Beyond Common Sense

Child Welfare, Child Well-Being, and the Evidence for Policy Reform

Fred Wulczyn, Richard P. Barth, Ying-Ying T. Yuan, Brenda Jones Harden, John Landsverk

• Publisher: Routledge
• Year: 2017
• Print ISBN: 9780202307350
• eBook ISBN: 9781351327985
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Helping vulnerable children develop their full potential is an attractive idea with broad common-sense appeal. However, child well-being is a broad concept, and the legislative mandate for addressing well-being in the context of the current child welfare system is not particularly clear. This volume asserts that finding a place for well-being on the list of outcomes established to manage the child welfare system is not as easy as it first appears. The overall thrust of this argument is that policy should be evidence-based, and the available evidence is a primary focus of the book. Because policymakers have to make decisions that allocate resources, a basic understanding of incidence in the public health tradition is important, as is evidence that speaks to the question of what works clinically. The rest of the book addresses the evidence. Chapter 2 integrates bio-ecological and public health perspectives to give the evidence base coherence. Chapters 3 and 4 combine evidence from the National Child Abuse and Neglect Data System, the Multistate Foster Care Data Archive, and the National Survey of Child and Adolescent Well-Being to offer an unprecedented profile of children as they enter the child welfare system. Chapters 5 and 6 address the broad question of what works. A concluding chapter focuses on policy and future directions, suggesting that children starting out, children starting school, and children starting adolescence are high-risk populations for which explicit strategies have to be formed. This timely volume offers useful insights into the child welfare system and will be of particular interest to policymakers, academics with an interest in Child Welfare Policy, Social Work educators, and Child Advocates.

Part 1 Origins and Purpose

Introduction to Part 1

In this volume, we examine the use of child well-being as an outcome for children involved with the child welfare system. Until the Adoption and Safe Families Act of 1997 (ASFA) was passed, child safety and permanency were the two primary outcomes used to judge whether the child welfare system was fulfilling its responsibilities. Since the Adoption and Safe Families Act, well-being has moved closer and closer to the center of the debate guiding child welfare reform.

It should come as no surprise that attention would one day turn to the well-being of children involved with the child welfare system. Helping vulnerable children develop their full potential is an attractive idea because it has broad, common-sense appeal, especially if the government is providing alternative living arrangements for the children.

However, as is often the case when policy choices have to be made, finding a place for well-being on the list of outcomes used to manage the child welfare system is not as easy as it first seems. Holding a system accountable for outcomes assumes that the resources needed to influence those outcomes are available. Historically, the child welfare system has focused on the question of parental fitness—can the parents provide a safe and stable family for the child? Well-being is a much broader concept, influenced by factors that are often beyond the direct control of parents. Because family autonomy is closely guarded in the United States, the legislative mandate for addressing well-being in the context of the child welfare system is not particularly clear.

Despite the challenges, it is unlikely that the avowed interest in child well-being will wane. As we show in later chapters of this volume, the well-being of children involved in the child welfare system has to be a concern, given what we now know from the National Survey of Child and Adolescent Well-Being. Policymaking will move forward. The question is, what will the policies look like and how will the choices be defended?

With this volume, we offer one approach to this question. The book is divided into three parts. Part 1 explores the theoretical foundations for the argument. The main thrust of the argument, laid out in chapter 1, is that policy should be evidence-based. We note that two types of evidence are needed. First, because policymakers have to make decisions that allocate resources, a basic understanding of incidence in the public health tradition is important. Second, evidence that speaks to the question of what works clinically is also needed. In addition to evidence, policymakers, program planners, and child welfare workers need a working definition of child well-being. Contemporary theory focuses on bio-ecological and life course perspectives as a way to understand how children develop over time. The second chapter integrates the bio-ecological and public health perspectives so as to give the evidence base coherence.

The second and third parts of the book are devoted to evidence. In Part 2, chapters 3 and 4, evidence from the National Child Abuse and Neglect Data System, the Multistate Foster Care Data Archive and the National Survey of Child and Adolescent Well-Being is combined to offer an unprecedented profile of children as they come into the child welfare system. These data point to the fact that rates of involvement reveal strong developmental themes and that children who come in contact with the child welfare system have pervasive developmental challenges.

In Part 3, chapters 5 and 6 address the broad question of what works. Following the developmental theme established in the previous chapters, we focus the discussion on very young children and older children with behavioral problems. Infants are the children most likely to come in contact with the child welfare system, and any systematic attempt to improve the safety, permanency, and well-being of children in the child welfare system has to address the particular needs of children under the age of 1 and their families. Although fewer in number relative to infants, the needs of older children with mental health issues are striking. Meeting their needs for safety, permanency, and well-being means combining child welfare services with specialized mental health services that are not now widely available for children in the child welfare system.

The concluding chapter focuses on policy. The basic conclusion is that the child welfare system will have to partner with other service delivery systems in order to meet the challenge of improving well-being. Service integration is not a new idea. What the evidence suggests, however, is that simplistic models of service integration will not work. In order to connect child welfare services with those provided by other systems, the strategy has to focus on partnerships that are explicitly developmental in their structure. As a starting point, the data suggest that children starting out, children starting school, and children starting adolescence are high-risk populations for which explicit strategies have to be formed. The analysis also suggests the child welfare system ought to act as an advocate for children in high-risk situations, helping families get the services their children need. However, expectations that the child welfare system can be held accountable for those outcomes stretch the child welfare system well past its limited resources.

1 Beyond Common Sense to Evidence-Based Policymaking

Introduction

Safety and permanency are the two outcomes that have long guided policy and practice. With the passage of the Adoption and Safe Families Act of 1997, the list of outcomes expanded to include well-being. After Congress passed ASFA with overwhelming bipartisan support, the U. S. Department of Health and Human Services (HHS) declared unequivocally that “our national goals for children in the child welfare system are safety, permanency, and well-being” (Administration for Children and Families, 1998, emphasis added).

Common sense suggests that interest in child well-being is a positive, albeit belated development. Yet as of 2005, the Department of Health and Human Services had not incorporated any direct measures of well-being into the Child and Family Services Reviews (CFSR), the main tool used to monitor state child welfare programs.

Unfortunately for policymakers and practitioners, common sense does not always transform easily into practical reality. The reasons for this are easy to understand. Well-being is not a particularly well-defined outcome despite its common-sense appeal. The concept of well-being draws on a very different knowledge base, one that will have to be imported into child welfare before practice can be modified to reflect the latest thinking. Moreover, child welfare workers have had their hands full learning how to assure safety and permanency, often with very mixed results. Although a child’s well-being has to be considered as part of the safety assessment that follows a report of maltreatment, developing explicit assumptions and guidelines that account for how well-being unfolds under a variety of circumstances (including closing cases, providing in-home services, and placing children into foster care) is a significant and critical challenge. Designing interventions that expressly promote well-being is harder still. From a treatment perspective, research has so far struggled to find effective services for maltreatment, placement prevention, and family reunification (Littell & Schuerman, 1995; Macdonald, 2001). Designing services that influence well-being will not be easy (DiPietro, 2000).

Definitional issues are not the only challenges that go along with an interest in child well-being. Context and timing are always very important, and the child welfare system in the United States already faces numerous difficulties. Rates of reported maltreatment, following a period of decline between 1993 and 1999, have stabilized. Although the foster care population in some states started to fall in the 1990s, the downturn has not been observed everywhere. In addition, legal action taken against states over the past decade has tended to focus on the fact that casework practice, the linchpin of the system, is often substandard. On the policy front, the field is polarized by ideological debates that divide those who favor limited state intervention in the lives of families and those who would act more readily to protect the best interests of children (Bernstein, 2001; Roberts, 2002; Shapiro, 1999). Each side of the debate, aided mostly by hindsight, relies on a handful of anecdotes to illustrate what happens when the state acts too quickly to remove a child and what happens when the state does not act quickly enough. On top of it all, the system of federal financing favors placement in foster care even though the weight of legislative language resonates with a commitment to placement prevention.

In existing child welfare policy, well-being and its developmental correlates are not taken into account to any large extent. There are special federal programs that focus on developmental goals for abandoned infants and children aging out of foster care, but these are small programs within the context of the larger child welfare system. In other important ways, there is virtually no sensitivity to well-being or child development. For example, the Child and Family Services Reviews rely on a single undifferentiated standard for reunification and adoption, despite the fact that research has shown repeatedly that placement outcomes and age are linked. The rule that states must pursue the termination of parental rights once the child has been in care for 15 out of 22 months does not consider well-being as a factor, except for a reference to the child’s best interest, itself a vague concept in practice. The rule has no developmental referent—it applies whether the child is 15 days or 15 years old at the time of entrance into foster care—a pretty sure sign that its impact on well-being is not being carefully considered. In short, the child welfare system has a long history of one-size-fits-all solutions that ignore what is known about well-being and human development.

The field also lacks the information needed to promote the idea of well-being in a systematic, planful way. Until the mid-1990s, the federal government was unable to produce a reliable count of children in foster care based on individual-level data. Today, although the reporting of national statistics is dramatically improved, the published counts do not yet reflect any substantive appreciation for the idea of well-being. The lack of evidence is hampered by theoretical traditions that have given short shrift to the sort of developmental perspective required to understand well-being in the context of child welfare services. Without data and theory, it will be hard to organize information in ways that reveal the influence of human development on fundamental issues of service utilization within the child welfare system.

Finally, despite what common sense tells us about the importance of well-being in the context of child welfare services, it is not at all clear that the way we fund and regulate services can nurture a focus on a child’s well-being as the reason for intervention. Although federal funding for child welfare comes from a variety of sources (Bess, Leos-Urbel, & Geen, 2001), the policy framework that guides state intervention emanates from Title IV of the federal Social Security Act (Committee on Ways and Means, 2000). In historical context, the federal Title IV programs have been used to define how the state should respond when parents are unable to carry out their various responsibilities. Title IV-E, the program that provides federal funds for eligible foster children, rationalizes state action by focusing on a particularly narrow, sequential set of questions: Have the parents failed to protect the child? Have the parents been given an opportunity to demonstrate their ability to provide a minimum and sufficient level of care? Has the state done what it can to help the parents? And, should the state seek new caregivers for the child?

On the one hand, the federal safety and permanency outcomes fit this policy structure nicely. Good parents, even in tough circumstances, can protect a child’s safety; when parents themselves pose the safety threat, the state can step in and take whatever action it needs to take to protect the child. Permanency fits, too, because in the end the objective behind the permanency outcome has to do with establishing who will parent the child. Restoring the parents as the persons responsible for the child or finding new parents affirms the basic framework for allocating responsibility between the parent, the child, and the state (Mnookin, 1978).

On the other hand, pursuit of well-being outcomes strains the simplistic model at the heart of federal policy. Contemporary theories of child development link well-being to a system of bio-ecological influences that includes but is clearly not limited to parents and other family members (Bronfenbrenner, 1979; Elder, 1998; Rutter, Champion, Quinton, Maughan, & Pickles, 1995; Shonkoff & Phillips, 2000). The basic question behind state action–what should the state do when parents fail?—is inherently limited in the case of well-being because there is no easy way to acknowledge causal influences outside the parent-child dyad. If improved well-being is an objective, then a wider range of influences will have to motivate state action, and the solutions proposed will have to meet a wider variety of needs. There will be times when the traditional model of parent-child interaction will frame the intervention, but that will not be true in every case. Moreover, as time passes, we may find it is not true in a majority of cases that come to the attention of service providers.¹ A substantial proportion of reports are related to issues that bear on well-being, such as exposure to domestic violence, school nonattendance, and conduct disorders. For these children, the traditional rationale guiding child welfare programs will become increasingly anachronistic; the fit between federal policy and the everyday job facing caseworkers will become more disjointed; and long-term accountability within the child welfare system will suffer—precisely the opposite of the result intended.

How then does the child welfare field move beyond common sense and undertake a meaningful effort to weave well-being into the policy framework that guides the nation’s system of child welfare services? Our argument is based on the idea that child welfare policy ought to be evidence based, and that the evidence no longer supports the current design of child welfare services. In part, this can be attributed to the fact that the evidence available at times when policy was being made was not particularly strong. Major federal programs and rules have been developed based on single studies in single locations—often with weak methodology. It can also be attributed to the role ideology has played in the development of child welfare policy, as some have argued was the case with family preservation (MacDonald, 1994). In either case, the available evidence is growing in both quantity and quality, so it is time to make deliberate use of that evidence for policymaking.

As it applies to the practice of medicine, evidence-based refers to the “conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients” (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996).² The widening interest in evidence-based medicine is tied to several concurrent developments within health care, but the central motivation is the idea that patients should receive treatments that afford them the best opportunity for a positive clinical outcome (Whynes, 1996). A similar movement is underway with respect to psychological services in schools, behavioral health services, and child welfare services (Curtis & McCullough, 1993; Hoagwood, Burns, Kiser, Ringeisen, & Schoenwald, 2001; Strein, Hoagwood, & Cohn, 2003).

By evidence-based policymaking, we mean the conscientious, explicit, and judicious use of evidence when making choices that shape child welfare policy. For this purpose, a definition of evidence that stresses efficacy at the clinical level is a necessary, but one-dimensional, perspective (Rychetnik, Frommer, Hawe, & Shiell, 2002). Clinical evidence of the efficacy of child welfare services must be augmented by evidence pertaining to the scope of the problem—information about who uses services and about basic indicators of risk. Without this kind of evidence, resources cannot be allocated in proportion to demand. Evidence-based policymaking does not replace ideology, social values, or political expediency in the policymaking process (Black, 2001). Rather, answers to questions about who needs services, who uses services and what services work form an evidence base that adds structure to policy discussions that other approaches to policymaking cannot (Petticrew & Roberts, 2003).

By child welfare policy, we are referring to the laws and regulations that rationalize the mission and purpose of the child welfare system.³ Resource allocation (i.e., fiscal policy) is an important aspect of policy inasmuch as policy legitimates certain types of investment. Although there is a wide variety of government policy at the federal, state, and local levels directed at children and their families, our focus is on abused and neglected children and on federal policy. Although state and local policy initiatives often pre-date changes in national policy (Wulczyn, 2003), the federal government’s approach to child welfare issues sets an important tone. The approach adopted by the federal government to considering the fundamental issue of child well-being will be especially important in the years ahead as state and local governments interpret the federal mandate.

Frameworks for Interpreting Evidence

Two research traditions—the bio-ecological/life course perspective on human development and the public health approach to using observational data to understand the scope of a problem—provide frameworks for organizing evidence. The focus on developmental constructs in the bio-ecological/life course perspective highlights the fact that well-being is a dynamic, age-, and role-sensitive construct. In a developmental context, well-being is about transitions over the life course of childhood. For this reason, we use well-being and development interchangeably. (Chapter 2 will explore bio-ecological, life course, and public health perspectives and how they relate to defining child well-being and organizing empirical work.)

The public health perspective is associated with epidemiology, a basic science that reveals how social problems are distributed from place to place and over time. Because a principal aim of policymaking is deciding where, when, how, and toward what end resources should be distributed, the epidemiological study of child maltreatment and service use provides invaluable insights. Moreover, with its emphasis on multi-factor analysis, the eco-epidemiological ...

Table of contents

• Cover Page
• Half title
• Title
• Copyright
• Contents
• List of Tables and Figures
• Acknowledgements
• Part 1 Origins and Purpose
• Part 2 The Epidemiology of Maltreatment and Foster Care Placement
• Part 3 Child Welfare Services in a Developmental Context
• References
• Index