children who have been orphaned, abandoned, or voluntarily or involuntarily relinquished by their birth parents to have a permanent family (McRoy, 2006). Over 2 million children under the age of 18 (2,072,312) were adopted and living in households in the United States in 2010 (U.S. Census Bureau, 2012, p. 2). There have been no recent public or private attempts to collect comprehensive national data on adoption, despite sporadic attempts since the 1970s (Kreider, 2003). For example, about 500,000 married or formerly married women between ages 18 and 44 were seeking to adopt children in 1995 (Chandra, Abma, Maza, & Bachrach, 1999). Social workers are involved in all forms of adoption, in both the private and the public sectors. For example, social workers counsel birth parents who are considering relinquishing a child for adoption, assess the needs of children available for adoption, recruit potential adoptive parents, perform assessments of the suitability of homes as adoption resources, and counsel adopted children and their parents.
The adoption of children who have been permanently removed from their parents because of parental abuse, neglect, or abandonment is typically handled through public child welfare agencies. According to the Adoption and Foster Care Analysis Reporting System (AFCARS) report, as of September 30, 2011, there were 104,236 children waiting to be adopted through public child welfare services and 49,866 children left out-of-home care in the United States through adoption in fiscal year 2009 (U.S. DHHS Administration for Children and Families, Children’s Bureau, 2012c). Although criteria vary across states, children in out-of-home care who are adopted and are members of a sibling group, members of a minority group, are older, or have an emotional, physical, or developmental disability are considered to be children with “special needs” under federal law, making their adoptive families eligible for federal adoption-subsidy payments. One concern is that too many children (more than 104,000 in 2011) wait for adoption while placed in foster care (that is, the child’s case goal is adoption or her parents’ rights have been terminated). For example, in federal fiscal year 2011, 40% of those adopted had waited a year or more to be adopted after the termination of their parents’ rights (TPR), and 14% had waited two years or more (U.S. DHHS Administration for Children and Families, Children’s Bureau, 2012c).
The practice of open adoption, or the continuance of contact or correspondence between the adopted child and his birth parents, is increasingly common. This movement began in earnest in the 1980s, and it has changed the face of adoption and the role of social workers. Today’s child welfare professionals must be familiar with clinical and policy challenges associated with open adoptions, which have largely replaced “secret,” or closed, adoptions. Contemporary social workers must be skilled with regard to various forms of contact among adoptees, birthparents, and adoptive parents, especially since the degree and nature of contact can change over time. Von Korff, Grotevant, and McRoy (2006) examined whether the degree of openness between adoptive- and birth-family members was associated with the behavioral and emotional adjustments of adolescents who had been adopted as babies. They recommend that openness arrangements be voluntary and that openness decisions be made on a case-by-case basis.
Child welfare social workers must also be familiar with the ongoing debate and controversy pertaining to adoptees’ access to their original birth certificates. Legislation has been introduced or passed in many states allowing adult adoptees to access their original birth certificates. Social workers throughout the United States have been very involved in this movement, which has been not universally accepted. (See Shireman, 2003; Evan B. Donaldson Adoption Institute website for a variety of materials: http://www.adoptioninstitute.org/index.php.)
Theoretical Frameworks Underlying Child Welfare Policies and Programs
While there is not universal agreement, a number of theoretical models appear to underpin many aspects of child-welfare-program design and policy: the ecological model (Bronfenbrenner, 1979, 1986; Cicchetti & Lynch, 1993), child development theories such as attachment theory (for example, Ainsworth, 1989; Weinfield, Ogawa, & Sroufe, 1997), trauma theory (for example, Briere, 1992; Cohen, Mannarino, Zhitova, & Capone, 2003; Cohen, Mannarino & Iyengar, 2011); social learning theory (for example, Bandura, 1977), and social support theory (Bailey, 2006; Whittaker & Tracy, 1990), and models of risk and protective factors (Fraser, Kirby, & Smokowski, 2004; Rutter, 1990). New developments in brain science, the impact of trauma on brain development, and epigenetics (study of changes in gene expression or cellular phenotype, caused by mechanisms other than changes in the underlying [inherited] DNA sequence such as environment and environmental stresses) are also being used to inform practice (Halfmann & Lindquist, 2010; Shonkoff, 2004; Stowers Institute for Medical Research, 2009; Tremblay & Harnet, 2008).
Trends, Challenges, and Debates
Imbalance in Funding and Emphasis Upon Placement
Most children placed in foster care come from poor families—often families that barely manage to survive on limited income from public-assistance programs (Lindsey, 2004; Pelton, 2011). Yet there is a great imbalance in funding between family strengthening and other forms of preventive services versus out-of-home care. Consequently, some critics argue that children are being inappropriately moved out of their homes, with insufficient efforts to help the parents to care for them (Lindsey, 2004; Walton, Sandau-Beckler, & Mannes, 2001). In recent years, advocates have proposed alternative funding schemes that would allow states to more flexibly use federal funding to meet the needs of children and families coming to the attention of child welfare authorities without resorting to out-of-home care (Casey Family Programs, 2010).
Innovation in Finding Permanent Homes for Children More Quickly
Agencies in Illinois, New York City, and other areas are making successful efforts to reduce the length of stay of children in out-of-home care, to reduce the level of restrictiveness of child placements, and to increase the proportion of children placed with relatives or American Indian members (U.S. DHHS Administration for Children and Families, Children’s Bureau, 2010). In addition, the number of children being adopted or securing a form of permanence through guardianship has increased since the late 1980s, as some states have significantly decreased the time to adoption (Avery, 1998; U.S. DHHS Administration for Children and Families, Children’s Bureau, 2012b). These innovations may expand further with new initiatives under way. These include child welfare demonstration waivers, expedited adoptive-parent assessments, expedited approvals of subsidy applications, increases in judicial personnel, and heightened attention by the agencies and courts to the need for more timely planning.
Family Group Conferencing and Decision-making
Family Group Decision Making (FGDM) is an umbrella term used to describe a variety of practice approaches to working with and engaging families in problem-solving. Many public child welfare organizations have elected to incorporate FGDM within their Child Protective Services program, while other agencies use FGDM at other key points in the service-delivery process, such as in determining when to reunify and to help prepare youths as they emancipate from foster care. Internationally, there are a number of models, known by different names, and they all share the common principle that families must be involved in the decision-making process in order to protect and assure the safety of their children. The main differences among the models relate to how much control the family has over the decisions made at the conference and the development of the case plan. It is difficult to determine exactly how many families have been served by this approach, but FGDM, Family Team Meetings, and other forms of family conferences are becoming widely used in child welfare agencies across the country. Some research provides evidence supporting the effectiveness of FGDM conferences over traditional services (Berzin, Cohen, Thomas & Dawson, 2008; Texas Department of Family and Protective Services, 2006), but few rigorous studies have been conducted.
Disproportionality and the Role of Race/Ethnicity in Policy and Practice
Child welfare agencies use the term disproportionality to describe the overrepresentation of some children of color in the child welfare system, relative to their proportions in the general population (Fluke, Jones-Harden, Jenkins, & Ruehrdanz, 2011; Hill, 2006). The terms disproportionality and disparity are sometimes used as if they were interchangeable, but they are not:
Disproportionality refers to the differences in the percentage of children of a certain racial or ethnic group in the country as compared to the percentage of the children of the same group in the child welfare system. For example, in 2000 black children made up 15.1 percent of the children in this country but 36.6 percent of the children in the child welfare system.
Disparity means unequal treatment when comparing a racial or ethnic minority to a non-minority. This can be observed in many forms including decision points (e.g., reporting, investigation, substantiation, foster care placement, exit), treatment, services, or resources. Research shows that children of color in foster care and their families are treated differently from—and often not as well as—white children and their families in the system. For example, fewer African American children receive mental health services even though the identified need for this type of service may be as great (or greater) for African Americans as for other racial or ethnic groups (Hill, 2006, p. 3).
In a more recent review of concepts, Wulczyn and Lery (2007) formulate a similar set of definitions. However, they are more precise in their use of the term disparities and define the term as “relative rates (i.e., the rate of placement per 1,000 African American children divided by the rate per thousand for white children)” (Wulczyn & Lery, 2007, p. 5).
The situation is complex. On one hand, based on interpretation of findings from the National Incidence Studies (NIS-2 and NIS-3), child welfare advocates and researchers assumed that children’s representation at each child welfare decision point should mirror their proportionate composition of the child population. One perspective, the NIS-4, however, challenged this assumption by concluding that African American children were at greater risk of maltreatment; Hispanic children had rates comparable to white children, and American Indian rates were not reported (Sedlak, McPherson, & Das, 2010). All NIS studies reported roughly similar differences across groups: variation in findings was because of differences in computed significance levels, likely an artifact of differences in subgroup sample sizes (Drake et al., 2011; Sedlak, McPherson, & Das, 2010; Sedlak et al., 2010). Thus this new evidence, showing that African American children have higher odds of poverty as well as higher rates of maltreatment, questions the prior assumption of some in the field that racial differences in rates of placement in and of itself is problematic.
Early reports (for example, Everett & McRoy, 2004; Roberts, 2002) and literature reviews since 2010 (for example, Fluke et al., 2011) outline a comprehensive view of the situation in which some child welfare agencies are recognizing that the outcomes reflecting numerical differences occur because of multiple factors, including greater needs among certain ethnic groups, and racially uneven services, including inequitable access to services. Indeed, recent work by Wulczyn (2011) showcased how, in certain communities, African American children had better permanency and other outcomes. Within child welfare services, there has been some evidence of unjust, unnecessary, or unequal treatment resulting from biased decision-making, institutional racism, and other related factors, which affect quality, access, and utilization of services (Fluke et al., 2011; U.S. Government Accountability Office, 2007; Wulczyn, 2008). So parent and family risk factors, community risk factors, and organizational and systemic factors may influence what services certain families receive, including foster care, and the relative effectiveness of certain strategies to improve racial equity (Lorthridge, McCroskey, Pecora, Chambers, & Fatemi, 2011).
Addressing the Needs of Sexual Minorities in Child Welfare Programs
There has also been relatively little attention directed toward sexual minorities involved in child welfare services. In the early 1990s, a special committee of the Child Welfare League of America called attention to the needs of gay and lesbian children and youths in the foster care system:
Because of negative societal portrayals, many gay and lesbian youths live a life of isolation, alienation, depression and fear. As a result, they are beset by recurring crises disproportionate to their numbers in the child welfare system. (Child Welfare League of America, 1991, p. 2)
Although attention is beginning to be given to their situations and needs, gay and lesbian children and youths continue to be poorly understood and underserved. Ongoing challenges for practitioners include appreciating the uniqueness of gay and lesbian adolescent development, helping the adolescents to negotiate life within a hostile environment, helping them to confront the consequences of breakdown of the family system, supporting gay and lesbian foster parents, and the lack of family support (Downs & James, 2006; Wilber, Ryan, & Marksamer, 2006; Wornoff & Mallon, 2006) and understanding the rights of lesbian and gay parents in regard to child custody and visitation (Mallon, 2007).
Foster Parent Screening, Recruitment, and Support
Some innovative approaches to permanency planning depend upon foster parents who can help the child maintain or develop healthy family connections. While many situations and children require a high degree of skill and patience on the part of the foster parents, there is a shortage of qualified foster parents (American Public Human Services Association, 2010; Barbell and Freundlich, 2001). Better recruitment and assessment must take place to best match child needs with foster parent capacities and strengths.
Continuing Emphasis Upon Accountability
ASFA included provisions to establish national performance standards for the federal government to assess states’ progress in maximizing the safety, permanency, and well-being of children receiving child welfare services. The resulting Child and Family Services Reviews have engaged the federal government in working with states to create a stronger focus on outcomes and results for children and families, providing technical assistance to assist states in improving their child welfare programs, holding states accountable for noncompliance with national standards (including fiscal penalties), and engaging the states in creating “program improvement plans” that are intended to improve outcomes over time. Unfortunately, state and county policies to promote evidence-based practice models and performance-based contracting have been hampered by a lack of knowledge of baseline conditions, sound target goals, infrastructure funding gaps, accountability frameworks, parsimonious performance dashboards, and a lack of information about what practice models are currently evidence-based (Freundlich & Gerstenzang, 2003; Testa & Poertner, 2010). In order to improve accountability in child-welfare-services provision, many child welfare agencies track output, quality, and outcome data carefully over time to implement a Continuous Quality Improvement approach to steadily improving practice (U.S. DHHS Administration for Children and Families, Children’s Bureau, 2010).
Improving the Relationship of the Child Welfare System to Other Systems
The efforts of multiple systems—such as public assistance, health, mental health, juvenile justice, substance abuse, and domestic violence—will be needed to address the major factors that bring families into contact with the child welfare system. For example, fragmented funding streams and policies fail to encourage effective treatment of comorbid (that is, co-occurring conditions) that are much more common in the United States than commonly thought (Cooper, et al., 2008; Kessler et al., 2005). Similarly, the changing nature of the public-assistance caseload in the wake of welfare reform may have increased the overlap between welfare-to-work and child-welfare-services populations, providing an opportunity for greater involvement of public welfare programs in supporting struggling parents (Brown, 2012; Courtney et al., 2005).
Increasing Adherence to the Indian Child Welfare Act and Improving Equity of Title IV-E Funding for Tribes
The Indian Child Welfare Act was intended to reduce the number of Native American children entering foster care, the majority of whom had traditionally been placed in non-Indian homes. The Indian Child Welfare Act, however, has been inadequately funded and unevenly implemented (National Conference on State Legislatures, 2011). As noted by Bending (1997, p. 151), “noncompliance, jurisdictional indifference, and culturally insensitive services have hindered full implementation” of the Act. Various authors propose specific child welfare training programs (Bending, 1997) as well as approaches for balancing child protection and family preservation in child welfare services for Native American children and families (Hand, 2006; Red Horse et al., 2000). The “Baby Veronica” case heard by the U.S. Supreme Court in early 2013 resulted in close scrutiny of some of the major provisions of the Act by the high court (see http://www.nicwa.org/babyveronica/).
As they have been doing since the beginning of the child-saving movement of the 19th century, child welfare practitioners still struggle with the often competing values and demands of protecting children while trying to preserve families. Although many child welfare programs are burdened, professionals, families, and advocates across the country are experimenting with new policies and procedures designed to ensure that children have safe and permanent living arrangements (U.S. DHHS Administration for Children and Families, Children’s Bureau, 2012b).
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