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AMA Denounces CPS
October 5, 2010 permalink
The Journal Archives of Pediatrics & Adolescent Medicine, a publication of the American Medical Association, has, in subdued academic language, denounced the current child protection regime as ineffective. The article and editorial are behind a paywall, enclosed below is a press release.
Child Maltreatment Investigations Not Associated With Improvements in Household Risk Factors
Newswise — Household investigations for suspected child maltreatment by Child Protective Services may not be associated with improvements in common, modifiable risk factors including social support, family functioning, poverty and others, according to a report in the October issue of Archives of Pediatrics and Adolescent Medicine, one of the JAMA/Archives journals.
“A Child Protective Services (CPS) investigation, regardless of outcome, signals a household at risk,” the authors write as background information in the article. “In the years following CPS investigation, households are at increased risk for family violence and parental dysfunction, for child medical and behavioral problems, and for future incidents of maltreatment when compared with households not investigated by CPS.”
Using data from the Longitudinal Studies of Child Abuse and Neglect, Kristine A. Campbell, M.D., M.Sc., of the University of Utah, Salt Lake City, evaluated a total of 595 children between the ages of 4 and 8 to evaluate if a CPS investigation for suspected child maltreatment is associated with subsequent improvements in household, caregiver and child risk factors. The authors used data from interviews conducted with the children’s maternal caregiver first when the child was 4 years old and again at age 8.
Of the 595 children included in the study, 164 (27.6 percent) had a CPS investigation occur between the first and second interviews. Those in the investigated group experienced an average of 2.2 CPS investigations (with a range between one and nine investigations) during the time of the study. The investigation occurred an average of 18.7 months prior to the interview conducted at 8 years. Additionally, the investigations “resulted in at least one substantiated finding of child maltreatment between the interviews at ages 4 and 8 years in 74 investigated subjects (45.1 percent).”
The authors also found that during the interview at age 4, households of children in the investigated group had lower family function and more poverty than households of non-investigated children. Maternal caregivers of investigated children were older, had less education and had more depressive symptoms than caregivers of children in the comparison group. Investigated children also were more likely to be white and to have had previous CPS investigation. Analysis of interviews conducted at age 8 found that a CPS investigation was associated with higher levels of poverty, maternal depressive symptoms and child behavior problems.
The findings “identified no significant difference in social support, family function, poverty, maternal education and child behavior problems associated with CPS investigation. Maternal depressive symptoms were worse in households with a CPS investigation compared with those without an investigation.” Based on these findings, the authors conclude that this study “provides an important perspective on the association between a CPS investigation for suspected child maltreatment and subsequent household, caregiver and child risk. Our finding that CPS investigation is not associated with improvements in common, modifiable risk factors suggests that we may be missing an opportunity for secondary prevention.”
Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: Child Protective Services Has Outlived Its Usefulness
“The concept of Child Protective Services (CPS) was idealistic when it first came into being in the early 1970s,” writes Abraham B. Bergman, M.D., of the University of Washington and Harborview Medical Center, Seattle, in an accompanying editorial. “Initially the task of identifying non-accidental trauma was relatively straightforward because it was the classic ‘battered child’ that was among most frequent diagnoses.”
“Much has changed in the child welfare field over the past 40 years, notably the types of child maltreatment seen and the explosive growth of the foster care system,” Dr. Bergman continues. “How has CPS responded to these changed responsibilities? Not well, according to this study by Campbell and colleagues in this issue of the Archives.”
“This gloomy prognosis notwithstanding, the changed picture of child maltreatment in the United States demands, at the very least, that we begin a wide-ranging discussion and testing of alternative responses.”
Editor’s Note: Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc.
Source: Newswise, Inc
Here are the first 150 words of the editorial:
The concept of Child Protective Services (CPS) was idealistic when it first came into being in the early 1970s. Following the lead of Henry Kempe and colleagues at the University of Colorado, pediatric centers began putting together multidisciplinary teams to evaluate infants and children with suspected inflicted injuries. Initially the task of identifying nonaccidental trauma was relatively straightforward because it was the classic "battered child" that was among most frequent diagnoses. (That is, the classic picture was an infant or child with multiple fractures incurred at varying ages, often coexisting with failure to thrive, and a mother who was depressed. It would be 1 or more decades before other forms of maltreatment like sexual abuse, Munchausen by proxy, and intimate-partner violence were "discovered.")
Management after the diagnosis was confirmed, however, was quite another matter. Few police personnel were capable of investigating a hitherto unknown entity, and . . .
Source: Arch Pediatr Adolesc Med
Addendum: Richard Wexler turns on the sarcasm to blast this study. He refers to a WNYC interview with study authors Kristine Campbell and Mike Arsham (mp3).
Dept of DUH: Big new study finds CPS doesn't work
Brace yourselves: this is bound to come as a shock. A big new academic study, published in the Archives of Pediatrics and Adolescent Medicine finds that when you send a child protective services investigator into a home where there's already a lot of stress simply because the family is poor and then pull the children aside and ask traumatic questions, possibly throw in a stripsearch, and inspect every nook and cranny of the home to see if it passes some caseworker's white glove test – it doesn't make things better, and sometimes makes things worse.
They had to do a study to figure this out? In fact, as I told Time magazine's Healthland Blog, this study simply confirms what NCCPR has been saying for years: Child Protective Services won't be effective until it becomes Child Poverty Services.
But contrary to what one of the study authors suggested this morning on WNYC public radio, that doesn't mean you have to eliminate poverty to eliminate child maltreatment – though whoever does the first will come closer than anyone else to doing the second. You can make enormous strides simply by ameliorating the worst effects of poverty. Some examples are in our publication Thirteen Ways to do Child Welfare Right. (The WNYC interview is worth listening to for the comments of the other guest, Mike Arsham, executive director of New York's Child Welfare Organizing Project.)
Of course, the scenario I described above in which the investigator interrogates, stripsearches and then goes away, is far from the worst that CPS can do.
In other cases, the parents will be forced to jump through a series of hoops either to keep their children with them or to get them back. It's almost always a cookie-cutter “service plan” almost always requiring lots and lots of “counseling” and “parent education” while the actual problems of poverty are ignored. So the “services” only add more burdens to this family.
At worst, of course, the caseworker leaves with the child, throwing that child into foster care, and probably doing at a minimum, serious psychological damage to that child. Then, if the child is returned, the family has to heal from this, while it is still just as poor and just as stressed out as it was in the first place.
So why, exactly, is anyone surprised that this doesn't work? It is a testament to the love and resilience in many poor families that only one of the many variables measured in this study got worse.
A FEEBLE DEFENSE OF CPS
One of the more feeble attempts to defend CPS came from one Janice Warren, DSW at the University of Virginia in Charlottesville, who told MedPage Today:
"Many children are taken out of very dangerous living situations permanently based upon investigations conducted by CPS. CPS serves an essential front line of protection for the most vulnerable children in our society,"
In fact, very few of the 250,000 children taken from their parents every year are taken from “very dangerous living situations.”
That is clear from the results of many other studies, most notably two that compared more than 15,000 typical cases seen by CPS workers. Those studies found that children left in their own homes typically fared better even than comparably-maltreated children placed in foster care. That was true even when CPS agencies provided families with little or no help.
In other words, when CPS traumatizes a family and then goes away, it doesn't do any good. When CPS traumatizes a family and compounds the trauma with needless foster care, CPS goes from doing no good to doing a great deal of harm.
That doesn't mean no child ever should be taken from his parents; it doesn't even mean CPS should be abolished. We need an agency to protect the relatively few children in real danger. Rather it means that foster care is an extremely toxic intervention that must be used sparingly and in very small doses.
It also means that the threshold for initiating an investigation should be higher than an anonymous call to a child protective hotline. After all, if a big study of the fire department found that, after they left a house, it almost always still was on fire and sometimes the fire was worse, wouldn't we at least try to do more to curb false alarms?
SUGGESTIONS IN AN EDITORIAL
The study was accompanied by an editorial which recommended some solutions. The editorial argued that law enforcement should handle allegations of “abuse” on grounds that all abuse is a criminal act, and public health nurses should investigate “neglect.”
But there are problems with arbitrary distinctions between abuse and neglect. For starters, you're going to ratchet up the largely pointless sideshow debate about corporal punishment if you start sending the cops in every time a parent is accused of spanking a child too hard. Conversely, though they are very rare, there are forms of neglect, like deliberately starving a child, which are criminal – and much more serious than some forms of abuse. And what do we do when there are allegations of both, either against the same child, or even an allegation of abuse against one child and neglect against a sibling?
As for turning over some cases to law enforcement, nearly a decade ago, the State of Florida asked County Sheriffs departments to take over the investigative function of CPS workers. A few counties agreed. But nothing changed. The Sheriffs investigators made the same mistakes as the CPS workers, and rates of child removal generally didn't change.
But there is a better way to achieve the goals the editorial is getting at: “Differential response” in which when the allegation of maltreatment, whether abuse or neglect, is less serious, the response is an offer of voluntary help. Differential Response is discussed in this previous post to this Blog.
Differential response is somewhat different from what the editorial proposes. The editorial proposes using public health nurses, apparently based on the Nurse Family Partnership program. That is a very good program, but it is a primary prevention program, and it is strictly voluntary. In the cases discussed in the editorial, there's already been a report to a child protective hotline, and it is not clear if the editorial contemplates families having a right to say “no” when the public health nurse comes to the door.
ERRORS IN THE ARTICLE
There also are some disturbing errors in the article itself.
- Right at the outset, the article declares that “A CPS investigation, regardless of outcomes, signals a household at risk.” No, it doesn't. It might mean the household is at risk, it might not. Given how easy it is to start an investigation it may just signal a household being harassed by a neighbor or a spouse harassing a spouse. Given the way calls to hotlines spike after a high-profile case is in the news, it might simply be that there was such a case in the news, and some well-meaning neighbor, or someone who saw the family in a store and didn't like what he saw, overreacted.
Indeed, this University of Minnesota study (another study showing that comparably-maltreated children fared worse in foster care than when left in their own homes) also suggests that there may be very little if any difference between the impoverished families who come to the attention of CPS via neglect allegations and those who don't. It may be little more than random chance.
- There also is a claim that “Family preservation … services after investigation are not associated with reductions in repeat maltreatment or foster care placement.” That claim is flat wrong. Indeed, few interventions have a stronger “evidence base” than real Intensive Family Preservation Services programs. That evidence of success is summarized in our Issue Paper on that topic.
Source: Richard Wexler blog