As professionals working closely with child protective services (CPS) for many years, we are well aware of its shortcomings, particularly undertrained and overwhelmed staff who may inadequately protect children and serve families as mandated by states’ laws. Some professionals and media have highlighted the problems, feeding into a popular narrative that damns CPS as a dangerous, damaging structure.¹ Missing from this picture are data and stories of when children are protected and families are helped. We think a balanced perspective is much needed, recognizing both CPS’ strengths and shortcomings, to move forward constructively.

The history of CPS in the United States clearly points to a broad concern for vulnerable children.² A seminal article on the “battered child” in 1962 in JAMA³ galvanized enormous attention and quickly led to civil laws in all 50 states to protect abused and neglected children. The primary intent has been and remains to help families, not to punish parents; in a small minority of instances, accountability does lead to criminal prosecution.

Despite the above goals, some argue that mandated reporting of suspected child maltreatment to CPS is implemented in a racist and paternalistic manner.¹ There is some dated support for this position, although recent research clarifies that the association is confounded by poverty.⁴ Indeed, after analyses control for sociodemographic variables, Black newborns exposed to illicit drugs appear less likely to be reported than White newborns. Similarly, others found that racial disproportionality in CPS’ overall statistics is largely confounded by poverty,⁵ with further support by a recent analysis.⁶ Reported Black children were less likely to have maltreatment substantiated and less likely to be placed out of home than White children.⁶ Clearly, child poverty and its many associated burdens are strongly linked to a lengthy list of problems.

Policies requiring mandatory reporting to CPS remain a subject of intense debate. We favor continuing mandatory reporting by professionals when there is a reasonable suspicion of child maltreatment, particularly involving moderate to severe physical abuse and sexual abuse. Situations involving neglect vary greatly, requiring careful discernment of the severity, risks, and alternative options. Research is needed to find optimal approaches to certain circumstances, such as a diversionary option regarding substance-exposed newborns, to guide policy and practice.

The harm attributed to CPS involvement is sometimes overstated, misstated, or simply assumed. For example, just 1% to 2% of children referred to CPS are placed out of home, often with kin, and typically temporarily. Some of them surely benefit from adoption. The vast majority of children reported to CPS remain with their biological families. Understandably, many families may resent being involved with CPS, even when the intervention is framed constructively with the goal of helping them take adequate care of their child. Others may come to appreciate the support and linkage to needed services. Indeed, research indicates that many parents regard their child welfare workers positively.⁷ There is no effective way to fully circumvent the stigma and tension between intruding into a family’s life and a compelling interest to ensure the safety and well-being of children who may be in danger. Despite this lofty goal, staffing problems and large caseloads too often compromise the quality of interventions.

What about the often-ignored potential benefits of CPS involvement? It is possible, for example, that CPS involvement for drug-exposed newborns leads to drug treatment. Schneiderman et al⁸ found that infants reported to CPS experienced 2 to 3 times the fatality rate from health problems, suggesting neglect of serious medical conditions. However, that rate was halved for children in foster care. Further, family treatment drug courts serving substance-misusing caregivers facilitated family reunification without increasing recidivism of maltreatment or entry into foster care.⁹ The immense short- and long-term toll of child maltreatment is cause for concern should the problem not be addressed. Avoidance risks greater harm than suboptimal intervention. There may also be a benefit to families from CPS monitoring, albeit unpleasant.

Why has the negative narrative regarding CPS gained such steam? The media favors sensational stories, and public interest lawyers focus on the few cases brought to their attention; quiet successes remain untold. We have witnessed many children and families benefit from CPS involvement. Examples include CPS helping ensure children receive necessary health care and families getting connected to valuable community resources, parenting programs, and childcare. Also, CPS is prohibited from commenting on active cases (and never comments about past cases unless there were fatalities). In addition, random assignment of maltreated children to different interventions is not possible, limiting rigorous evaluation and clearer findings of benefit. A promising development in CPS in recent decades is differential response, which focuses on meeting families’ needs rather than finding fault. More than half the states now apply this model, largely replacing the traditional investigation with an assessment of what a family needs, to most cases of neglect and less-severe physical abuse. The overall response of professionals and families suggests that this is a more constructive approach without increased recidivism and placements into foster care, compared with states without differential response.¹⁰

We concur with Tucker Edmonds¹ that racism and its tragic consequences need to be understood in its historical and ongoing structural context. The health care and child welfare systems do need to counteract this problem, by monitoring, for example, potential bias in prenatal and newborn drug screening. Health care and other professionals can help address inequities by, for example, better linking families to financial, housing, and behavioral health services. Achieving equitable outcomes requires a broad set of strategies to tackle broad and deep underlying systemic societal problems, such as racism and poverty, and to promote equitable educational opportunities and evidence-informed prevention policies and programs. However, this aim is largely outside the realm of CPS.

The big question is how to optimally support families to ensure at least adequate care of their children. While we sharply disagree with the view that involving CPS inevitably harms rather than helps, we do agree with the need for culturally responsive interventions. However, even if all the above were in place, there would still be vulnerable children in dangerous family situations who deserve protection and help. We should be ever mindful about how inherently challenging the work of CPS is. Mitigating harm and partial success are still worthwhile. We need to enhance CPS to better meet its mission of ensuring children’s safety and well-being, mostly by supporting and strengthening families.

We ask those who may favor abolishing mandatory reporting and even CPS, how will that protect endangered children? What are the alternatives? What should be done when a newborn tests positive for an opiate? Or when a child has been sexually abused? How bad must circumstances be to intrude on the sanctity of a family? Hoping that motivated, insightful, able parents will voluntarily engage in effective community-based interventions is a grand vision. Unfortunately, it is often unrealistic. Many children and families need intensive help now. Professionals and the public would benefit from a balanced view of the shortcomings and strengths of CPS as we seek a constructive path forward toward a shared goal of flourishing families and children.

Corresponding Author: Howard Dubowitz, MD, MS, University of Maryland School of Medicine, 520 W Lombard St, Baltimore, MD 21201 (hdubowitz@som.umaryland.edu).

Published Online: July 31, 2023. doi:10.1001/jamapediatrics.2023.2578