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PACEs in Pediatrics

A BETTER CHILD WELFARE SYSTEM

 

The Pandemic’s Blueprint for a Better Child Welfare System by Romero Davis, Social Current, Oct 15, 2024



There is a shift underway in child welfare that places a greater focus on public health approaches that emphasize prevention of abuse and neglect, and less on an approach that only intervenes once harm to a child has occurred or has been alleged. This is being supported through policies, like the Family First Prevention Services Act, that are moving funding and resources upstream, with a goal of offering family support that can prevent crises and separations.

The challenge we face in achieving a more preventive system, though, is that our child welfare systems are set up to respond only after a child has come to their attention through a report from a mandatory reporter, hotline call or when a child is hospitalized due to harm.

If we are to achieve a more preventive child welfare system, we must start by moving away from the idea that it is solely the function of child protective services (CPS) to keep kids safe. Instead, CPS is one component in what should be a shared responsibility and accountability among families, communities and child-serving agencies working collaboratively to support child and family well-being.

This was one of the key recommendations of the Commission to Eliminate Child Abuse and Neglect Fatalities, which released its report in March 2016, calling for a 21st century child welfare system predicated on a proactive public health approach that was framed by greater leadership and accountability, decisions grounded in better data and research, and multidisciplinary support for families.

What does this look like in practice? Surprisingly, the COVID-19 pandemic and the federal government response to it are helping us answer that question.

When the COVID-19 pandemic struck and America went into lockdown, calls to child abuse hotlines declined and child welfare systems across the country sounded the alarm. As one news story framed it: “While much of the city has been staying indoors and ‘staying safe,’ for many children from troubled homes, the coronavirus pandemic has confined them to the most dangerous place they can be.”

While child abuse reports varied across jurisdictions, it became clear that the expected child abuse epidemic did not occur. A study published in JAMA Pediatrics found that the rate of child abuse emergency department visits actually declined in the early months of the pandemic, from an average of 1,000 a month to a low of 400 a month in March 2020. Hospital admissions for child abuse also declined sharply.

Why did child safety improve at such a volatile time in our history? Researchers pointed to a simple explanation: families received the support they needed to help weather the turbulence of a global pandemic.

For example, the Biden Administration’s $1.9 trillion American Rescue Plan Act of 2021 included a groundbreaking provision that was credited with cutting child poverty in the U.S. in half. Among other supports, there was a $120 billion provision that provided for an expanded Child Tax Credit and significantly increased resources for families with children under the age of six. Analysts estimated that 90 percent of the country’s children benefited from these investments, and as a result, millions of children were lifted from poverty and given the opportunity to thrive.

Research supports the potential that public benefit programs such as cash assistance, affordable housing, subsidized child care, the Earned Income Tax Credit and medical assistance programs have in reducing child welfare system involvement and child fatalities due to maltreatment. Chapin Hall at the University of Chicago published a groundbreaking analysis of the relationship between economic and concrete supports and child maltreatment and child welfare involvement, noting: “Research suggests poverty is a key driver of child welfare system involvement … even modest economic supports can stabilize families and alleviate the need for more intensive intervention.”

Poverty can lead to or worsen issues such as substance abuse, mental health problems, domestic violence and other family stressors such that challenges become crises. In the past, our nation has responded to these needs with CPS involvement and family separation, but by focusing on protective factors and supports, these families can weather the storm, and more families can keep their children safely in the home, as was so evident during the pandemic.

This is particularly important for families of color who experience higher rates of family separation and greater disparities in child welfare system response.

In addition to the research in support of family-strengthening policies, there is increasing evidence that well-implemented prevention and early intervention programs are cost-effective, achieving more in benefits than costs.

The clear positive impacts of economic support programs on reducing child welfare involvement means we must rethink and rebuild our social services systems to bolster child and family well-being and better support families in need. We can achieve this not just by moving child welfare resources upstream, but by increasing supports across all systems that impact families and children, including workforce development, economic assistance, child care support, housing and more.

The evidence is clear — effective early intervention and prevention programs that focus on protective factors for struggling families are not only impactful and cost-effective, but they can reduce child welfare involvement, and most importantly, help ensure that children grow up safely with their families.

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