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eyond CPS: Developing an ffective system for helping hildren in “neglectful” amilies

ichael S. Wald∗ tanford Law School

olicymakers have failed to address the neglect of eglect

ver the past 25 years, reports of phys- ical abuse and sexual abuse to child protective services (CPS) agencies

ave declined by 56% and 62%, respectively. oncurrently, domestic violence declined by ver 60%.

Unfortunately, there has been little or no

because of alleged neglect and the percent of children living in poverty. The numbers are alarming. In 2012, CPS agencies in the United States investigated allegations of child maltreatment involving over 3 million undupli- cated children, nearly 5% of all children. More than 70% of these reports involved allegations

ecline in two other factors affecting the well- eing of millions of children—the number of amilies reported to child welfare agencies

∗ Correspondence concerning this article should be addre uadrangle, 559 Nathan Abbott Way, Stanford, CA 94305, US

http://dx.doi.org/10.1016/j.chiabu.2015.01.010 145-2134/© 2015 Elsevier Ltd. All rights reserved.

ssed to Michael Wald, Stanford Law School, Crown A. Electronic mail may be sent to mwald@stanford.edu.

of neglect, although there were overlapping allegations of physical or sexual abuse in a por- tion of cases. (The number of “pure” neglect

Child Abuse & Neglect 41 (2015) 49–66

cases cannot be determined from available data.)1 Cases categorized as neglect accounted for 75% of substantiations and over 60% of all foster care placements. Especially troubling is the evidence, developed by Chris Wildeman and his colleagues, that at least 12% of all American children will have a substantiated CPS finding, usually for neglect, before they reach their 18th birthday.

Like the prevalence of neglect, the pro- portion of children living in poverty has not declined in the past 20 years. Although there have been variations over time, about 1 in 5 children live in families with income below the poverty level. Neglect and poverty have always been closely linked. As Dee Wilson recently observed, child welfare agencies in the United States are serving a large population of families who are not just poor, many of these families are on the verge of destitution, with yearly incomes less than half of the federal poverty standard.

Despite the prevalence of neglect as a basis for CPS interventions, many researchers and practitioners have asserted, for over 40 years, that there is a deep failure of policymakers to acknowledge the problems in “neglectful” families and take the steps necessary to meet the needs of their children—the “neglect of neglect.” These commentators contend that

public child welfare agencies and the general public pay less attention to neglect than to

1 Three million other reports were not investigated for reasons that are not clear. All of these numbers are approximations. They are drawn from the National Child Abuse and Neglect Data System (NCANDS), published by the U.S. Department of Health and Human Services and based on reports from states. Unfortunately, the inconsistency in reporting and labeling of data by the states makes the data very hard to interpret. The true incidence of any particular threat to children’s safety is not obtainable from any state or national data sets.

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physical or sexual abuse and are more toler- ant of neglect even in its chronic forms, even though chronic and or severe neglect may be more detrimental to a child’s health and devel- opment than physical or sexual abuse.

Commentators offer a variety of policy changes to address these perceived failures. Some experts call for a clearer definition of neglect that broadens the basis for CPS involve- ment. For example, Laura Proctor and Howard Dubowitz recently wrote, “We advocate defin- ing child neglect as any situation in which a child’s basic needs are not adequately met, resulting in actual or potential harm.” Others focus on expanding formal CPS intervention in currently reported cases. For example, Eliz- abeth Bartholet argues that there is a need for more CPS oversight of neglectful families and more removals of neglected children from their families. Advocates also call for reorganizing CPS policies and services so that they are bet- ter designed to meet needs of the children in the multi-problem families that are cur- rently brought to the attention of CPS agencies for neglect, especially in families evidencing chronic neglect. In contrast, other commen- tators have long contended that poverty is the primary cause of neglectful parenting and advocate poverty reduction as the core strategy for addressing the needs of these children and parents.

I agree that the current approaches for sup- porting children (and their families) reported to CPS for neglect are often quite deficient. There is solid evidence that the development of a substantial percentage of these children will be significantly impaired by the inability of their parents to provide minimally adequate care, nurturance, and support during periods

of their childhood, especially early childhood. Some of these children also face the threat of serious physical injury or sexual abuse because

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f their parent’s failure to provide adequate are or supervision. For most of these chil- ren, however, the major risks are to their cademic, emotional, and social development, ot their immediate safety. The majority of hildren reported to CPS as neglected have sig- ificant developmental problems, which may ave begun years before CPS involvement with heir families. As a group, these children are ess likely to succeed in school, more likely o engage in persistent delinquent activities, nd much more likely to experience physical nd mental health problems throughout life han other children from families in similar conomic circumstances who are not reported o CPS. Moreover, as Brett Drake and others ave reported, these outcomes do not differ ubstantially between substantiated and unsub- tantiated cases.

Under current policies, many of these chil- ren and families do not receive services until hey have been reported multiple times and the hildren’s development has been significantly ompromised. When they receive services, hese often are time-limited and insufficient o promote the children’s development or help heir families overcome the challenges they ace in providing adequate parenting.

Much more needs to be done. I take issue ith the proposed remedies, however. Defin-

ng the term neglect more clearly (which the roctor and Dubowitz definition fails to do: .g., what are basic needs, what types of harms, hat does potential mean?), or expanding the

cope of CPS involvement will not promote he development of most children currently eported as neglected. Neither would putting ore resources into the existing CPS system to

erve more children. (Resources are needed to

etter serve children who should be under CPS upervision.) To the contrary, CPS involvement hould be reduced as a means of responding to

“neglectful” parenting. CPS systems will never be able to meet the needs of most of these chil- dren and families and should not be the system responsible for so doing.

A pure income approach also lacks ade- quacy. There is a strong association between poverty and neglect, although most poor fami- lies do not neglect their children. These parents’ poverty must be addressed. Persistent or dire poverty itself is a threat to children’s safety. (Most poor families are not chronically poor; while at least 40% of families with children experience poverty at some point, typically this is for relatively short periods of time.) How- ever, income transfers alone will not enable most of these parents to alter the behaviors that harm their children’s development, or to escape poverty. An adequate approach must address these behaviors, while simultaneously address- ing parents’ income needs.

There are indications that the situation of poor children in multi-problem families has worsened over time. As I have detailed in sev- eral recent papers, as many as 20% of children in recent birth cohorts will experience seri- ously inadequate parenting for at least a period of time during their childhoods, almost dou- ble the number who will have a substantiated maltreatment case. Perhaps 4%-5% will suf- fer from chronic inadequate parenting. Recent studies have found that “neglectful” parents, to an increasing degree, experienced inadequate parenting during their childhood and live in areas of concentrated poverty, both urban and rural.

A new approach is needed, one that focuses on providing a realistic system of services for engaging and helping these families, a system that will be accepted by policymakers and the

public. I propose here an alternative approach, embedded in the health and education systems, that focuses on facilitating positive parenting

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from the time that a woman becomes pregnant, rather than the remedial and limited efforts that are inevitably associated with reliance on child welfare systems.

I first examine three outcomes for children that generally are the goals of public pol- icy regarding children: (a) that children are physically safe during childhood; (b) that chil- dren develop the cognitive and socio-emotional capacities needed to become self-sufficient adults; and (c) that children experience a “reasonable” level of mental health, in both childhood and adulthood. Each of these out- comes is influenced by the quality of parenting a child receives, although other factors, includ- ing the resources provided to both children and families, greatly influence whether children attain these outcomes. I then examine which of these outcomes is the appropriate focus for CPS programs. I argue that CPS should be utilized when there is a need to protect children’s basic safety (being safe from physical harm caused by parental actions or inactions; being safe from sexual abuse; receiving adequate medi- cal care for physical or mental illness). Finally, I propose an alternative approach for helping all children attain the other outcomes.

Focus on Outcomes

In thinking about ways to strengthen par- enting, policymakers and child advocates need to start by focusing on the outcomes for chil- dren that society wants to attain through public policies and programs. When the quality of parenting appears to be a central barrier to whether a child is likely to attain a partic- ular outcome, policymakers should consider

which approaches and systems, including pub- lic health, education, and CPS, are most likely to be effective at strengthening parenting.

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Although state policies seek to achieve a number of outcomes or goals for children, three are primary. The first is child safety; it is a goal of public policy that no child should experience parental (or non-parental) care that substantially impairs her or his cur- rent physical safety. A second outcome that underlies almost all policies regarding children is economic self-sufficiency in adulthood; a central goal of most policies regarding chil- dren is to help them acquire the academic and social/emotional skills necessary to succeed economically in adulthood. A third outcome relates to physical and emotional health. Child welfare professionals frequently propose that public policies should be designed to max- imize the likelihood that children have a minimal level of physical and mental health throughout life. In the words of a commit- tee of the National Academy of Sciences, public policy should be designed to ensure that children will be provided with the types of care and resources needed for them “to live healthy, happy, and productive lives in caring relationships with others.” This goal clearly is a more ambitious outcome than safety or self-sufficiency, and public investments designed to achieve this goal are relatively lim- ited.

The various types of parental behaviors com- monly associated with “neglectful” parenting affect whether children achieve each of these outcomes. (The outcomes are interrelated.) But there are a number of ways of helping par- ents meet their children’s various needs. Which of these outcomes is the appropriate focus for CPS? I look next at this question.

The Role of CPS

The appropriate goals for CPS in respond- ing to various forms of inadequate parenting

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ave been debated for almost 60 years. The cur- ent structure of child welfare services began o take shape in the 1960s, following the pub- ication of “The Battered Child Syndrome,” ritten by Henry Kempe and his colleagues. he primary focus was initially on physical buse and later on sexual abuse, which were he concerns discussed in Kempe’s writing. A ajor change occurred in 1974, when the U.S. ongress enacted the Child Abuse Prevention nd Treatment Act (CAPTA). CAPTA offered tates funds to deal with child abuse. A critical rovision was that to receive federal support or its child protection system, the state must stablish a system for investigating reports not nly of physical abuse but also of neglect and erious harm to a child’s emotional or aca- emic well-being caused by parents or primary aregivers.

Thus the mandate for CPS was expanded onsiderably—even exponentially. In 1967, pproximately 10,000 cases of child abuse or eglect were reported to child welfare agencies. y 1975, nearly 300,000 cases were reported. ver the past 40 years, the reach of the child rotection system continued to expand to the urrent 3 million investigated reports each year. ases involving allegations of neglect have ccounted for most of this increase.

From the time of CAPTA’s passage, a umber of commentators, including myself, xpressed concern with the broadened defini- ion of neglect. At that time, while serving s the draftsman for the American Bar Asso- iation’s Juvenile Justice Standards Project, I rgued that the primary purposes of labeling arental behavior as maltreatment should be o allow the state to require reporting of the arent’s behavior, investigate the child’s home

nvironment, require parental participation in ervices, and, in some instances, terminate arental rights. Applying these criteria, I

proposed that CPS intervention should be lim- ited only to situations involving threats to a child’s physical safety, instances of sexual abuse, or situations where a child evidences serious physical or mental health problems but the parents are not willing to provide treat- ment. In these situations, the harm is clear, the parental behavior causes the harm, and supervi- sion often is needed to prevent recurrence of the parental conduct. Labeling this conduct mal- treatment also sends a clear social message that this parenting behavior is not acceptable.

I argued that other systems would be bet- ter able to help parents provide the types of care and interactions needed to promote the cognitive and emotional development of their children. Contrary to this recommendation, policymakers, largely by default, left the CPS system as the primary system with responsi- bility for dealing with all forms of inadequate parenting.

Looking at developments over the past 40 years, I continue to believe that CPS interven- tion should be limited to the types of situations proposed in the ABA Standards. Applying these criteria, the need for CPS involvement is clear with respect to situations involving parental sexual conduct with a child and many situations currently reported as physical abuse. The same is true with respect to “neglectful” parental behavior that could lead to serious physical harm, or when a parent fails to protect a child from sexual conduct with an adult. For example, a parent may fail to feed a child, home conditions may be so unsafe that a child has suf- fered serious physical injury or there is a high likelihood of such injury, a young child may be left unattended or in the care of other young children for lengthy periods of time in situa-

tions that pose a significant risk of injury, or the parent may fail to provide urgently needed medical care. When a child actually suffers

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serious physical injury as a result of parental inattention or unsafe home conditions, or when these actions clearly create a threat of immi- nent serious physical injury to a child, CPS involvement (at least in terms of investigation) is justified for the same reasons as in physi- cal abuse cases. Specifically, monitoring and supervision may be needed to protect the child from harm. Referral to CPS for a determination of risk also may be appropriate when there are indications of significant drug or alcohol use during pregnancy, because there is substantial evidence that this behavior is a strong predic- tor that the safety of the child is likely to be compromised.

In contrast, utilization of CPS is not a desir- able approach to help children where the need for state services rests primarily on helping children to achieve self-sufficiency as adults or where parent–child interactions threaten children’s long-term emotional or social devel- opment. I am not arguing that society should do nothing to address situations where the quality of parenting is clearly diminishing the likeli- hood that a child will develop the capacities needed for self-sufficiency and/or emotional health. It is morally unacceptable to do nothing to help the millions of children in households where the quality of parenting is likely to impair their long-term development. The policy chal- lenge is determining the most effective way to help these parents provide basically adequate care and to support their children’s develop- ment.

If our society really wants to promote the developmental needs of most of the children in families currently reported for neglect, this goal is not likely to be achieved through use of CPS systems. Proponents of broader CPS

intervention acknowledge that no current CPS system has the capacity to promote the long- term development of most of the children who

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receive services through the child welfare sys- tem, although intervention often does prevent continuation of physical or sexual abuse and other immediate safety threats. Numerous stud- ies find that children who receive commonly available services provided or funded by child welfare agencies do not generally fare better developmentally than those who do not.

These commentators contend, however, that CPS intervention can be made effective by defining neglect more clearly and broadly, providing more resources to CPS agencies, expanding some apparently effective program models for working with high-need families, and greater use of CPS as a connector to other services through alternative or differ- ential response. Some also argue that most neglecting parents need CPS or court oversight in order to prod them into taking the actions needed to address the factors that are affecting their parenting (e.g., substance misuse, domes- tic violence).

These claims are unpersuasive. Let us be realistic. Most CPS agencies lack the capac- ity to help those families and children that currently receive services, let alone provide high quality services to several million more children and families. There is no basis for believing that CPS is likely to receive substan- tially more resources, that a few small model programs that have been successful in work- ing with parents in child welfare settings can be taken to scale, or that CPS will come to be seen by most parents and the community as a positive resource. The need to better address the situation of children in families that face multiple barriers to providing consistent care and attention has been a focal point of scholars, practitioners, advocates and reformers for more

than 50 years. Numerous new approaches have been proposed, including three reports issued by the U.S. Advisory Board on Child Abuse and

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eglect in the early 1990s. With the exception f some recent efforts by the Obama Admin- stration with respect to expansion of home isiting, policymakers have not responded in ny significant manner. It is not going to hap- en. There also is no persuasive evidence that ost of these families will respond only to

hreats. To begin with, as Dee Wilson has written,

CPS programs were not designed for chronic eglect that does not meet a threshold for physi- al danger. . .. Child welfare agencies are often t a loss for what to do for children in these amilies who may not be in physical danger, but ho experience cumulative developmental and

motional harm resulting from chronic neglect f their basic needs, including lack of nurtu- ance.” The child welfare system is designed o investigate allegations of specific parental ehaviors that threaten children’s safety and to ry to prevent the recurrence of these behaviors ver a relatively short period of time.

This approach is not adequate to help most f the children who come to the attention of PS through neglect allegations. The major

hreat to most of these children is not a specific ction or inaction, such as lack of supervision. ather, the harm comes from the stress and

nconsistency in the home environment and the ervasive failure of the parents to respond con- istently to the child’s physical and emotional eeds. As documented by Norman Polansky nd others, in these households, there may e chronic understimulation, limited caregiver esponsiveness or nurturance, extreme lack of ttention to children, and/or high levels of fam- ly conflict. Some of the parents (the extent is ot well-documented) suffer from depression r other mental health problems and/or may be

ependent on drugs or alcohol. Helping many of these parents acquire

he skills necessary to meet their children’s

basic development often requires intensive, expensive high-quality services. In some per- centage of families of chronically referred families, there will be a need for such services over a lengthy period of time. These families also need a regular source of adequate income. CPS agencies do not control the health, educa- tion, financial, and other community resources needed to work with multi-problem families. Even assuming that having CPS involved with a family for a long period is desirable, it is extremely unlikely that the federal government or many states are going to change the statutory mission of CPS in fundamental ways. Nor is it likely that legislators will mandate integrated approaches among multiple systems guided by CPS. The health care and education systems are far better situated to compete for the needed resources and personnel and to take a lead role in coordination of services.

Even with respect to its basic mission, CPS systems throughout the United States experience great difficulty in helping the seri- ously endangered children who are currently in the system; the same appears to be true in other countries. Despite a variety of legislative efforts, lawsuits, and foundation investments aimed at improving systems, most states still have a long way to go in meeting children’s basic safety needs. For example, in just the past two years, the child welfare systems in Arizona, Colorado, Florida, Oklahoma, and Los Ange- les have been found to be woefully deficient by political and community leaders, an old story in child welfare reforms around the country (and world).

I hope that legislators can be persuaded to provide the additional funding needed by child welfare agencies if they are to protect

children subjected to, or threatened with, seri- ous physical harm or sexual abuse. In these cases, agencies also should provide services

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designed to meet the children’s developmental needs. There is no realistic prospect of budget increases to child protection agencies sufficient to allow them to develop high-quality programs for addressing the needs of a million more families than currently receive child welfare services. As a practical matter, CPS agencies are competing with schools, preschool and afterschool programs, and health care orga- nizations for limited public funds targeted at supporting children. There are not enough resources to fund all of these demands, and the health and education systems are far better situ- ated to compete for funds. The same is true for personnel. Child welfare agencies have trou- ble hiring and retaining qualified staff, creating adaptable organizational structures, keeping stable leadership, and maintaining political support. Recruitment and retention of child protection caseworkers has been made more challenging with the expansion of preschool and other children’s programs, because CPS must compete for personnel with these better- funded and better paying programs.

Relying primarily on CPS to promote the developmental needs of children experiencing inadequate parenting inevitably means missing many children who need help. CPS interven- tion is a haphazard means of helping children and parents because CPS can only respond to situations reported to the public agency. Moreover, state and locally run CPS systems vary greatly in coverage. Reporting rates range from more than 1 in 10 children each year in the District of Columbia and West Virginia to fewer than 5 per 1,000 each year in Hawaii and Minnesota; substantiation rates also vary widely. Differences in reporting and substanti- ation rates appear to be unrelated to differences

in family characteristics in the states. States also differ in the attention paid to neglect. For example, the percentage of total substantiated

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cases with a neglect finding ranges from 100% in New York to 20% in Kansas. Given the historical American preference for local gov- ernance, particularly with respect to family and child issues, there is little possibility that Congress will create a system with more uni- form standards for intervention and services.

Aside from the issues related to resources and capacity, there is the problem of framing. The CPS system does carry a moral message, and in some respects it should. Recently four authors wrote in this journal that “members of the British public have come to recognize that child maltreatment is both highly prevalent and morally reprehensible.” Although many case- workers offer support to parents and services, blame is often in the minds of the parents, the community, and many caseworkers when a child is labeled maltreated.

Although it may be desirable for the public to believe that hitting a child in a manner that can cause severe injury or using a child for sex- ual purposes are morally reprehensible actions, such opprobrium should not be the goal with respect to most of the parental behaviors that are labeled neglect. Most of these parents are not intentionally doing things that hurt their children, such as severe physical mistreatment or using them as sexual objects. Categorizing most of the types of inadequate parenting that now comes to the attention of CPS as morally blameworthy is conceptually wrong and often counterproductive. As detailed by the U.S. Advisory Board on Child Abuse and Neglect in its reports Creating Caring Communities and Neighbors Helping Neighbors and demon- strated by projects like Durham Connects and the Harlem Children’s Zone, community involvement must be a central ingredient in

efforts to promote the long-term well-being of children in high need. Just labeling par- ents as neglectful may negatively influence

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ommunities’ willingness to invest the esources needed by the parents. Thus, CPS urisdiction may actually decrease public upport for assistance to children receiving nadequate care.

In addition, CPS intervention in situations n which the parenting is not threatening the hildren’s basic safety—but is compromising heir cognitive and emotional development—is ikely to be highly arbitrary and to place a dis- roportionate burden on the poor. There are hildren in families of all income levels who xperience serious emotional problems. Poor arenting in higher-income families (such as lcoholism, inattention, and high levels of fam- ly conflict) can contribute to these problems, ut these families are unlikely to be reported o CPS. Fortunately, many (but by no means ll) higher-income parents can afford to obtain elp, which they do seek, in addressing their ersonal problems and their children’s difficul- ies. The same types of services must be made vailable to low-income families, but building ublic support for an adequate system of men- al health services is not likely to happen if he parents are viewed through a maltreatment ens.

Finally, I have doubts about the claim that PS supervision and the threat of losing cus-

ody of their children is an essential element n inducing highly disorganized parents to ddress their needs. This claim rests in part n the assumptions that the vast majority of amilies reported as neglecting suffer from rug or alcohol abuse and that people who are rug-dependent will not respond to voluntary reatment. It is difficult to determine the portion f the parents reported for neglect who suf- er from major drug abuse or alcoholism. It is

ndoubtedly very high with respect to reports nvolving infants because these reports often re based on substance use during pregnancy

or at the time of the baby’s birth. The per- centage of parents who abuse substances has not been reliably measured in cases involving older children. However, there is no evidence supporting the common claim that substance abuse is involved in 80% of these families (the best available evidence would put the number at 20%–30%).

In addition, although there is evidence that multi-problem families often do not follow through with services, several studies have found that they are initially willing to enroll in programs like home visiting and parent training. These families face many challenges surviving on a day-to-day basis. Some suf- fer from depression, which undermines their capacity to take action on their own behalf. But it is not clear that these parents are more respon- sive to services ordered by a court or overseen by CPS than they are to well-designed and com- petently administered voluntary services.

Is Safety a Major Issue in Reports of Suspected

Neglect?

I have been arguing that CPS involvement is appropriate when there is an indication that a child’s immediate safety (as defined above) is threatened, but not when the basic concern is with longer-term developmental issues. I would try to strengthen the parenting in the latter group of families through the new system that I am proposing. In order to focus CPS on the “right” cases, I would revise mandatory report- ing laws by greatly narrowing the definition of reportable harms; two possible definitions are included in the appendix.

Some commentators argue that most cur- rent reports of neglect, especially substantiated reports, involve threats of serious physical

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injury or sexual abuse, in addition to threats to the children’s long-term involvement. These commentators conclude, therefore, that neglect cases do require some form of mandatory inter- vention. Unfortunately, this claim cannot be clearly answered from the data drawn from the “neglect” cases now investigated or substanti- ated by CPS. States use varying, often vague, terminology in defining neglect. Therefore, summary statistics, such as those published annually in NCANDS, provide only a limited understanding of what is happening in these families. (The inability to establish a reliable system of data collection in the 40 years since the establishment of the National Center on Child Abuse and Neglect is another indicator of limited capacity to implement a competent and coherent child protection system.)

Proponents of CPS involvement in more neglect cases often cite the fact that more children die from neglect than physical abuse as evidence that neglect allegations generally entail the threat of serious physical harm to children. Approximately 1,600 children die as a result of parental abuse or neglect each year, with perhaps 900 of these from causes related to neglect. This number, however, constitutes less than 0.1% of the 2 million children named in investigated reports of alleged neglect. It makes no sense from a resource or targeting perspec- tive to expand CPS involvement in millions of more families as a way of trying to prevent some of these deaths. This point is especially true for the 60% of neglect cases involving chil- dren older than 5. The use and improvement of risk assessment tools is a better way of increas- ing the likelihood that children at real risk of serious harm will be identified.

Of course, an additional portion of reported

cases involve parental behaviors that could lead to substantial physical harm from abandon- ment, seriously inadequate supervision, failure

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to provide medical care, or other forms of gross inattention. Although it is not possible to deter- mine what percentage of reports fall in this category, several factors, including discussions with highly knowledgeable observers of the CPS systems, lead me to conclude that the fig- ure is no more than 20%.

First, even with respect to the approximately 600,000 substantiated neglect reports, about half of the families do not receive formal ser- vices. For whatever reason, the child welfare agency determined that there was not a suf- ficient threat of future harm to the child to require substantial CPS involvement. Fewer than 200,000 families (fewer than 10% of reported families) are placed under court super- vision, an indication that extensive monitoring is believed necessary to assure a child’s safety. It appears that court involvement is primarily invoked in situations where the CPS agency is requesting legal authorization for removal of children from the parents’ homes.

The risk of serious harm is likely to be even smaller in the approximately 2 million investigated neglect cases that are deemed unsubstantiated. I recognize, as Brett Drake and others have pointed out, that the fact that a report is not substantiated does not necessar- ily mean that there was no problematic parental behavior. The problem may relate to the inabil- ity of the agency to document the behavior. In addition, as Emily Putnam-Hornstein and oth- ers have shown, re-reports occur in as many as half of all unsubstantiated reports. The par- enting in these families often is dysfunctional in many ways that threaten the development of their children. However, it is far from clear that there is a serious threat to the child’s immedi- ate safety. The majority of re-reports are not

substantiated and, when substantiated, gener- ally do not lead to removal of the child. The child welfare system is unable and unwilling

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o place most of these children into foster care. oreover, foster care is not a good option for ost of the children. (It might be a needed

esponse with respect to families who per- istently fail to utilize the services I propose elow.) Again, I believe that society has a moral bligation to help all children reach the out- omes I have identified. These children and heir parents need an adequately funded, coor- inated set of services, designed to help the arents develop the capacities that they need oth to support themselves and to further the asic development of their children. However, his help should be provided outside CPS.

Differential Response

It might be argued that the concerns that have identified regarding CPS are being ddressed by the adoption in at least 30 states f a two-tier response system, generally called ifferential or alternative response (DR). Dif- erential response takes many forms. In some tates, the goal is to provide a more positive pproach to working with a portion of the fam- lies reported to CPS where there has been some orm of maltreatment, as defined by state law, ut where a full-scale investigation and/or CPS versight is considered unnecessary to protect he children from further harm. In other juris- ictions, DR is designed to provide services o families who would otherwise not receive ervices because the reports are not substan- iated. (There are mixed systems as well.) In

any DR systems, the vast majority of fami- ies assigned to a non-investigative assessment rack have been reported for suspected neglect.

Proponents view DR as a way of maintain-

ng broad reporting laws in order to identify ossible risky situations while allowing a less dversarial approach to families in situations

where the child does not appear to be in immediate danger of serious harm. DR also may allow for some surveillance. DR is sup- ported as major step towards better help for neglecting families and as a means to con- nect more families to services, even though the parental care has not been determined to meet the legal definition of maltreatment. How- ever, some critics see DR as inappropriately leaving many children unprotected. Such com- mentators want more formal, court-enforced intervention rather than referrals for voluntary services. In addition, they claim that DR often is funded with dollars that would otherwise be used to serve children and families in substan- tiated cases, so that those children are put at greater risk.

There is some merit to the claims of both sides. In some states, DR is providing needed services that families would otherwise not receive. It also seems likely that some children are exposed to greater risk of serious harm by the lack of a formal CPS investigation or CPS oversight, given the lack of conceptual clar- ity with respect to both the purposes of DR and the procedures that would be necessary to implement it in a sound manner. In addition, in some jurisdictions, DR does draw funding and other resources away from children who are appropriately under the supervision of CPS.

Even if DR were implemented so that it focused solely on situations that do not pose a risk of serious harm to children and was funded with additional dollars, I doubt that the services offered through DR could adequately address the needs of the children in the families I am discussing. In order to adequately help these families, there needs to be a well-defined set of services, with a dedicated funding stream,

clear mandates regarding outcomes, clear cri- teria regarding whom is served, a consistent theory of service provision, development of

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performance standards, and consistent data col- lection and evaluation. The funding stream should not take resources away from CPS agen- cies, which need more resources to protect children whose safety is at risk and who should receive services to promote their well-being once they are appropriately in the CPS system.

At present, DR in virtually all jurisdictions consists of a hodgepodge of local programs (a) that vary greatly in quality, approach, and effectiveness; (b) that do not provide the types and length of services generally needed to help highly disorganized families; (c) that are not preventive; and (d) that do not address the poverty issue. It seems very unlikely that DR can be transformed into the type of system needed for impoverished neglecting families. DR programs will not be given the resources that they need, and they rely too heavily on underfunded and inadequately staffed local programs. They are not designed for account- ability, and they cannot easily be transformed into programs containing the elements needed for continuous improvement. Thus, I would not try to extend the reach of CPS through DR.

A Different Approach

As I have mentioned, I estimate that as many as 20% of all children will experience seriously inadequate parenting at some point during their childhood. For at least half of these children, such inadequate care will occur before they reach age 5. Child advocates should push policymakers not to rely on the haphazard involvement of CPS but instead to develop and adequately support a set of services that help all children who are at high risk of experiencing

inadequate parenting. The new system should include active outreach to identify and connect with these parents, not just to provide services

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to parents who seek help. It must be combined with, and deeply rooted in, programs to address the disabling poverty in many of these fami- lies. Because many such families are reluctant to engage in and complete services, the system may need to include some incentives for par- ticipation, conditional on the level of parental participation and behavioral changes.

I outline here an approach focused on parents with young children, especially newborn and toddlers. Children younger than 5 account for nearly half of all neglect reports. A recent study by Emily Putnam-Hornstein found that 5% of all children born in California between 2006 and 2007 were reported to CPS before they reached their first birthday, in virtually all cases because of neglect or the threat of neglect. Most received no services. The period from concep- tion to age 5, especially from birth to age 3, is particularly important from a developmental perspective and for children’s brain develop- ment. The quality of parent–child interactions plays an especially large role in children’s development during this period.

In order to minimize the need to cre- ate new organizations and generate maximum political support for expanded services, the system would build on two national pro- grams that currently serve vulnerable parents and children: the Women, Infants, and Chil- dren Program (WIC) and Early Head Start (EHS). Both of these programs have political support and a strong infrastructure. The sys- tem would also include home visiting (HV) or some other widely adopted support pro- gram for parents with newborns; HV is now available to a substantial number of fami- lies in many states and has a federal funding base. Utilizing these nationally supported pro-

grams, which are funded with health and education dollars, would facilitate the devel- opment of a more uniform set of programs

Child Abuse & Neglect 41 (2015) 49–66

w f m p

p v p a l t w v m e s t v c i H b p c

m d s i a t f

p i p p h d p i

ith quality standards, technical assistance, ederally-supported research and, I hope, a ore reasonably secure funding base than is

ossible using social service dollars. WIC would be provided to all low-income

regnant women and new parents. WIC ser- ices would be expanded to offer a range of ositive support programs to pregnant women t high risk of experiencing parenting prob- ems. These women would then be connected hrough WIC, during pregnancy or at birth, ith access to home visitors, who would pro- ide parenting support and education directly, onitor the quality of parenting, and help par-

nts who need additional support access other ervices. (HV would be made available at birth o women who did not access WIC.) Home isitors also would connect parents with edu- ation and training programs designed to work n coordination with the parenting activities. V services also could be used for referrals y pediatricians and others who are aware of arents who seem to be providing inadequate are.2

The third component of this system would ake Early Head Start available to all chil-

ren in low-income families. This eligibility tandard would encompass virtually all fam- lies of young children now reported to CPS s neglected. Again, there would be a need

o redesign some aspects of EHS, so that the ocus would be as much on the parent as the

2 There are other possible approaches to provision of arenting support that might be less expensive, easier to mplement, and more successful at engaging high-risk arents than has been the case with many home visitor rograms. For example, Larry Aber and his colleagues ave suggested that pediatricians be at the center of the elivery system and that parents be encouraged to partici- ate in less intensive parenting programs than is common n HV.

child. There are a number of successful local programs that can serve as models for the system.

As Jack Shonkoff and others have elabo- rated, the programs provided through WIC, HV, and EHS should focus on helping parents to acquire capacities in self-regulation, planning and problem-solving, and stress management. These capacities are often inadequately devel- oped because of the parents’ own experiences in childhood.

Some parents will require more intensive ser- vices than can be provided directly through WIC, HV, and EHS. Professionals in these pro- grams would be charged with identifying such parents and linking them with other needed ser- vices. For example, referrals might be made to evidence-based parenting programs, such as SafeStart, PCIT, Triple P, and Incredible Years, which are designed to help parents acquire and maintain specific parenting skills. Some chil- dren may need to be placed in full-day, very high quality childcare, such as Educare, so that the parent can participate in intensive services for themselves. If such a system were in place, it would not be limited to serving only those par- ents identified during pregnancy or at the time of a child’s birth. Pediatricians and other pro- fessionals concerned about a child could refer the parents to both HV and EHS, which could then assess the types of services needed. This approach would be more focused and reliable than the current reliance on CPS workers to make referrals. Depending on local commu- nity resources, these services might be based in a family resource or community health cen- ter. (See Fig. 1 for a diagram of the possible operation of such a system.) Some states and localities are already developing systems along

these lines, often under the impetus provided by funding through The Maternal, Infant, and Early Childhood Home Visiting Program.

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Child Abuse & Neglect 41 (2015) 49–66

sed system

Fig. 1. Propo

States and localities’ capacity to develop coordinated services has been enhanced in many instances by advances in use of large, linked administrative data sets to monitor use of services and to develop risk assessment instru- ments to estimate the levels needed of various types of services. Such technology also can improve budgeting decisions.

Two questions that must be answered to make this system work are (a) how to address the income needs of the vast majority of target families and (b) how to motivate par- ents to engage in needed services. These problems need to be considered together. As Robert Halpern has described in detail, cop- ing with poverty creates major obstacles “to attentive and nurturant child-rearing.” Current

approaches to reducing poverty revolve largely around connecting all parents with jobs. This approach has had some successes, but many

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of services.

parents are not able to connect to the labor force on a consistent basis. The emphasis on work also interferes with some parents’ finding the time and energy to engage in activities relating to improved parenting.

One possibility is the adoption of a children’s allowance for low-income families, made con- ditional on certain parental behaviors. For example, the allowance might be obtained at WIC or pediatricians’ offices or during home visits and conditioned on regular pediatric visits or involvement with the home visitor. New York City is currently experimenting in using Conditional Transfers to influence parental behavior. A less extensive approach currently being tested is combining parenting education with “hard” services to parents. For

example, there are job training and parent- ing education programs being offered in many localities throughout the country, generally in

Child Abuse & Neglect 41 (2015) 49–66

c p c s e a h w n

e d s p i t i m g p e l b c p S c a i r v c p

i o C d H c t

oordination with childcare centers and other rograms, such as EHS and HS. There are many hallenges in developing a fair and effective ystem of implementation of contingent ben- fits. Nonetheless, we need new thinking to ddress the plight of the children living with ighly disorganized and/or depressed parents ho are often unresponsive to their children’s eeds. In addition, these programs should be

mbedded in community-wide initiatives esigned to engage parents, broaden the social upport network available to more isolated arents, and reduce the levels of toxic stress n the community. Some, perhaps many, hard- o-reach parents may respond more readily to nformal services offered by neighbors than to ore formal programs. Moreover, facilitating

ood parenting requires more than teaching arenting skills. Parenting is influenced by, and mbedded in, the community in which a parent ives. In addition, community programs may e able to generate a greater level of public oncern with the problems that inadequate arenting poses for children’s development. uch initiatives may also be able to generate learer community standards for minimally cceptable parent care. Finally, community nitiatives may make childrearing easier by educing the need to cope with an unstable, iolent social environment, a particularly hallenging task for parents who start with oor coping skills.

There are at least four promising models for ncreasing community engagement in support f parenting: Durham Connects, the Harlem hildren’s Zone, Strong Communities for Chil- ren, and Triple P. Durham Connects and the CZ also provide mechanisms for delivering

oordinated services, a constant challenge at he local level.

The Conundrum

I suspect that proponents of paying more attention to neglect within CPS would sup- port the type of system that I am proposing; many have called for expansion of the pro- grams I identify. However, they also would like to expand services within or connected to CPS. Some believe that the CPS system is the only one with the authority to change some parents’ behaviors, which may be true with respect to a portion of the parents, especially those with substantial drug addictions. Others may sup- port full reliance on an alternative system, but only if the current jurisdictional standards for CPS remain in place until the new system is fully developed and implemented. Otherwise, they fear that too many children will be left unprotected.

In the absence of an alternative system, con- striction of reporting laws and a decrease in the number of investigations would undoubtedly leave some children (a very small percentage, I believe) at greater risk of experiencing serious physical harm. It also might mean that little to no attention is paid to some of the chil- dren living with parents who are chronically unable to provide basic nurture and atten- tion. It is certainly true that there are people raising children who do not have the capac- ity to manage their lives, let alone provide the support that children need, and that these parents often fail to engage in available ser- vices.

Moreover, the proposed system would require major changes in most WIC and EHS programs and some HV programs. As even expert practitioners have reported, these are not easy families to work with, even

for very high quality programs with well trained staff. Many HV and EHS programs are

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aware of this challenge, and they are exper- imenting accordingly with new approaches. Full implementation of the proposed sys- tem would be expensive, because any set of new services, even if part of a coordi- nated system of delivery, will have limited success in producing better outcomes for children unless the services are of high qual- ity.

Given these challenges, some urge policy- makers to adopt a slow, cautious approach. These commentators would wait for the results of the various research experiments now evalu- ating various alternatives, and they would strive to improve DR and other CPS services at the same time.

Despite the risks involved in “starting at scale,” I believe that an incremental approach is not sufficient. Children’s advo- cates, including the U.S Advisory Board on Child Abuse and Neglect, foundation com- missions, and organizations like Zero to Three, have been calling for new approaches for many years. Nonetheless, despite some progress, the services currently available are insufficient in both quantity and quality. As a result, millions of children are grow- ing up under conditions that decrease the likelihood that they will have “decent” child- hoods and that they will live reasonably adequate emotional and economic lives as adults.

Reliance on prevailing reforms is likely to offer them little relief. Current policy ini- tiatives for assistance to children emphasize increased access to preschool and improved quality of K-12 education. These services will benefit many children from low-income, low- education homes, but they are unlikely to

help the 15%-20% of young children in dys- functional families. Instead, greater availability of preschool and improved quality of K-12

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education are much more likely to benefit children living in families that have limited income but in which parental care is gener- ally adequate (about 30% of all children in my estimates).

Moreover, experimental research generally requires many years and often does not yield clear policy directions. There has been little progress over the past 40 years in altering the situation of the worst-off 20% of children. Waiting for more knowledge likely means little change in their well- being.

Given the urgency and magnitude of the problem, child advocates should unite behind a set of programs. They should urge policymakers to enable adoption of some version of the system that I have outlined at scale. Then advocates and administra- tors should join to improve the system over time.

I also would alter reporting laws so that CPS focused only on the most serious cases. CPS agencies do not have resources to handle addi- tional cases. The savings that would accrue from elimination of CPS’s obligation to inves- tigate millions of reports that will not lead to CPS services in any case could be used to ful- fill the developmental needs of children who have experienced serious physical harm or sex- ual abuse. Hard choices must be made. If there is to be any real hope of improved outcomes for all children in multi-problem families, policy- makers need to understand that the CPS system is not helping—and indeed cannot help—most of these children.

American policymakers and the public seem to prefer parent-blaming over recognition of societal obligations to help all parents meet

their children’s basic needs, the approach that is common in most other developed countries. Children in the United States have no legal

Child Abuse & Neglect 41 (2015) 49–66

r d q s I r

ights to the resources needed for adequate evelopment—no rights to a basic income, uality childcare, truly adequate education, or afety in the neighborhoods where they live. ronically, children do not even have a legal ight to CPS protection, as the Supreme Court

Suggestions for Further Reading

Dodge, K. A., Berlin, L. J., Epstein, M., Spitz-Roth, A., O’Donnell, K., & Kaufman, M. (2004). The Durham Family Initiative: A preventive system of care. Child Welfare, 83, 109–128.

Halpern, R. (1999). Fragile families, fragile solutions. New York, NY: Columbia University Press. Polansky, N., Borgman, R., & DeSaix, C. (1972). The roots of futility. San Francisco, CA: Jossey Bass. Putnam-Hornstein, E., Webster, D., Needell, B., & Magruder, J. (2011). A public health approach to child

maltreatment surveillance. Child Abuse Review, 20, 256–273. Shonkoff, J. (2014). A healthy start before and after birth: Applying the biology of adversity to build the capabilities

of caregivers in improving the odds for America’s children. In K. McCartney, H. Yoshikawa, & L. B. Forcier (Eds.), Improving the odds for America’s children (pp. 28–39). Cambridge, MA: Harvard Education Press.

Wald, M. S. (1975). State intervention on behalf of neglected children: A search for realistic standards. Stanford Law Review, 27, 985–1040.

Wald, M. S. (2014). Beyond maltreatment: Developing support for children in multi-problem families. In J. Korbin, & R. Krugman (Eds.), Handbook of child maltreatment (pp. 251–280). Dordrecht, Germany: Springer.

Waldfogel, J. (1998). The future of child protection. Cambridge, MA: Harvard University Press.

ruled in DeShaney v. Winnebago Department of Social Services. It is time for change!

Keywords: neglect; inadequate parenting; child maltreatment; child protective services; child protection policy; system reform

Wilson, D. (2014). Preventing child maltreatment: How is ne from www.casey.org.

glect different? Sounding Board. April 2014 Retrieved

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Appendix. Possible Criteria for Authorization of CPS

Involvement

American Bar Association, Juvenile Justice Standards Project

The child (a) has no caring adult available and willing to care for her or him; (b) has suf- fered physical injury causing disfigurement or impairment of bodily functioning as a result of conditions created by his parent or the failure of his parent to adequately supervise him, or where there is a substantial risk that the child imminently will suffer death, disfigurement, or impairment of bodily functions as a result of conditions created by his parent or the failure

of his parent to adequately supervise him; (d) is suffering serious emotional damage, evidenced by severe anxiety, depression, or withdrawal

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or untoward aggressive behavior or hostility toward others, and his parents are not willing to provide treatment for him; (f) is in need of med- ical treatment to cure, alleviate or prevent his suffering serious physical or emotional dam- age, and his parents are unwilling to provide the medical treatment.

Department of Health, United Kingdom

The persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development. It may involve a par- ent or carer failing to provide adequate food, shelter and clothing, failing to protect a child from physical harm or danger, or the failure to ensure access to appropriate medical care or

treatment. It may also include neglect of, or unresponsiveness to, a child’s basic emotional needs.