Jennifer M.

Geiger
Lisa Schelbe

The Handbook
on Child Welfare
Practice
The Handbook on Child Welfare Practice
Jennifer M. Geiger • Lisa Schelbe

The Handbook on Child

Welfare Practice
Jennifer M. Geiger Lisa Schelbe
Jane Addams College of Social Work College of Social Work
University of Illinois Chicago Florida State University
Chicago, IL, USA Tallahassee, FL, USA

ISBN 978-3-030-73911-9    ISBN 978-3-030-73912-6 (eBook)

https://doi.org/10.1007/978-3-030-73912-6

© Springer Nature Switzerland AG 2021

This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microfilms or in any other physical way, and transmission or information
storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology
now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional affiliations.

Cover image: A variety of hand prints together form a seamless tileable pattern. © Robert Kneschke /
Alamy Stock Photo

This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
For Kate Rich, the person who drew me into
child welfare practice and taught me
everything I know about advocating for and
supporting families to keep children safe.
This book is dedicated to all the parents
and professionals who do their best every
day to improve the lives of children
-JMG

I dedicate this book to Deb Daro for her

visionary work and passion for the
prevention of child maltreatment and to all of
the people involved in the Doris Duke
Fellowship for the Promotion of Child
Well-Being who seek to continue
Deb’s legacy.
-LS
Preface

I (Jen) never planned to work in child welfare. When I worked on my Master of

Social Work degree, I wanted to be a counselor. When I graduated, there was a job
as a child welfare specialist with the Office of the Legal Advocate that housed attor-
neys who served as Guardians ad Litem. They had a unique model where attorneys
and social workers worked together to do what they each did best to represent the
best interest of children involved with the child welfare system. I had no idea I
would love this work so much. I met countless heroes along the way—parents, fos-
ter parents, grandparents, relatives, case managers, therapists, attorneys, judges, and
most importantly, the kids. I learned a lot about our broken system that was often
left without the resources needed to prevent families from becoming involved with
child welfare systems or to help families get back together. I also saw the hard work
of many families to reunify, to complete guardianships, and create families through
adoption. I was especially inspired by the youth I worked with, which ultimately led
me back to school to work on a PhD. It was hard to leave the job, but I kept one foot
in the field to make sure my work was meaningful. I have been fortunate to be able
to continue doing work that helps us to understand how to better serve vulnerable
youth and families. I have also been lucky enough to be able to teach future social
workers who want to work with children and families. It takes a special person to do
child welfare work. It is not an easy job and families are complex, and having to
navigate multiple systems is challenging when the lives of children and families are
in our hands. What I’ve also learned is this work is rewarding, it’s emotional, and it
matters.
Like Jen, my (Lisa’s) journey to child welfare was not planned. When I was a
doctoral student, I worked on a research project with youth who were transitioning
out of foster care to understand their experiences leaving care. The first interview
that I conducted was with a young woman who had recently left foster care after
turning 18. Her strength and resilience inspired me; at the same time, I was horrified
by how difficult her life was after leaving foster care. The system that had func-
tioned as her parents for years largely abandoned her as she was transitioning to
adulthood. It was my first real understanding of the child welfare system as it could
impact children and youth, although previously I interacted with the system when I

vii
viii Preface

had worked in various agencies serving women who had experienced domestic vio-
lence. It was this young woman and the youth I got to know through the research
project that motivated me to be part of improving the child welfare system and
eliminating—or at least minimizing—the need for the system through child mal-
treatment prevention.
I have had the privilege of knowing and working with many who share a similar
vision to end child maltreatment, many of those who I met through the Doris Duke
Fellowship for the Promotion of Child Well-being. It was in the fellowship where
Jen and I met and started working together. Part of the vision of ending child mal-
treatment is ensuring that the child welfare system functions optimally such that the
children and families who are involved will be helped and both the likelihood of
children’s reentry into care and their children’s entry into care is minimized.
Educating the next generation of the child welfare workforce is central to this vision.
Over the years, we have been teaching courses in social work related to child
abuse and neglect and child welfare practice and have struggled to find a recent text
to use that would be comprehensive and that would be useful for undergraduates
and graduate students at various levels of experience. We envisioned a textbook that
could be used across states and at different institutions for instructors to add content
and context around policies and practices where they are. When asked to write this
text, we wholeheartedly agreed and took it on.
We are so pleased to be able to offer a textbook that we hope provides a solid
foundation for what child welfare practice is, its history, and how child welfare
professionals play an important role in supporting families and protecting children
through prevention, reunification, and permanency. We hope that this text provides
aspiring child welfare professionals with the knowledge, skills, and tools to be able
to improve the lives of children and their families by understanding the policies,
best practices, and hearing from some of the experts in the field. We balance the text
with stories from those who have experienced them as youth, parents, professionals
and from researchers and policy-makers across disciplines.
It is our hope that faculty who select this textbook will continue to use state-­
specific content to increase the relevance for the communities their students will
likely serve. It is our desire that this textbook is useful to students and others who
want to understand child welfare. We hope that this book helps those who are going
to be working with children and families to ultimately help children and families
and prevent child maltreatment.

Chicago, IL, USA Jennifer M. Geiger

Tallahassee, FL, USA Lisa Schelbe
Acknowledgments

There are so many people to acknowledge for their support, input, and guidance
throughout the process of writing this book. Thank you to our editors at Springer—
Jennifer Hadley at Springer who first approached us and had the confidence in us to
write this much-needed textbook, and Janet Kim, for supporting us throughout this
process.
We would like to thank the Doris Duke Charitable Foundation and the Doris
Duke Fellowship staff, leadership, and fellows. Thank you to Deb Daro for your
vision and tireless work to create this network, keeping us all together, and moving
us forward. Thank you to Lee Ann Huang for keeping us going and being such a
great support and cheerleader for us. The fellowship is how we met 10 years ago and
we’ve since developed such a strong collaborative relationship with researchers,
practitioners, and policy-makers working hard to prevent child maltreatment and
improve the lives of children and families.
Thank you to our colleagues across the country who gave feedback and offered
contributions based on their research and their own personal and professional experi-
ences. We are so excited to highlight the important work from our friends, students,
co-workers, and community partners. Thank you to Allison Kipphut and the students
from her child welfare practice course at the University of Illinois Chicago who agreed
to pilot the text and give us valuable feedback to improve the text. We also want to
thank all of the students we’ve had the honor to work with through their journey into
learningmoreaboutthechildwelfaresystem,childmaltreatment,andchildwelfarepractice.–
Special thanks from Jen: I am so fortunate to have an amazing partner who supports
everything I do. Thank you, Mike, for valuing my work and being the amazing
father you are to our kids. You keep us balanced, happy, and always know what
we need. My kids make this work even more meaningful for me and put it all into
context. Thanks, Z, R, and H!
Special thanks from Lisa: I want to thank my sisters and parents who are always
encouraging of my work. I could not have written this book without their loving
support. The daily support from my husband, Chris, made my writing possible.
Thank you for all that you did to support this book, including making coffee,
cooking meals, listening, offering suggestions, encouraging, and loving me.
ix
Contents

1 
Introduction to Child Welfare Practice��������������������������������������������������    1
Introduction����������������������������������������������������������������������������������������������     1
Child Welfare Systems����������������������������������������������������������������������������     2
Systems’ Historical Response to Child Maltreatment ����������������������������     3
Key Federal Child Welfare Policies in the United States������������������������     5
Adoption Assistance and Child Welfare Act of 1980��������������������������     6
Adoption and Safe Families Act of 1997 (ASFA) ������������������������������     6
Family First Prevention Services Act��������������������������������������������������     7
Federal Child Welfare Policies Addressing Racial and Ethnic
Disparities������������������������������������������������������������������������������������������������     8
Racial Disparities and Disproportionalities in Child Welfare��������������     8
Indian Children Welfare Act of 1978 (ICWA) ������������������������������������    10
Multiethnic Placement Act of 1994 (MEPA)
and Interethnic Placement Act of 1996 (IEPA)������������������������������������    12
Goals of Child Welfare����������������������������������������������������������������������������    13
Safety ��������������������������������������������������������������������������������������������������    13
Permanency������������������������������������������������������������������������������������������    13
Well-Being ������������������������������������������������������������������������������������������    14
Child Maltreatment Prevention����������������������������������������������������������������    15
Protective Factors������������������������������������������������������������������������������������    16
Child Welfare Practice as a Profession����������������������������������������������������    16
Characteristics of a Child Welfare Professional����������������������������������    16
Professional Responsibilities ��������������������������������������������������������������    16
Mandates����������������������������������������������������������������������������������������������    17
Ethics����������������������������������������������������������������������������������������������������    18
Empathy in Child Welfare��������������������������������������������������������������������    19
Understanding Trauma������������������������������������������������������������������������    20
Managing Bias and Navigating Professional Identity�������������������������    21
Outline of the Book����������������������������������������������������������������������������������    23
Conclusion ����������������������������������������������������������������������������������������������    25
References������������������������������������������������������������������������������������������������    27

xi
xii Contents

2 
How the Child Welfare System Works ��������������������������������������������������   29
Introduction����������������������������������������������������������������������������������������������    29
Current Child Welfare System Description����������������������������������������������    29
Intake����������������������������������������������������������������������������������������������������    33
Case Management��������������������������������������������������������������������������������    33
Law Enforcement Investigations��������������������������������������������������������������    34
Professional Partners��������������������������������������������������������������������������������    35
Services����������������������������������������������������������������������������������������������������    37
Privatization ��������������������������������������������������������������������������������������������    38
Roles in Child Protection and Foster Care����������������������������������������������    40
Navigating the Dependency Court System����������������������������������������������    44
Preparing for and Testifying in Court������������������������������������������������������    48
Parents’ Rights ����������������������������������������������������������������������������������������    49
Children’s Rights ������������������������������������������������������������������������������������    50
Conclusion ����������������������������������������������������������������������������������������������    50
References������������������������������������������������������������������������������������������������    52
3 Child Development and Well-Being ������������������������������������������������������   55
Introduction����������������������������������������������������������������������������������������������    55
Domains of Child Development��������������������������������������������������������������    55
Factors that Impede or Delay Normative Development��������������������������    59
Supporting Healthy Child Development��������������������������������������������������    64
Developmental Monitoring, Screening, and Evaluation��������������������������    65
Attachment, Bonding, and Development������������������������������������������������    66
Attachment Theory������������������������������������������������������������������������������    66
Parent-Child Bonding��������������������������������������������������������������������������    69
Attachment Disorders��������������������������������������������������������������������������    69
Family Roles��������������������������������������������������������������������������������������������    70
Parenting Styles ��������������������������������������������������������������������������������������    70
Child Discipline ��������������������������������������������������������������������������������������    72
Challenging Child Behaviors ������������������������������������������������������������������    73
Difficult Developmental Phases��������������������������������������������������������������    73
Supporting Healthy Parent-Child Relationships��������������������������������������    76
Conclusion ����������������������������������������������������������������������������������������������    78
References������������������������������������������������������������������������������������������������    80
4 Identifying Child Maltreatment ������������������������������������������������������������   83
Introduction����������������������������������������������������������������������������������������������    83
Physical Abuse ����������������������������������������������������������������������������������������    84
Signs and Symptoms of Physical Abuse����������������������������������������������    85
Sexual Abuse��������������������������������������������������������������������������������������������    86
Sexual Abuse Disclosure����������������������������������������������������������������������    87
Signs and Symptoms of Sexual Abuse������������������������������������������������    88
Emotional Abuse��������������������������������������������������������������������������������������    88
Signs and Symptoms of Emotional Abuse������������������������������������������    89
Neglect ����������������������������������������������������������������������������������������������������    90
Contents xiii

Signs and Symptoms of Neglect��������������������������������������������������������������    93

Polyvictimization ������������������������������������������������������������������������������������    94
Understanding Maltreatment ������������������������������������������������������������������    96
Risk Factors ����������������������������������������������������������������������������������������    96
Consequences of Maltreatment����������������������������������������������������������������   101
Consequences of Physical Abuse��������������������������������������������������������   102
Consequences of Sexual Abuse������������������������������������������������������������   103
Consequences of Emotional Abuse������������������������������������������������������   103
Consequences of Neglect ��������������������������������������������������������������������   104
Societal Consequences����������������������������������������������������������������������������   106
Prevention������������������������������������������������������������������������������������������������   107
Cultural Considerations ��������������������������������������������������������������������������   107
Ongoing Debates in Child Welfare����������������������������������������������������������   108
Conclusion ����������������������������������������������������������������������������������������������   109
References������������������������������������������������������������������������������������������������   110
5 Trauma-Informed Child Welfare Practice�������������������������������������������� 115
Introduction����������������������������������������������������������������������������������������������   115
What Is a Traumatic Event?��������������������������������������������������������������������   115
How Does Trauma Affect Individuals?����������������������������������������������������   116
Signs of Traumatic Stress������������������������������������������������������������������������   116
Infants and Toddlers����������������������������������������������������������������������������   116
Preschool and Elementary School-Age Children��������������������������������   117
Middle School- and High School-Age Children����������������������������������   117
Triggers and Trauma Reminders��������������������������������������������������������������   117
Impact of Trauma������������������������������������������������������������������������������������   119
Adverse Childhood Experiences (ACEs)������������������������������������������������   122
Assessment Tools and Strategies for Children Who Have
Experienced Trauma��������������������������������������������������������������������������������   124
Engaging Families in the Screening Process ������������������������������������������   126
Reducing the Trauma Associated with Child Investigation,
Removal, and Out-of-Home Placement ��������������������������������������������������   126
Overview of Treatment of Trauma����������������������������������������������������������   128
Evidence-Informed Interventions to Address Trauma in Children������   129
Using a Trauma-Informed Approach ������������������������������������������������������   130
CDC’s Guiding Principles to a Trauma-Informed Approach��������������   131
Trauma-Informed Child Welfare System ������������������������������������������������   131
Conclusion ����������������������������������������������������������������������������������������������   134
References������������������������������������������������������������������������������������������������   135
6 
Child and Family Engagement in Child Welfare Practice ������������������ 137
Introduction����������������������������������������������������������������������������������������������   137
Engagement����������������������������������������������������������������������������������������������   137
Strength-Based Practice in Child Welfare������������������������������������������������   139
Family-Centered Practice in Child Welfare ��������������������������������������������   141
Building Rapport and Developing an Alliance with the Family��������������   143
xiv Contents

Connecting with Children������������������������������������������������������������������������   145

Culturally Grounded Engagement in Child Welfare��������������������������������   146
Child Welfare Professional as Change Agent������������������������������������������   146
Solution-Focused Approach in Child Welfare ����������������������������������������   148
Motivational Interviewing in Child Welfare Practice������������������������������   149
Managing Difficult Encounters with the Family ������������������������������������   151
Working with Families Experiencing Mental Health Challenges,
Substance Abuse, and Intimate Partner Violence������������������������������������   152
Substance Abuse����������������������������������������������������������������������������������   153
Intimate Partner Violence (IPV)����������������������������������������������������������   154
Mental Illness��������������������������������������������������������������������������������������   155
Promoting Collaborative Practice in Child Welfare��������������������������������   157
Working with Substitute Caregivers����������������������������������������������������   157
Working with Kinship Placements������������������������������������������������������   159
Working with Residential and Group Home Placement Staff ������������   160
Working with Law Enforcement����������������������������������������������������������   161
Working with Attorneys and Court Personnel ������������������������������������   162
Working with Medical and Behavioral Health Providers��������������������   163
Working with Educators and the School System ��������������������������������   165
Child and Family Teams��������������������������������������������������������������������������   167
Conclusion ����������������������������������������������������������������������������������������������   168
References������������������������������������������������������������������������������������������������   170
7 
Child Maltreatment Prevention and Family Preservation������������������ 175
Introduction����������������������������������������������������������������������������������������������   175
Child Maltreatment Prevention����������������������������������������������������������������   175
History of Child Maltreatment Prevention����������������������������������������������   177
Prevention Strategies��������������������������������������������������������������������������������   179
Center for the Study of Social Policy (CSSP)
Strengthening Families������������������������������������������������������������������������   179
CDC Essentials for Childhood������������������������������������������������������������   181
Child Maltreatment Prevention Models��������������������������������������������������   183
Home Visiting Programs����������������������������������������������������������������������   183
Parent Education Programs������������������������������������������������������������������   185
Community-Level Interventions����������������������������������������������������������   185
Policies Supporting Child Maltreatment Prevention ������������������������������   187
Family Preservation ����������������������������������������������������������������������������   188
Conclusion ����������������������������������������������������������������������������������������������   191
References������������������������������������������������������������������������������������������������   192
8 
Assessment in Child Welfare Practice���������������������������������������������������� 195
Introduction����������������������������������������������������������������������������������������������   195
Assessing Safety and Risk ����������������������������������������������������������������������   195
Safety Assessment Goals ��������������������������������������������������������������������   197
Assessment Tools������������������������������������������������������������������������������������   199
Actuarial and Clinical-Based Approaches ����������������������������������������������   200
New Ways to Identify Families in Need of Services ������������������������������   203
Contents xv

By Abuse Type ������������������������������������������������������������������������������������   203

Assessment in Different Contexts��������������������������������������������������������   205
Skills for Assessment in Child Welfare����������������������������������������������������   205
Family Engagement in Interviewing��������������������������������������������������������   206
Conducting Family and Home Assessments��������������������������������������������   207
Understanding Families ����������������������������������������������������������������������   208
Child Assessments ������������������������������������������������������������������������������   208
Forensic Interviewing������������������������������������������������������������������������������   209
Documentation����������������������������������������������������������������������������������������   210
Writing Effective Case Notes������������������������������������������������������������������   211
Conclusion ����������������������������������������������������������������������������������������������   214
References������������������������������������������������������������������������������������������������   215
9 Foster Care Placement���������������������������������������������������������������������������� 219
Introduction����������������������������������������������������������������������������������������������   219
Child Removal and Placement Process����������������������������������������������������   219
Trauma of Removal������������������������������������������������������������������������������   220
Placement Ideals��������������������������������������������������������������������������������������   221
Least Restrictive Environments ����������������������������������������������������������   221
Family/Kin ������������������������������������������������������������������������������������������   222
Siblings������������������������������������������������������������������������������������������������   224
Culturally Appropriate Settings ����������������������������������������������������������   225
Proximity���������������������������������������������������������������������������������������������   226
Types of Placement����������������������������������������������������������������������������������   226
Relative/Kinship����������������������������������������������������������������������������������   227
Nonrelative Family Placement������������������������������������������������������������   228
Congregate Care����������������������������������������������������������������������������������   228
Pre-adoptive Homes����������������������������������������������������������������������������   229
Supervised Independent Living ����������������������������������������������������������   229
Emergency Foster Care������������������������������������������������������������������������   230
Placement Trends ������������������������������������������������������������������������������������   230
Relevant Policies��������������������������������������������������������������������������������������   232
Services for Children in Foster Care��������������������������������������������������������   234
Services for Foster and Kinship Care Providers��������������������������������������   235
Services for Parents with Children in Foster Care����������������������������������   238
In-Home Services and Family Preservation Services������������������������������   240
Recruiting, Training, and Licensing Foster Parents��������������������������������   241
Conclusion ����������������������������������������������������������������������������������������������   244
References������������������������������������������������������������������������������������������������   245
10 
Permanency in Child Welfare Practice�������������������������������������������������� 249
Introduction����������������������������������������������������������������������������������������������   249
Permanency Planning������������������������������������������������������������������������������   249
Principles Guiding Permanency Planning ������������������������������������������   251
Permanency: Policies and Laws����������������������������������������������������������   252
xvi Contents

Permanency Goals ����������������������������������������������������������������������������������   253

Adoption����������������������������������������������������������������������������������������������   255
Guardianship����������������������������������������������������������������������������������������   257
Concurrent Permanency Planning������������������������������������������������������������   258
Achieving Permanency����������������������������������������������������������������������������   259
Factors Influencing Permanency����������������������������������������������������������   261
Permanency Planning for Older Youth������������������������������������������������   261
Family-Centered Practice��������������������������������������������������������������������   264
Foster Care Re-entry����������������������������������������������������������������������������   265
Conclusion ����������������������������������������������������������������������������������������������   266
References������������������������������������������������������������������������������������������������   268
11 
Special Populations in Child Welfare Practice�������������������������������������� 271
Introduction����������������������������������������������������������������������������������������������   271
Children and Youth with Disabilities and Special Needs������������������������   272
Achieving Permanency for Children with Disabilities������������������������   274
LGBTQ Youth������������������������������������������������������������������������������������������   274
Youth Aging Out/Transition-Age Youth��������������������������������������������������   277
Supporting Youth During the Transition����������������������������������������������   280
Immigrant and Refugee Children and Families ��������������������������������������   285
Siblings in Foster Care����������������������������������������������������������������������������   288
Human and Sex Trafficking ��������������������������������������������������������������������   288
Conclusion ����������������������������������������������������������������������������������������������   292
References������������������������������������������������������������������������������������������������   293
12 
Supervision and Professional Development in Child Welfare������������� 299
Introduction����������������������������������������������������������������������������������������������   299
Supervision in Child Welfare Practice ����������������������������������������������������   300
Importance of Supervision in Child Welfare ��������������������������������������   300
Clinical Supervision����������������������������������������������������������������������������   301
Strengths-Based Supervision ��������������������������������������������������������������   302
Trauma-Informed Supervision������������������������������������������������������������   304
Solution-Focused Supervision ������������������������������������������������������������   305
Group Supervision ������������������������������������������������������������������������������   306
Maximizing Supervision��������������������������������������������������������������������������   307
Agency Responsibility for Supervision ��������������������������������������������������   308
Supervision Practices and Strategies ������������������������������������������������������   309
Professional Development for Child Welfare Professionals��������������������   313
Professional Goals ������������������������������������������������������������������������������   314
Ethics and Legal Issues������������������������������������������������������������������������   315
Racial Equity and Cultural Humility ��������������������������������������������������   316
Licensing and Certification������������������������������������������������������������������   317
Child Welfare Professional Safety ����������������������������������������������������������   318
Retention and Job Satisfaction����������������������������������������������������������������   320
Contents xvii

Burnout and Secondary Traumatic Stress������������������������������������������������   320

Self-care ��������������������������������������������������������������������������������������������������   321
Developing a Self-care Plan����������������������������������������������������������������   323
Boundaries ����������������������������������������������������������������������������������������������   324
Conclusion ����������������������������������������������������������������������������������������������   324
References������������������������������������������������������������������������������������������������   326

Index������������������������������������������������������������������������������������������������������������������ 329
Contributors

Leah Bartley, PhD University of North Carolina at Chapel Hill, Chapel

Hill, NC, USA
Breanna M. Carpenter, LMSW, MPA Arizona State University, Phoenix, AZ,
USA
Barbara H. Chaiyachati, MD, PhD Children’s Hospital of Philadelphia,
Philadelphia, PA, USA
Leah Cheatham, PhD, JD University of Alabama, Tuscaloosa, AL, USA
Carly B. Dierkhising, PhD California State University – Los Angeles, Los
Angeles, CA, USA
Elizabet Bonilla Escobar, MSW Illinois Department of Children and Family
Services, Springfield, IL, USA
Libby Fakier, MBA Atlanta, GA, USA
Lisa Garcia, MSW Waukegan, IL, USA
Justin S. Harty, MSW, LCSW University of Chicago, Chicago, IL, USA
Kris Jacober Arizona Friends of Foster Children Foundation, Phoenix, AZ, USA
Colleen Cary Katz, PhD, LCSW Hunter College, New York, NY, USA
Nicole Kim, MSSW Dallas, TX, USA
Cynthia A. Lietz, PhD, LCSW Arizona State University, Phoenix, AZ, USA
Kizzy Lopez, EdD Fresno Pacific University, Fresno, CA, USA
Brittany Mihalec-Adkins, M.S.Ed Purdue University, West Lafayette, IN, USA

xix
xx Contributors

Christina Mondi-Rago, PhD Brazelton Touchpoints Center, Boston, MA, USA

Harvard Medical School, Boston, MA, USA
Terry A. Solomon, PhD University of Illinois Chicago, Chicago, IL, USA
Carol Taylor, MSW, LCSW University of Illinois Chicago, Chicago, IL, USA
Tova B. Walsh, PhD, MSW University of Wisconsin-Madison, Madison, WI, USA
Ashley Wilfong, MSW Fairmont, WV, USA
About the Authors

Jennifer M. Geiger, PhD is an assistant professor at the Jane Addams College of

Social Work at the University of Illinois Chicago. Her research focuses on promot-
ing access and success for youth in care and foster care alumni in higher education
settings. She also conducts research to support and promote resilience among care-
givers (kin and non-relative) for children and youth in care. Dr. Geiger has co-­
authored 35 peer-reviewed journal articles and 6 book chapters on foster care and
child maltreatment. She co-authored Intergenerational Transmission of Child
Maltreatment and Assessing Empathy in 2017.
Dr. Geiger received her Master of Social Work degree in 2004 and PhD in social
work in 2014 from Arizona State University (ASU) in Phoenix. Dr. Geiger was a
Doris Duke Fellow for the Promotion of Child Well-being and continues to be an
active member of the network. Prior to returning to work on her PhD, she worked at
the Maricopa County Office of the Legal Advocate as a child welfare specialist. She
worked alongside dedicated attorneys appointed to advocate for the best interests of
children in foster care and ensure their social-emotional, psychological, educa-
tional, and medical needs were met.
Dr. Geiger is the principal investigator (PI) for the Cook County Permanency
Enhancement Project (PEP), a statewide partnership with the Illinois Department of
Child and Family Services, which provides technical assistance to action teams in
Cook County to address issues related to racial disproportionality and disparity in
the child welfare system and communities. She is the co-founder for the National
Research Collaborative for Foster Alumni in Higher Education (NRC-FCA), a
national research collaborative to promote access and success for youth in care and
alumni in higher education. She helped develop and implement Bridging Success at
Arizona State University and the Sparking Success Scholars Program, recruitment
and retention programs for foster care alumni, and was Co-PI for Bridging Success
Early-Start, a pre-college program for foster care alumni designed to orient new
students to college life and expectations at a higher education institution.

xxi
xxii About the Authors

Lisa Schelbe, PhD is an associate professor at the Florida State University College
of Social Work in Tallahassee. Additionally, she is a faculty affiliate at the Florida
Institute for Child Welfare. Dr. Schelbe is co-editor of the Child Adolescent Social
Work Journal and editor of the American Professional Society on the Abuse of
Children (APSAC) Advisor and Alert. Dr. Schelbe’s research focuses on youth
aging out of the child welfare system with a special interest in their experiences with
post-secondary education and early parenting. She is a qualitative methodologist
with experience working on interdisciplinary teams. Dr. Schelbe has written over 35
journal articles and co-authored Intergenerational Transmission of Child
Maltreatment.
Dr. Schelbe earned her doctorate in social work from University of Pittsburgh in
Pennsylvania where she was a Doris Duke Fellow for the Promotion of Child Well-­
Being. She obtained her Master of Social Work degree from the Brown School at
Washington University in St. Louis, Missouri. Dr. Schelbe is a co-director of the
Child Well-Being Research Network and served as co-chair of the Leadership
Committee for the Doris Duke Fellowship for the Promotion of Child Well-Being.
She is a member of ReSHAPING (Research on Sexual Health and Adolescent
Parenting IN out-of-home environments Group), an interdisciplinary network of
scholars dedicated to research on understanding needs and improving outcomes
related to sexual health and parenting for youth who are homeless, trafficked, or in
out-of-home environments, whether in child welfare, juvenile justice, or other sys-
tems. Dr. Schelbe is co-chair of the National Research Collaborative for Foster
Alumni in Higher Education (NRC-FCA).
Chapter 1
Introduction to Child Welfare Practice

Introduction

Child maltreatment is an epidemic. Recent estimates are that approximately one-­

eighth of children in the United States will experience child abuse or neglect by the
age of 18 (Wildeman et al., 2014); however, it is difficult to discern the true numbers
and impact of child maltreatment as many incidents are not reported or investigated,
and therefore not counted. According to the U.S. Department of Health and Human
Services (2020), in 2018 in the United States, approximately 4.3 million reports
were made to child protective services annually which involved 7.8 million chil-
dren. Approximately 678,000 children were identified as experiencing child mal-
treatment. Three-fifth (60.8%) of the children experienced only neglect.
Approximately 1.3 million children received post-response services from a child
protective services agency. States reported that a total of 1770 children died in 2018
due to abuse or neglect, which translates to almost 5 children dying each day as a
result of child maltreatment. Over 70% of these deaths are children under the age 3.
Child fatality rates for African American children are 2.8 times greater than White
children and 3.4 greater than Hispanic children. Racial disparities exist in most
other statistics pertaining to child maltreatment and the child welfare system,
although as will be discussed later does not necessarily mean that there are higher
rates of child maltreatment.
Of the cases where maltreatment was substantiated in 2018, approximately
250,000 children were removed from their homes and placed into out-of-home
placements (USDHHS, 2020). According to the Adoption and Foster Care
Analysis and Reporting System annually in the United States, over 400,000 chil-
dren are in foster care were in care on September 30, 2019, and over 670,000
children are served in foster care annually (USDHHS, 2020). Of children who left
care in 2019, the median time in care was 15.5 months, with 22% of children
spending less than 6 months in care, and 30% of children spending more than 2
years in care.

© Springer Nature Switzerland AG 2021 1

J. M. Geiger, L. Schelbe, The Handbook on Child Welfare Practice,
https://doi.org/10.1007/978-3-030-73912-6_1
2 1 Introduction to Child Welfare Practice

Child maltreatment is costly to society. In an assessment of the economic burden

of child maltreatment in the United States, researchers estimated that each child
victim would incur over their lifetime $210,012 in health care, child welfare, crimi-
nal justice, special education, and productivity losses (in 2008 dollars; Fang et al.,
2012). Child fatalities due to maltreatment were estimated to cost $1,272,900 per
child. Considering all of these costs, it was estimated that for the child maltreatment
that occurred in 2008, the lifetime costs would be almost $124 billion. A more
recent study included the additional costs of disease and disability, and almost qua-
drupled the cost each child who is maltreated will incur over the lifetime to $830,928
(in 2015 dollars; Peterson et al., 2018). The study also increased the costs of a child
fatality to over $16.6 billion per child. With these updated estimates, the economic
burden of the lifetime costs of child maltreatment that occurred in 2015 was $428
billion (Peterson et al., 2018). When these recent costs of maltreatment were applied
to the number of child maltreatment cases substantiated in 2018 as well as the child
fatalities that occurred in the same year, the costs were approximately $592 billion
(Klika et al., 2020).
Child maltreatment is a problem worldwide, with the World Health Organization
(WHO, 2020) reporting that a quarter of all adults report experiencing physical
abuse as a child. UNICEF, also known as the United Nations Children’s Fund,
works in over 190 countries to ensure child can grow up in safe environments
through their advocacy for policies and children’s access to services (UNICEF,
2020). Worldwide there are efforts to address child abuse and neglect. The focus of
this book is in the United States and how the child welfare system seeks to help
children and families before and after abuse and neglect occur.

Child Welfare Systems

The child welfare system includes an array of services seeking to keep children safe
and ensure families can successfully care for their children. The services focus on
promoting the goals of safety, permanency, and well-being of children. There is not
a single child welfare system in the United States, rather each state and tribe has
their own organization and set of policies that operate on a state level or other juris-
diction (e.g., county, district, regional). The federal government provides oversight
through legislation and monitoring and supports states through funding.
Child welfare agencies are responsible for preventing child maltreatment through
the provision of services, education, and support to families. Agencies receive reports
of child maltreatment, often through a “hotline” mechanism, and determine if abuse
or neglect is occurring. Through an assessment process, agencies determine if a fam-
ily can safely care for a child. When it is not safe for a child to remain in the home,
the agency oversees the child being removed from the home and placed in an out-of-
home placement such as foster care or relative care. The agency’s responsibilities
continue after a child is removed in that the agency ensures the safety, permanency,
and well-being of the child while the child is in care. Child welfare agencies continue
Systems’ Historical Response to Child Maltreatment 3

to work with the child and family with the goal of reunification, adoption, or other
permanency option with and without court oversight. Child welfare professionals are
responsible for the safety, permanency, and well-being of children.

Systems’ Historical Response to Child Maltreatment

Child maltreatment has occurred throughout history across multiple cultures. In

ancient history, there were sometimes societal acknowledgment of children’s vul-
nerability, although there were not consistently interventions to ensure that children
were cared for. In some ancient societies, child sacrifices were sanctioned. However,
across multiple cultures, children who were orphaned were adopted or cared for by
other families. The Hammurabi Code, one of the oldest deciphered code of law
which was in the ancient society of Mesopotamia (c.1754 BC), included informa-
tion on adoption of children and the protection of orphans. There are stories of fami-
lies adopting children like Moses in the book of Exodus (Exodus 2, New International
Version). Historically looking at how children have been treated, it is evident that
throughout history children have had limited rights and were vulnerable to abuse. In
Roman Law (c. 450 BCE), children were considered property of the male head of
the household.
Elizabethan Poor Laws (1601), which greatly influenced the policies in the
United States, addressed the issues of poverty in England and Wales and developed
a formal process by which relief was provided to the poor. While not all specifically
related to child maltreatment, the Elizabethan Poor Laws are relevant in that there
were guidelines that affected how children were cared for. Perhaps most notable is
that the Poor Laws identified those who were considered “deserving poor” as com-
pared to those who were the “non-deserving poor.” The non-deserving poor were
broadly able-bodied men perceived as capable of work and providing for them-
selves, including those who were perceived as “lazy” or “drunks.” The deserving
poor included children, the elderly, those with health problems not caused by them-
selves (i.e., drinking), and women. The communities would only assist those who
were the deserving poor, although assistance was not guaranteed and there were
certain requirements. For example, one requirement was that those needing assis-
tance needed to meet a residency requirement, meaning they needed to be from the
community. Those who came into the community who were poor and needing assis-
tance were pushed out of the community and not assisted. Some support was avail-
able to children and families living in their home, yet some of it was only provided
in residential facilities of work houses or almshouses. During this time, evidence
exists that some free Black children received assistance, yet they were treated more
harshly than White children.
Colonial times in the United States (c. 1600) included many of the practices of
Elizabethan Poor Laws to both provide for and control those living in poverty,
including children. During this time, there were no formal child protection efforts,
and any interventions were sporadic. The Body of Liberties 1641 is the first child
4 1 Introduction to Child Welfare Practice

abuse law in the United States. It was only for cases of extreme abuse: “If a parent
were to ‘exercise an unaturall severitie towards them, such children shall have free
libertie to complaine to Authoritie for redress’” (sec. 83, as cited in Myers, 2011,
p. 272). Within the law, children were permitted to defend themselves against abuse.
It is worthy to note that girls had fewer rights than boys and “bastard” children had
no rights. Children were viewed as the property of their families (father), were seen
as “little adults,” and children were expected to work and help support their families.
Two centuries later in the 1800s, concerned citizens developed charitable organi-
zations to address the needs of orphans and poor children in urban centers in the
United States. To ensure children did not live in deplorable conditions and were
engaged in prosocial behaviors, these organizations attempted to care for children.
The focus was not entirely on children who were maltreated yet included those who
were. Black children were often excluded from services that were developed for
White children. Separate institutions were developed for Black children, such as the
Association for the Care of Colored Children which the Society of Friends estab-
lished in 1822, which cared for Black orphans (Hogan & Siu, 1988). Additionally,
African American churches, extended kin networks, and African American families
helping other families through aid and support assist with providing for poor and
orphaned Black children, sometimes through informal adoptions (Jimenez, 2006).
Orphan trains, established in 1854 under the leadership of Charles Loring Brace,
a minister from New York City, were a program to relocate orphans and poor chil-
dren to the Midwest. Coinciding with the period of Western Expansion, children
were placed on trains and sent to families in the Midwest who would assume the
responsibility for raising the children. Loring Brace saw many orphaned and home-
less children in the city and believed that poverty could be avoided by getting chil-
dren off the streets and into a rural environment with families. While not without
critics, this program continued until 1929 with over 250,000 children placed, despite
reports that these children were being treated poorly with little oversight, were sepa-
rated from their siblings, and that some children with families were taken inadver-
tently. Further, these Children’s Aid Societies were not making efforts toward family
reunification or alleviating poverty and harsh living conditions in the city.
It was not until the late nineteenth century that there were formal services in
place to address child maltreatment in the United States. In 1875, the New York
Society for the Prevention of Cruelty to Children (NYSPCC) was formed as the first
child protection agency in the world. The story of Mary Ellen, a 10-year-old child
who was severely abused by her foster parents, is credited for impetus to create
NYSPCC. She is the first recorded case of child maltreatment within the United
States. Within a couple of decades, there were hundreds of child protection organi-
zations in the United States. Once again, it must be stressed that Black children
were often excluded from these private charitable organizations, and specific orga-
nizations developed in response to serve the needs of Black children. Additionally,
there was the practice to send Black children to institutions for delinquent children
or to adult prisons, rather than receiving child protection services (Jimenez, 2006).
In 1935, the federal government established the Child Welfare Service Program,
Title IV-B of the Social Security Act which made grants available to states to address
child maltreatment and offered payments for foster care.
Key Federal Child Welfare Policies in the United States 5

Child maltreatment largely came to the attention of professionals and citizens in

1962 with the paper “The Battered-Child Syndrome” written by Dr. Henry Kempe
and his colleagues. This seminal work identified child maltreatment as a serious
problem. Prior to this, there was not widespread recognition of the problem of child
maltreatment. Nor was there any systematic government involvement. Child protec-
tion agencies run as non-government child protection entities had previously
addressed the needs of children abused and neglected; however, they lacked author-
ity to intervene in cases of child maltreatment.
The early 1960s heralded a new era of child protection. The Social Security Act
of 1962 required states to make child welfare services available statewide by 1975.
This is a substantial shift to a government involving child welfare system with
accountability to the federal government. The Child Abuse Prevention and Treatment
Act of 1974 (CAPTA) was passed. This landmark piece of federal legislation
became the cornerstone of the modern child welfare system. In it, along with a defi-
nition of maltreatment, there was a mandate for states to develop a response to the
child maltreatment. In effect, it was the birth of the modern child welfare system.
After the passage of CAPTA, each state had developed a child welfare system to
respond to child maltreatment and ensure the safety and permanency of children.
Since the formation of child welfare systems and this initial legislation, there have
been efforts to improve the responses and better protect children.

Key Federal Child Welfare Policies in the United States

Starting with CAPTA, congress has passed significant federal child welfare policies
which have shaped the current child welfare system. It should be noted that legisla-
tion prior to CAPTA did have implications for child well-being yet is not typically
classified as child welfare legislation (e.g., Bezark, 2021). This chapter presents the
most important federal legislation to child welfare practice. See Fig. 1.1 for a time-
line of key child welfare policies in the United States. It is important to note that
what is covered here is not exhaustive. Additionally, it is necessary to remember that
child welfare agencies are state-based; thus, state-specific legislation plays a central
role in child welfare.

1978 1997 2018

1994
Indian Child Adoption and Family First
Multiethnic
Welfare Act Safe Families Prevention
Placement Act
(ICWA) Act (ASFA) Services Act

1974 1980 2008

Child Abuse Adoption 1996 Fostering
Prevention Assistance and Interethnic Connections to
and Treatment Child Welfare Placement Act Success & Increasing
Act (CAPTA) Act Adoptions Act

Fig. 1.1 Key child welfare policies in the United States

6 1 Introduction to Child Welfare Practice

Adoption Assistance and Child Welfare Act of 1980

States followed CAPTA after its passage. As child welfare systems were removing
children from families, it became evident that some children were languishing in
care and may not have needed an out-of-home placement. The Adoption Assistance
and Child Welfare Act of 1980 prioritized family preservation and permanency. It
was an attempt to make sure that children were not unnecessarily removed from
their families and when they were removed, there were guidelines to facilitate per-
manency. The Adoptions Assistance and Child Welfare Act requires child welfare
agencies to make “reasonable efforts” to work with families to try to avoid unneces-
sarily removing children from the home through providing caregivers with resources
that will ensure the child’s safety and well-being in the home. When children were
removed, the legislation required reviews of the status of a child in an out-of-home
placement every 6 months. The courts had to determine if a child would be reunified
with caregivers, adopted, or remain in foster care within 18 months of the child’s
placement in foster care. The legislation also required states to make adoption assis-
tance payments for children with special needs, which is defined as children who (1)
cannot be reunified with parents, (2) have a special condition that requires assis-
tance, or (3) have not been placed without assistance.
The Adoption Assistance and Child Welfare Act created the Title IV-E program
of the Social Security Act which established reimbursements from the federal gov-
ernment to states for foster care and adoption. Under Title IV-E, states could be
reimbursed by the federal government for some of the expenditures on children who
were in foster care as well as adoption assistance. Adoption assistance reimburse-
ment was reserved for children with “special needs” as defined by individual states,
which often was defined as children who may be difficult to be adopted due to their
health or mental health needs, or being in a sibling group, of a certain race/ethnicity,
or of a certain age. Title IV-E also developed a state-university partnership training
component to professionalize the child welfare workforce.

Adoption and Safe Families Act of 1997 (ASFA)

At times, the Adoption Assistance and Child Welfare Act was interpreted as keeping
children in their homes regardless of the safety and as giving parents unlimited time
to change their behaviors so that they could provide for their children. The Adoption
and Safe Family Act of 1997 (ASFA) was an attempt to correct this and to prioritize
child safety and promote adoption. The policy created specific timelines for reunifi-
cation or termination of parental rights to ensure that children were not languishing
in care. ASFA redefined “reasonable efforts” and further clarified circumstances
where services to prevent removal of a child and to reunify a child were not neces-
sary. Shorter time limits were added for determining permanent placements and
terminating parental rights. Hearings needed to be held no later than 12 months after
the initial placement. Additionally, states were required to terminate parental rights
Key Federal Child Welfare Policies in the United States 7

after a child had been in foster care for 15 of the 22 months, except in cases where
it was not in the best interest of the child or if the child was being cared for by a rela-
tive. Along with these timelines was the concept of concurrent planning, that in
addition to working toward reunification, there could be an additional permanency
goal. For example, an additional goal of adoption or guardianship that was also
being planned for if the reunification failed. One of the goals of ASFA was to pro-
mote the adoption of children in foster care, and states were given incentive funds
for increasing adoptions. States efforts to promote adoptions and document the pro-
cess were required. In addition to focusing on safety and permanency, ASFA stresses
the importance of well-being. As a policy, it sought to increase innovation and
accountability within child welfare. ASFA amended Title IV-E funding.
With the passage of ASFA, there was an increase in permanency in the number
of children exiting foster care. In addition to more timely reunifications, there was
an increase in children who were adopted and children placed in guardianships. In
the years following ASFA, the number of children adopted out of foster care dou-
bled. There was some concern with the increased number of terminations of paren-
tal rights (TPR) due to ASFA’s timelines, more children to be “legal orphans” within
the system without connections to their parents, and no prospects for adoption.

Family First Prevention Services Act

The Family First Prevention Services Act (Family First) was signed into law in 2018
and is seen as a major shift in child welfare legislation. This legislation is significant
as it provides states, territories, and tribes an option to use Title IV-E funding for
providing evidence-based prevention services. Previously the funds could only
reimburse expenses for “foster care maintenance for eligible children; administra-
tive expenses to manage the program; and training for staff, foster parents, and cer-
tain private agency staff; adoption assistance; and kinship guardianship assistance”
(NCSL, 2020). Now states, territories, and tribes can be reimbursed for prevention
services after an evidence-based, trauma-informed prevention plan is developed and
approved. Many states, territories, and tribes are in the process of creating such
plans and identifying appropriate evidence-based programs for their jurisdictions.
The prevention services can serve children who are “candidates” for foster care,
meaning they are identified in a prevention plan for being at risk of entering foster
care but can safely be at home or a kinship placement as well as their families.
Additionally, prevention services can be provided to foster youth who are pregnant
or parenting. There are no income eligibility requirements. Services may include
mental health and substance abuse treatment programs as well as in-home parenting
programs. All services must be trauma-informed and be evidence based. Prevention
services can be offered for no longer than 12 months, starting when a child is recog-
nized in a prevention plan.
Family First legislation also seeks to reduce the use of congregate care and group
care for children and emphasizes family foster homes. With limited exceptions, the
federal government will not reimburse states for children in congregate care
8 1 Introduction to Child Welfare Practice

facilities for more than 2 weeks. The only approved setting is “qualified residential
treatment programs” which provide trauma-informed care with registered or licensed
professional staff. There are additional limitations on the setting including that the
number of children in the placement should be no more than six and there must be
formal assessments of a child within 30 days of placement to determine whether a
child’s needs can be met by family, a family foster home, or another setting.

 ederal Child Welfare Policies Addressing Racial

F
and Ethnic Disparities

In addition to the federal legislation broadly addressing child maltreatment, there is

legislation designed to address racial and ethnic disparities and populations where
system involvement is overrepresented. Before presenting the legislation, a review
of racial disparities is necessary to provide context.

Racial Disparities and Disproportionalities in Child Welfare

Historically, there have been differences in how children of different races/ethnici-

ties have been treated by child protective services, and unfortunately differences in
the child welfare systems persist. Race continues to play a role in decisions and
outcomes in the child welfare system (e.g., Cleveland & Quas, 2020). It must be
stressed that there is no evidence that maltreatment occurs at the higher levels in
different racial groups. Multiple factors have been identified including poverty, dis-
crimination, biases, and lack of resources. Racial disparities and disproportionali-
ties in child welfare are well documented at every decision point and part of the case
(e.g., reporting, screening, investigating, assessing, removing from parents, select-
ing placement type, reunifying/adopting). Racial disparities mean there are unequal
outcomes for different racial groups. Disproportionality is defined as unequal repre-
sentation of a group compared to its percentage in the total population.
African American children and American Indian children are overrepresented in
the child welfare system and consistently have found to have poorer outcomes than
children of other races in the system. Approximately a quarter of children in foster
care are African American, although they are only 15% of the population of children
in the United States (USDHHS, 2020; Child Trends, 2018). American Indian chil-
dren are in foster care at rates 2.7 greater than the general population; they are 0.9%
of the child population, yet 2% of children in foster care (USDHHS, 2020; Child
Trends, 2018). It must be emphasized that there is great variation within different
states and communities; some systems have higher rates of disparities than others.
Nevertheless, national estimates indicate that there is a problem with race and child
welfare. It is documented that there are multiple decision points where individual
and systematic racism impact children and families involved in the child welfare
system (Miller et al., 2013).
Federal Child Welfare Policies Addressing Racial and Ethnic Disparities 9

Note from the Field

Addressing Racial Disproportionality: Child Welfare Professionals
Becoming Part of the Solution
Terry A. Solomon, PhD.

The social unrest we are experiencing requires child welfare workers to

reflect on their role in maintaining systems of oppression or creating sys-
tems of racial equity. The unjustified police killing of African-American
men and women, the denial of medical care for COVID-19 residents of
urban communities, and the history of discrimination and persistent low
wages, minimum wages, and non-living wages created the perfect storm that
capitulated the Black Lives Matter Protest to the world stage. As an African
American, I know firsthand of the results of failed public policies resulting
in under-­resourced schools, substandard housing, poor health care, and eco-
nomic inequality. These failed public policies have resulted in racial dispari-
ties in economic and social well-being. The consequences of the public
policies have created generational wealth for the majority of the dominate
society and generational poverty for many African Americans. Child wel-
fare workers are members of both groups. Child welfare workers who are
privileged want to protect their privileges, and child welfare workers who
lived experiences of racial inequities continue to challenge the status quo
abuse of institutional and systemic power. Are child welfare workers part of
the problem or part of the solution for achieving racial equity for all families?
The social work profession “promotes social change and development,
social cohesion, and the empowerment and liberation of people” (International
Federation of Social Workers, 2014). It is critical for social work programs
to examine how the above principles are integrated in preparing profession-
als, particularly child welfare workers to work in diverse communities. The
racial disparities and disproportionality in child welfare outcomes for fami-
lies of color require one to examine how the above-stated principles are
infused in the education and training of child welfare workers. Recognizing
that many of the child welfare workers do not reflect their clientele or the
community where they practice, several questions come to mind. Are
social work schools preparing child welfare workers to uphold the profes-
sion’s value of social justice and racial equity, or are we teaching child
welfare workers to maintain the status quo training on color blindness?
Can child welfare workers confront their individual fears and understand
how such fears negatively impact the successful reunification of African
American children and all children of color? How can we overlay antira-
cism tenets with the profession’s core values? Child welfare professionals
must decide if they answer the call for justice or promote structural
racism. Do we want to be part of the problem or part of the solution?

(continued)
10 1 Introduction to Child Welfare Practice

The Black Lives Matter Protest is grounded in social work practice and
social work action. Institutional and systemic racial equity offers social work-
ers an opportunity to expand its body of work founded on the principles of
protest, resistance and reform. It is a call to action for child welfare workers
to examine their implicit biases about families of color and to be intentional
of improving permanency outcomes for all families. For times such as this,
child welfare workers cannot be part of the problem. The greater mandate is
for child welfare workers to be part of the solution.

While African American children and American Indian children are overrepre-
sented in child welfare systems, some groups are underrepresented. White children
make up 50% of the population yet are only 44% of the children in foster care
(USDHHS, 2020; Child Trends, 2018). Nationally, the proportion of Asian-­
American and Hispanic children involved in child welfare is lower than their pro-
portion in the population. There is not a general consensus about why there is such
underrepresentation; and in some geographic areas, the national trends do not match
what is occurring at the state and community levels. In some states and in some
communities, Hispanic children are overrepresented. As such, it is recommended
that without knowing the local context, one should not assume that there are no
disparities for Hispanic children.
Attempts through legislation to address the racial disparities are presented below;
however, child welfare practices and protocols at the agency, team, and individual
level can also play a role in reducing racial disparities and racism in child welfare.
Throughout the textbook, information will be included about factors that contribute
to disparities as well as child welfare professionals’ responsibilities for reducing
racial disparities and promoting racial equity.

Indian Children Welfare Act of 1978 (ICWA)

Soon after the enactment of CAPTA, it became readily apparent that American
Indian and Alaskan Native children were disproportionally removed from their fam-
ilies and placed with non-American Indian families. There were grave concerns that
this not only was detrimental to the individual children but also had the potential to
damage the passing of culture down to the younger generations. The Indian Child
Welfare Act of 1978 (ICWA) was designed “...to protect the best interest of Indian
Children and to promote the stability and security of Indian tribes and families by
the establishment of minimum Federal standards for the removal of Indian children
and placement of such children in homes which will reflect the unique values of
Indian culture, and by providing for assistance to Indian tribes in the operation of
child and family service programs”(25 U.S. C. 1902; Pub. L. 95–608, § 3, Nov. 8,
1978, 92 Stat. 3069). ICWA outlined guidelines and minimum standards for states
in how to handle cases of child maltreatment and adoption of native children.
Federal Child Welfare Policies Addressing Racial and Ethnic Disparities 11

Specifically, Indian children were required to be placed in foster or adoptive homes

that reflected Indian culture. ICWA created tribal jurisdiction over all child custody
proceedings involving an Indian child when requested by a Tribe, parent, or Indian
“custodian.” State and federal courts were required to honor the Tribal court decrees.
The legislation provided assistance to Tribes for child and family programs and
resources for the development of organizations or centers designed to improve child
welfare services for Indian children and families.
ICWA is credited for progress in the handling of cases involving American Indian
children; however, more work needs to be done as large disparities remain. American
Indian children are two to three times more likely than White children to be removed
from home and placed in foster care. American Indian children are in foster care at
a rate 14 times higher than their rate in the general population. There are ongoing
concerns with how ICWA is implemented. In 2016, the Bureau of Indian Affairs
provided more federal guidelines about how to implement ICWA.

Note from the Field

Balancing Permanency and Honoring Tribal Sovereignty
Richard1 was 18 months old when he was placed with a foster family when his
biological mother was unable to care for him. When interviewed, his mother
indicated that his biological father was a member of the Navajo Nation. The
Child Welfare Agency was required to notify the Tribe and include them in all
legal proceedings and to determine the child’s eligibility for membership of
the Navajo Nation. Richard was cared for by a White family during his time
in foster care. As the case proceeded, his biological mother had been unable
to meet the requirements for him to be reunited with her permanently, and the
case was moving toward severance and adoption. Due to Richard’s member-
ship with the Tribe, the case was under the purview of ICWA, and the Tribe
was involved in decisions made about permanency. By this time, Richard had
been in the same home with the same caregivers for 3 years, and the foster
parents were interested in adopting him. The Navajo Nation legal representa-
tives were opposed to adoption as this would cease Richard’s connection to
the Navajo Nation and likely impact his cultural relationship to traditions and
practices. As a child, Richard was entitled to permanency and stability with
his family. Several attempts were made to identify a family who were Native
American to adopt Richard; however, the agency was unable to find another
permanent placement. After hearings and mediation, the Tribe and the Child
Welfare Agency agreed that it would be in his best interest to be adopted by
his current caregivers; however, they also implored his caregivers to make
every effort to preserve his heritage.

1
All names and other personal identifiers in cases and examples throughout this book have
been changed to protect privacy and confidentiality.
12 1 Introduction to Child Welfare Practice

 ultiethnic Placement Act of 1994 (MEPA) and Interethnic

M
Placement Act of 1996 (IEPA)

The goal of the Multiethnic Placement Act was to reduce delays in permanent place-
ment of children, specifically with children of color. The legislation was created to
address (1) the practice of children being placed in foster or adoptive parents of the
same race (“race matching”) and (2) the practices that created a shortage of foster
and adoptive parents who were minorities. With these practices, minority children
frequently languished in care. Additionally, with “race matching” children in place-
ment with a foster parent whose race was different could be bonded with the family,
and an agency would move them to a different placement that was with foster par-
ents of the same race as the child without consideration of the attachment to the
family and the best interest of the child.
The provisions of MEPA prohibit agencies from delaying or denying a foster
care or adoption placement due to the parent’s or child’s race, color, or national
origin. However, the legislation allows agencies to consider a child’s culture, eth-
nicity, and race when determining a placement. Thus, race, color, and national
origin could be one factor in a decision to place a child in a foster or adoptive
home, but it could not be the only factor. As a part of MEPA, states were required
to recruit diverse foster and adoptive families that reflected the demographics of
children in the state. The requirements of MEPA were necessary for states receiv-
ing federal funding. The Interethnic Placement Act (IEPA) amended MEPA, clari-
fying language about cultural considerations. It specified that race, color, or
national origin could not be used in any placement decisions. It added an excep-
tion in individual cases where it could be demonstrated that considering race,
color, or national origin was in a certain child’s best interest. Additionally, the
legislation added fines for states which do not follow IEPA guidelines with regard
to making placement decisions. It is important to note that Native American chil-
dren are not covered by MEPA/IEPA, rather they are covered by the Indian Child
Welfare Act.
MEPA/IEPA has not been as successful as hoped. In part, this because of there
was a misconception that “race matching” was the cause of children of color
remaining in care, and by removing the practice, White families would adopt the
children of color who needed home. The legislation did not impact the length of
time that children of color were in out-of-home placement. Some critics of MEPA/
IEPA have stressed that there has been inadequate emphasis on the provisions
about recruiting diverse foster and adoptive families. There is also the recognition
that people of color face additional barriers when seeking to adopt a child; thus,
there may be more people interested in adopting children who have been
unable to do.
Goals of Child Welfare 13

Goals of Child Welfare

Through legislation, the federal govern-

ment has identified three goals for child The Children’s Bureau conducts
welfare: safety, permanency, and well- Child and Family Services Review
being. Together, these goals provide a (CFSR) using the following
foundation for child welfare practice. The definitions:
Children’s Bureau, a part of the Safety: All children have the right
Administration for Children and Families, to live in an environment free from
conducts Child and Family Services abuse and neglect.
Reviews (CFSR) to review states’ compli- Permanency: Children need a
ance with federal child welfare require- family and a permanent place to
ments, to determine how children and call home.
families engaged in child welfare services Child and Family Well-Being:
are faring, and to assist states in promot- Children deserve nurturing envi-
ing positive outcomes for children and ronments in which their physical,
families. The CFSRs focus on the goals of emotional, educational, and social
safety, permanency, and well-being. needs are met.

Safety

The goal of safety is to have children not abused or neglected and, as possible, to
keep them safe in their home. A child is safe when there is no threat of danger, or if
there is a threat of danger, there are sufficient safeguards in place to mitigate the
threat and protect the child. When considering if the goal of safety is met, child
welfare practice considers the response of the child protection services agency in
responding to the report, assessing the family, and providing services.

Permanency

The goal of permanency is for every child in an out-of-home placement to have a

legally permanent family through reunification, adoption, guardianship, or another
planned permanent living arrangement (APPLA). Child welfare agencies ensure
permanency through a case plan that prioritizes the child returning home or to
another permanent placement and not reentering the system. Placement instability,
or the frequent changes among placements, challenges the permanency goal. Thus,
efforts are made to ensure a child is not moved among different placements.
14 1 Introduction to Child Welfare Practice

Well-Being

In 2012, The Children’s Bureau as part of the US Department of Health and Human
Services Administration on Children, Youth and Families added well-being as a
goal of child welfare. The memo explained: “The Administration on Children,
Youth and Families (ACYF) is focused on promoting the social and emotional well-­
being of children and youth who have experienced maltreatment and are receiving
child welfare services. To focus on social and emotional well-being is to attend to
children’s behavioral, emotional and social functioning – those skills, capacities,
and characteristics that enable young people to understand and navigate their world
in healthy, positive ways. While it is important to consider the overall well-being of
children who have experienced abuse and neglect, a focus on the social and emo-
tional aspects of well-being can significantly improve outcomes for these children
while they are receiving child welfare services and after their cases have closed.”
(p. 1) Well-being includes physical health and development as well as cognitive,
behavioral/emotional, and social functioning. Consistently, there are concerns about
assessing well-being as it is not as straightforward as safety and permanency.

Note from the Field

A First Look at Poverty
Over 20 years ago, I was an intern shadowing my supervisor during a home
visit. I don’t remember the family or any details about the case. However, I
vividly recall a heavily stained mattress on the floor near the front door of the
sparsely furnished apartment. No sheets were on the mattress, but crumpled
clothes were on it piled on it. I realized that multiple people slept on this bed
and used the clothes for pillows and blankets. I don’t remember much else
about the home, but I remember feeling sick thinking about the living condi-
tions. It was hard to focus on the conversation my supervisor and the client
were having because I was distracted thinking about the living conditions. It
was my first exposure to poverty and poor living conditions within someone’s
home. I had a wide range of intense feelings: anger, disbelief, frustration, guilt,
curiosity. Afterward, I processed the visit with my supervisor who helped me
acknowledge my privileged background and sort through my feelings. I
encountered other homes where the living conditions were similar, and I wit-
nessed worse. Some of the homes were in squalor, unfit for people to live. I
remember one apartment where the odors assaulted me when the front door
open and I resorted to breathing through my mouth to minimize the smells that
made me nauseous. I grew to understand that poverty was not always linked
with poor living conditions. I also learned how some of the conditions − includ-
ing the filth − were based in larger problems. After shadowing a case manager
on a home visit to a youth aging out who was living in a subsidized apartment,
Child Maltreatment Prevention 15

the case manager reflected that he understood why the young man did not clean
the apartment. The cost of a vacuum was great, and the apartment, including
the carpet, was in poor condition before the youth moved into it. It was logical
for the youth not to clean the floor considering that the apartment was com-
pletely rundown. Many of the homes that I visited had problems. I frequently
heard clients complain about their “slumlords” and a litany of problems with
where they lived. Landlords would not repair the properties. In some cases,
health and safety were issues. Numerous homes had problems with mold which
caused breathing problems for those living there. In one apartment with a bro-
ken window lock that repeatedly had been reported to a landlord, someone had
been able to break into and burglarize the apartment. I learned to empathize
with people living in poverty and not quickly judge the conditions. Nothing
prepared me for the first time I saw poverty in a person’s home. While it no
longer shocks me, I continue to have the range of feelings when I see people
living in poverty where their basic needs are not met. I am upset that people
live in homes where conditions threaten their safety and health. I am angry that
landlords do not maintain their properties. I am frustrated that families struggle
and there is not enough support. I am grateful that I did not know such condi-
tions as a child. I am hopeful that my work can help families escape poverty
and children live in an environment where they can thrive.

Child Maltreatment Prevention

If all child maltreatment were prevented, child welfare professionals would be out
of work. While we remain a long way from preventing all child maltreatment, the
importance of prevention is increasingly recognized. This is the case in the federal
legislation Family First that priorities prevention for states. Child welfare systems
do not have to wait for abuse and neglect to occur to assist children and families.
There is ample evidence that it is cost effective to prevent child maltreatment rather
than dealing with its aftermath. A full argument and details about prevention are
discussed in depth in Chap. 7; however, throughout the entire textbook, it is impor-
tant to carry a prevention lens. Child welfare professionals have the obligation to
work to prevent child maltreatment.
Child maltreatment is multi-faceted and consists of more than just stopping
abuse and neglect occurring in the first place. While preventing maltreatment from
occurring definitely is part of prevention efforts, it is also important to prevent it
from re-occurring and to mitigate its harmful effects. Making sure that children who
have been abused and/or neglected are safe from future maltreatment is part of child
maltreatment prevention. Additionally, child maltreatment prevention efforts
attempt to reduce the likelihood of poor outcomes due to maltreatment. Often this is
done through various interventions. Prevention efforts, as will be discussed in Chap.
7, take place at multiple levels and may be universal, selective, or targeted.
16 1 Introduction to Child Welfare Practice

Protective Factors

Protective factors are characteristics of individuals, families, and communities that

reduce the likelihood of negative outcomes. Through a rigorous review of child mal-
treatment research, the Strengthening Families framework identified the following
five key protective factors to reduce child maltreatment: parental resistance, social
connections, knowledge of parenting and child development, concrete support in
times of need, and social and emotional competence of children. Many states have
adopted this framework and seek to prioritize helping all families increase these
protective factors. More details about protective factors will be provided in Chap. 4.

Child Welfare Practice as a Profession

Working in child welfare provides the opportunity to help children and families.
Professionals in the field have the ability to literally save lives and change the life
trajectory of some of the most vulnerable people in society: children. However, the
high rates of turnover suggest that not everyone who enters the child welfare field
was prepared for the work. Attempts to reduce this turnover often target improved
training. This book is designed to educate people about what is necessary to under-
stand in child welfare so that they can be successful and help children and families.

Characteristics of a Child Welfare Professional

Not everyone would make a good child welfare professional. Skills can be taught as
can protocols and procedures; however, some people are better suited than others to
work in child welfare. The Vermont Department for Children and Families (n.d.)
identifies the following characteristics of a successful child welfare work: a positive
attitude and sense of humor, the ability to maintain a healthy balance between per-
sonal and professional life, the ability to work with clients and achieve positive
outcomes, good communication, organization, critical thinking, problem solving,
and time management skills, professional commitment to clients, resilience, flexi-
bility, and high energy, realistic expectations about the challenges of the work, and
the willingness to reflect on own work and learn from others. Many of these charac-
teristics are consistent with social work skills, which is why some child welfare
systems require degrees in social work.

Professional Responsibilities

While there may be different titles and responsibilities, child welfare professionals
work with children and families to ensure children’s safety, permanency, and well-­
being. Frontline child welfare workers are largely divided into two categories: child
protection investigators (CPIs) and case managers. CPIs have the responsibility of
Child Welfare Practice as a Profession 17

conducting assessments in cases referred to the system to determine if a child is safe

or at risk for maltreatment. Case managers work with children and families in the
system in an ongoing manner. There are additional positions such as hotline person-
nel and supervisors that are intimately connected to cases as well as a wide range of
professionals who work with families to provide services. See Chap. 2 for more
information about the different types of positions and their roles within child welfare.

Mandates

There are multiple levels of mandates, policies, and procedures that child welfare
professionals must follow. Federal legislation is the overarching policy under which
states have specific legislation. There are also agencies policies and guidelines and
protocols at the individual unit level. These mandates are all designed to protect
children. Mandates outline timelines and requirements for working with children
and families. Child welfare professionals must know and follow the mandates in the
jurisdictions in which they work. Some states and child welfare agencies have very
specific and extensive policies, forms, and procedures to follow to ensure

Note from the Field

Becoming a Child Welfare Professional
Breanna M. Carpenter, LMSW, MPA
I have become passionate about child welfare and keeping families safe and
healthy. I am particularly interested in making sure that youth who transition
out of foster care have positive outcomes in adulthood. This passion initially
grew out of my own experience in foster care. Later, my work as a youth advo-
cate and now professional social worker has expanded my knowledge and
understanding of the challenges and the importance of the child welfare sys-
tem. Decisions made in child welfare are life-defining moments for each indi-
vidual child, young person, and parent. In my life, I have seen the system from
many perspectives, as a youth, a volunteer advocate, and now a professional.
What drives me most is a desire to better prepare professionals working in this
system. I see it from all perspectives now. Too often the roles are at odds with
one another. Parents are at odds with the investigators; courts are at odds with
the caseworkers; and foster parents are at odds with the court. Too often people
see only one perspective but miss the bigger picture. Through my transition
from youth, to advocate to social worker, I have gained a great understanding
of all sides of these issues. This understanding drives my passion to do more.
I exited the foster care system at 17 years old when I entered a guardianship
with my grandparents. One year later, I went off to college and started my social
work degree. January of my freshman year in college, Children’s Action
Alliance invited me to join their Youth Advisory Board, allowing me to influ-
ence state policy and practice. Through this work, I had the opportunity to
18 1 Introduction to Child Welfare Practice

testify in front of the state legislature over ten times to influence three significant
bills related to a college tuition waiver, car insurance, and housing and mental
health services for foster youth. My history in foster care was influential in these
efforts, as it allowed me to directly use my voice informed by personal experi-
ence to influence the system. It is a privilege to use my voice on behalf of others,
giving a seat to all youth involved in the child welfare system who will follow.
Although my advocacy work directly leverages my own personal history,
my role as a social worker is informed not just by experience but also by
theory, research, and professional knowledge and standards. My education
and professional experience have created a third transition, one where I moved
from a youth advocate to a child welfare professional. It is important to men-
tion that I have been mentored by many experienced social workers, and I
would not have developed into a competent professional without their guid-
ance and wisdom. I am looking forward to growing in the field through ongo-
ing professional experience. I look forward to my next transition – one where
I can use my experience and knowledge to prepare the next generation of
social workers who too are passionate about creating positive change.

consistency in reporting, documentation,

Reflection
and protocol for staff in accordance with
Is the child welfare profession a
the laws and practices in place. These
good fit?
polices are often described and reviewed
To determine if someone is a good
during child welfare professional training
fit for a career in child welfare, they
and used as a reference in daily practice.
may want to ask themselves:
• Can I work in a stressful, unpre-
dictable environment?
Ethics • Can I meet rigid deadlines?
• Do I function well in ambiguous
situations?
There is no single code of ethics for child
• Do I like working with people
welfare professionals; however different
in crisis?
states and child welfare systems have ethi-
• Can I handle learning about
cal guidelines and may have a code of eth-
children who are hurt?
ics. The National Association of Social
• Do I have strategies to take care
Workers (2013) has outlined standards for
of myself?
social work practice in child welfare and
If the person finds themselves
provides guidance for handling ethics in
answering yes to these questions,
child welfare. The standards present
they may be well suited for work in
expectations on topics including profes-
child welfare. Do not worry if they
sional development, advocacy, collabora-
answered no; they still may thrive as
tion, confidentiality, cultural competence,
a child welfare professional! These
assessment, engagement, supervision, and
questions which were answered no
administration. More information on eth-
can guide their selection of posi-
ics is provided in Chap. 12 on professional
tions within child welfare as well as
development.
their professional development.
Child Welfare Practice as a Profession 19

Skills in Child Welfare

The work child welfare professionals do demands a wide range of skills. This is in
part due to the breadth of the positions and the high variability among cases. There
are many concrete skills that child welfare professionals must possess to be success-
ful in securing the safety, permanency, and well-being of children. Child welfare
workers must possess oral and written communication skills so that they work with
children, families, and colleagues. Listening without judgment is central to all of
this. Child welfare professionals need to be able to interview, document interac-
tions, and create reports. They also need to be able to talk with people, often in set-
tings where there are great emotions. Child welfare professionals need to be able to
work well with people and be part of a team. They need to be able to deescalate
potentially volatile situations. Child welfare professionals need to be able to think
quickly and be creative in their problem solving. Fortunately, the skills required in
child welfare work can be taught and refined.

Empathy in Child Welfare

Child welfare professionals should use empathy within their work. Empathy is the
ability to understand others’ experiences while effectively regulating one’s emo-
tions and maintaining health boundaries and self-other awareness (Gerdes et al.,
2010). Empathy is a physiological, emotional, and cognitive process that involves
understanding of others’ experiences, thoughts, and feelings.
Empathy is a critical skill for child welfare professionals working with children
and families who may have very different beliefs and experiences than they do.
These differences can lead to misunderstanding and mistreatment and potentially
impact case outcomes. This trait and skill is discussed in more depth in Chap. 6 as
it relates to developing rapport and relationships with children and families. It is
important to understand empathy and its components to better understand the pro-
cess of empathy. Empathy is part of our human biology and social interactions. It is
a complex process that involves physiological responses, cognitive processes, and
behaviors (Segal et al., 2017). Researchers have identified five components that
together contribute to the full scope of empathy: affective response, self-other
awareness, perspective-taking, affective mentalizing, and emotion regulation.
The brain includes neurological pathways that are capable of physiologically
simulating the experiences of others. Often referred to as “mirroring,” this ability is
unconscious, automatic, and involuntary. For example, if a person starts crying in
front of us, even if we do not understand why, we too may feel like crying – not
because we are sad, but because we are mirroring what the other person is doing
behaviorally. Affective sharing can run through all types of emptions (e.g., happy,
sad) as well as physical sensations (e.g., feeling pain when watching another person
being physically hurt).
Once the affective response occurs, individuals need to recognize the difference
between the experiences of another person from our own or have a self-other aware-
ness. We may feel like crying (as in the example above), but it is the other person’s
20 1 Introduction to Child Welfare Practice

experience and not our own, and it is important to recognize this difference in expe-
rience. By acknowledging that the emotions are different moves the empathic
response into a cognitive, conscious place.
Assuming that one successfully mirrors and then processes the affective response
to understand that it belongs to the other person, it becomes possible to cognitively
process what it might be like to personally experience the experiences of another or
perspective-take. This is what we commonly refer to as “stepping into the shoes of
another.” Further, affective mentalizing is the process of cognitively weighing
someone else’s emotional response or state. We assess others’ emotional states
through their facial expressions, body language, and/or words. Finally, emotion
regulation helps us to move through these affective and cognitive processes without
becoming overwhelmed or swept up into someone else’s emotions. This is the abil-
ity to sense another’s feelings without becoming overwhelmed by the intensity of
their experience. Understanding empathy and how it is manifested, particularly in a
client-professional relationship, is critical to relationship development and mainte-
nance and ensuring the client has adequate support and services. Without empathy,
workers may become frustrated with the children and parents they work with when
they don’t fully understand where a family is coming from, what has led them to
their current situation, or what feelings and thoughts surrounding their circum-
stances (Mullins, 2011). Further, burnout is common given the everyday profes-
sional stressors child welfare professionals are exposed to. However, empathy has
been shown to be a buffer in some cases for burnout among social workers, possibly
because of one’s ability to regulate emotions, see the self apart from another, and
perspective-taking (Wagaman et al., 2015).

Practice Highlight
Understanding Trauma Using Empathy in Child Welfare
Work with Biological Parents
Child welfare professionals serve children Empathy is a critical skill in child
(and families) who have experienced welfare practice; however, many
trauma. A traumatic event is one that is overlook the importance of using
dangerous and frightening and that poses empathy when working with bio-
a threat to a person’s life or body. Traumas logical parents.
frequently experienced by children who Child welfare professionals may
come to the attention of child protection have negative perceptions of par-
services include maltreatment, neglect, ents involved in the child welfare
sudden loss of a loved one, removal from system, which may be reflected in
their families, family violence, commu- value judgments in their practice.
nity violence, illnesses, serious accidents, The parents’ perception of the child
poverty, homelessness, or exposure to welfare professional’s lack of
someone with a substance use disorder. understanding and ability to empa-
Someone who experiences trauma can thize with their circumstances can
have a wide range of responses as they impact service implementation and
process the trauma. A person’s response the success of family interventions.
can depend on various factors including
Child Welfare Practice as a Profession 21

severity, exposure, chronicity, reactions of

Through empathy, child welfare
others, developmental stage, incidence of
professionals can enhance their
multiple traumatic events, and previous
relationship
experiences. Children’s physical, emo-
while encouraging parent partici-
tional, social, and cognitive development
pation in services and ultimately
can be impacted by trauma. Their reac-
promoting family reunification.
tions may include depression, anxious-
There are several ways child wel-
ness, behavior changes (e.g., sleeping,
fare professionals can use empathy
eating), physical complaints, issues related
as a key skill in supporting biologi-
to school performance, social relation-
cal parents. Child welfare profes-
ships, withdrawal or isolation, and/or risky
sionals should make an effort to
behaviors (e.g., substance use or sexual).
acknowledge the parent’s emo-
A trauma-informed approach in child
tional response, their feelings about
welfare is based on the premise that to be
having to be separated from their
able to work with children and families,
child, and show understanding of
there is an acknowledgment of trauma(s)
the associated challenges of being
and an understanding of how the trauma(s)
involved with the child welfare sys-
influence behaviors and thinking. For
tem. Child welfare professionals
example, a child who has been removed
can try to better understand the
from her parents because of being sexu-
various experiences the parent has
ally abused by her mother’s paramour
had that have led them to their cur-
may scream and curse at the group home
rent system involvement and rec-
staff the first day when told it is time to go
ognize the trauma they may have
to school. Without a trauma-informed
experienced. Finally, the child wel-
approach, she could be labeled “noncom-
fare professional should ensure
pliant” and as “acting out.” Taking trauma
they are able to separate their own
into account, her behaviors can be
emotions from those of the parent,
reframed as reactions to the trauma of the
acknowledging that they under-
abuse and removal from her home. Rather
stand those feelings but that they
than describing her as a “bad child,” it is
are separate from their own. This
possible to see that things were done to
will help protect them from overi-
her outside of her control and she is react-
dentification of emotions that may
ing to the traumas. It is central that child
lead to burnout.
welfare professionals understand trauma
and a trauma-informed approach. Chapter
5 explores trauma and using a trauma-
informed approach in depth as it relates to child maltreatment and child welfare.

Managing Bias and Navigating Professional Identity

Racial and ethnic disparities are well documented within child welfare. Professionals
working in child welfare settings must be cognizant of their potential role in per-
petuating the inequalities and disparities through biased decision making. Broadly,
child welfare professionals must be aware of their biases and how they impact their
22 1 Introduction to Child Welfare Practice

work with children and families. Biases extend beyond race and ethnicity; other
biases may include beliefs about a wide range of other characteristics such as age,
family structure, marital status, nationality, gender, sexual orientation, and religion.
Personal beliefs and biases can impact practice if they are unchecked. A starting
place in ensuring biases do not negatively impact child welfare practice is for work-
ers to understand their personal beliefs and identify where they could be biased.
Ensuring that workers continue to check their biases at every interaction and reflect
on their thoughts and behaviors also helps improve practices. As one develops into
a child welfare professional and gains more experience, one will also learn more
about the self, beliefs, and how they might play a role in interactions with children
and families. Being honest, reflective, and acknowledging bias, along with a genu-
ine effort to make changes, is a good starting point.

Note from the Field

Changing the System to Improve Outcomes
Nicole Kim, MSSW
After graduating from college, I took a gap year and became licensed as a fos-
ter mother. The sound of children crying while they were removed from their
families and placed into my arms will stay with me forever. Every removal, no
matter the circumstance, was a traumatic experience of loss for the child. In
one instance, a mother had attempted to take formula from a grocery store
when her WIC balance was depleted. As a result, her child was placed with me.
Poverty led to this child’s entrance into the child welfare system – and he was
not the only one. I cared for children who would save chicken nuggets in their
pockets in case we ran out of food. I bathed babies who arrived covered in dried
up milk and grime because their families did not have access to clean water and
toiletries. I picked sleeping toddlers up from floors because they never had a
bed before and were unused to sleeping in one. After fostering 28 children, I
knew that I wanted to do whatever I could to strengthen families and address
the systemic and structural inequalities that bring too many families into care.
After my time as a foster mother, I became a caseworker. I was often in the
field visiting homes, prisons, and hospitals and advocating for children and
parents at court hearings. I worked with a young mother who had aged out of
foster care, had been abused in care, and did not receive attention from case-
workers until she burned down her foster home. By then, she was pregnant
with her child. Soon after giving birth, her child was removed from her care
due to her unmet mental health needs and homelessness, which were out of
her control. Her story was one that I would see repeated too many times in the
lives of the parents I served.
As both a foster parent and caseworker, I wondered – what policies, pro-
grams, and financing innovations are needed to prevent system involvement in
the first place and to improve the system for those currently involved? What
could be done to better train staff and to better support families? My experience
inspired me to dedicate my career to the reform of the child welfare system and
to find solutions to improve the well-being of the children and families it serves.
Outline of the Book 23

Outline of the Book

This text is divided into 12 chapters that are described below. Within each chapter,
there is information based on the latest research available. Additionally, there are
sidebars that include case studies and experiences from the field. These are included
to provide real-life examples of what child welfare professionals experience.
Additionally, key information and definitions are highlighted in sidebars. At the
conclusion of each chapter is a section to assess understanding and a list of addi-
tional resources. Through answering these questions, readers can apply what they
learned in the chapters and demonstrate understanding of the material.
Chapter 2 describes how the child welfare system works and the various steps
throughout the life of a case in child welfare, including intake, investigations, place-
ment, and adoption. It includes information about various roles within child protec-
tion, how to navigate the system, and who some of the key players are in the child
welfare system. The chapter explores the importance of working in teams both
within child welfare and across systems. It also provides an overview of preparing
for and testifying in court.
Chapter 3 focuses on introducing information about normative physical, social-­
emotional, and cognitive development as well as how this development is inter-
rupted and altered as a result of trauma associated with child maltreatment. The
chapter outlines several domains of normative development and behavior as it
relates to a child’s physical and social environment and key caregiver responsibili-
ties and nurturing. The chapter describes the family life cycle, attachment and bond-
ing, and relationships and describes the research regarding promoting child and
adolescent well-being. The chapter also presents parenting styles, discipline, and
what the research concludes about healthy and unhealthy parenting and its short-­
term and long-term implications.
Chapter 4 provides in-depth descriptions of the different types of child abuse and
neglect: physical abuse, sexual abuse, psychological and emotional abuse, and
neglect (physical, educational, emotional, and medical). In addition, it describes
what is known about the short-term and long-term consequences of each type of
maltreatment. The chapter discusses how these various types of abuse and neglect
can be assessed in various contexts using specific tools and knowledge. Information
about important cultural considerations in the identification and assessment of vari-
ous types of child maltreatment is also included.
Chapter 5 describes trauma-informed practice broadly and applies this frame-
work to child welfare practice. It will present how trauma is defined, how it impacts
one’s development, and how we can use a trauma-informed approach to reducing
the impact of trauma on development and child and adult functioning. The chapter
provides information about what is known in the research about adverse childhood
experiences (ACEs) and how pervasive and diverse trauma experiences can be. The
chapter also presents information about what is known about trauma-informed
approaches to prevention and treatment of experiences of child maltreatment.
24 1 Introduction to Child Welfare Practice

Chapter 6 discusses the importance of child and family engagement in child

welfare practice as well as describes key skills in engaging and interviewing the
various parties involved at various stages of a case. Effective strategies for develop-
ing and maintaining appropriate and culturally grounded relationships with children
and their families are discussed, as well as ways to work with parents/guardians to
provide, monitor, and support services. The chapter also discusses various models
for engaging families such as Family Group Decision Making (FGDM), Parent
Cafes, and Child and Family Teams (CFTs) and how to work closely with various
professionals, family, and caregivers involved with the case (e.g., school personnel,
medical and behavioral health professionals, and law enforcement). The chapter
highlights strategies for working with families who experience mental health chal-
lenges and substance abuse and other issues as they relate to child welfare system
involvement.
Chapter 7 discusses the importance of child maltreatment prevention in child
welfare practice. The chapter outlines several prevention strategies, including
evidence-­based individual, family, and community-level approaches to preventing
maltreatment, the reoccurrence of child maltreatment, and the preservation of fami-
lies through treatment and provision of services and support. This chapter discusses
family preservation models and approaches used by child welfare systems across
the United States as well as their goals and what is known about outcomes.
Information about the role of the child welfare professional in prevention and fam-
ily preservation service delivery is also included.
Chapter 8 provides concrete skills needed for assessment and intake in child
welfare practice. The chapter explores the various ways safety and risk are assessed
by the type of abuse and in different contexts. The chapter documents the assess-
ment tools used by practitioners, such as actuarial- and clinical-based approaches as
well as the advantages and disadvantages of each and how they inform decision-­
making. The chapter also discusses new ways states and child welfare agencies are
identifying families in need of services (i.e., predictive analytics). The chapter
describes how to conduct family and home assessments and assessing for child and
family needs and strengths. The chapter outlines documentation procedures and
how to write effective case notes.
Chapter 9 provides a description of the various types of placement options (e.g.,
relative/kinship, nonrelative family placement, in-home, congregate care, etc.) and
the frequency and trends related to placement. The chapter discusses policies that
inform placement options and decision making. The chapter describes child removal
and placement process. This chapter also presents the importance of placement in
least restrictive environments, with siblings, with family/kin, culturally appropriate
settings, and in homes closest to a child’s neighborhood and school. It provides
research about placement stability and strategies for finding and promoting the best
placements based on the child’s needs. It describes the process of recruiting, train-
ing, and licensing foster parents.
Chapter 10 outlines policies and procedures related to permanency options for
children and families. The chapter outlines the types of permanency outcomes and
Conclusion 25

ways to identify permanency goals alongside family members and professionals to

ensure timely permanence. The chapter discusses service planning to meet perma-
nency goals as well as establishing concurrent permanency plans and the impor-
tance of family reunification. The chapter discusses meeting service goals, rates of
permanency, and foster care reentry.
Chapter 11 describes how to work with special populations involved with the
child welfare system (e.g., youth in care; children with disabilities; lesbian, gay,
bisexual, transgender, or queer/questioning [LGBTQ] youth; immigrant or refugee
children) to ensure professionals work collaboratively alongside them to ensure
their voice is heard and that as practitioners, child welfare professionals are provid-
ing optimal services to ensure child and family well-being. The chapter also dis-
cusses best practices when working with siblings and youth experiencing human
and sex trafficking.
Chapter 12 discusses the importance of clinical supervision in child welfare
practice and highlights ways that supervisors and child welfare workers and other
professionals can best structure and benefit from clinical supervision. It describes
effective models of strengths-based supervision and how to enhance supervision
interactions and its impact on family-centered practice and other child welfare prac-
tice outcomes. The chapter also outlines strategies and planning in professional
development for child welfare professionals, including various issues related to pro-
moting self-care, professional development (education and training), legal and ethi-
cal issues, licensing, and ensuring child welfare practitioner safety at home and on
the job. The chapter discusses issues related to longevity, burnout and secondary
traumatic stress, job satisfaction, retention, and professional goals and what the
research says about promoting healthy personal and professional practices for child
welfare professionals.

Conclusion

Child maltreatment continues to be a major social problem today. Child welfare

agencies seek to address all types of child maltreatment. They do so by following
the framework provided by federal legislation. The modern child welfare system’s
goal is to ensure safety, permanency, and well-being for children. Child welfare
professionals in various capacities seek to meet these ideals. Regardless of their
specific job responsibilities, child welfare professionals need to be able to engage
children and families. This can best be done through using empathy in their work
and managing their biases. The work of child welfare professionals is important as
it directly can save children’s lives and offer them a better future.

Acknowledgments The authors thank Breanna M. Carpenter, LMSW, MPA; Nicole Kim,
MSSW; and Terry A. Solomon, PhD, for their contributions to Chap. 1.
26 1 Introduction to Child Welfare Practice

Discussion Questions
1. Why is child maltreatment considered a major public health concern?
2. What are the economic impacts of child maltreatment?
3. How has society’s view of child maltreatment and child welfare changed in the
last century?
4. What are the reasons for racial disparities and disproportionality in child welfare?
5. What are the three goals of child welfare? How are they related and how are they
different?

Suggested Activities
1. Read the Miami Herald’s investigative report “Innocents Lost” about how child
welfare policies can impact child maltreatment: https://media.miamiherald.com/
static/media/projects/2014/innocents-­lost/
2. Visit the University of Minnesota’s Center for Advanced Studies in Child Welfare
(https://cascw.umn.edu/) and view video: “Child Protection Work in Minnesota:
A Realistic Job Preview” and read other resources around professional develop-
ment as a child welfare worker. Write a reflection about how you see yourself in
a child welfare role. Ask yourself about how your experiences, interests, and
training have prepared you for this role. Explore what role you would like to
serve in child welfare and what you may need to do to get there.
3. Go online to see if your state has a child fatalities dashboard. For example,
see South Carolina’s: http://reports.dss.sc.gov/SSRSReportServer/Pages/
ReportViewer.aspx?%2fChild+Fatalities
Look at the child deaths in the state and identify trends for the state you live in
(i.e., age of children, causes of death, circumstances, etc.)
4. Access the Kempe et al. (1962) article from your institution’s library. Consider
ways that it is relevant today and ways that it may be outdated. Discuss with a
peer, professor, or field instructor.
Kempe, C. H., Silverman, F. N., Steele, B. F., Droegemueller, W., & Silver,
H. K. (1962). The battered-child syndrome. Journal of American Medical
Association, 181(1), 17–24. Available: https://www.kempe.org/wp-­content/
uploads/2015/01/The_Battered_Child_Syndrome.pdf
5. Read Klika, et al. (2020). Identify the amount of money that your state is spend-
ing on child maltreatment. Write an essay your thoughts about how much money
is being spent.
Klika, J. B., Rosenzweig, J., & Merrick, M. (2020). Economic Burden of
Known Cases of Child Maltreatment from 2018 in Each State. Child and
Adolescent Social Work Journal, 37(3), 227–234. (Available: https://rdcu.
be/cbo5D).

Additional Resources
American Professional Society on the Abuse of Children: https://www.apsac.org/
Child Welfare Information Gateway. (2018). What is child welfare? A guide for
educators. Washington, DC: U.S. Department of Health and Human Services,
Children’s Bureau. https://www.childwelfare.gov/pubs/cw-­educators/
References 27

Child Welfare Information Gateway. (2013). How the child welfare system works.
Washington, DC: U.S. Department of Health and Human Services, Children’s
Bureau. https://www.childwelfare.gov/pubs/factsheets/cpswork/
Child Welfare Information Gateway. (2013). Understanding child welfare and the
courts. Washington, DC: U.S. Department of Health and Human Services,
Children’s Bureau. https://www.childwelfare.gov/pubPDFs/cwandcourts.pdf
Child Welfare Information Gateway. (2019). Major Federal legislation concerned
with child protection, child welfare, and adoption. Washington, DC:
U.S. Department of Health and Human Services, Children’s Bureau. https://
www.childwelfare.gov/pubs/otherpubs/majorfedlegis/
National Association of Social Workers, Standards for Social Work Practice in
Child Welfare. https://www.socialworkers.org/LinkClick.aspx?fileticket=zV1
G_96nWoI%3D&portalid=0
Child Welfare Information Gateway, Multidisciplinary Teams: https://www.
childwelfare.gov/topics/responding/iia/investigation/multidisciplinary/
Child Welfare Information Gateway, Child and Family Well-being: https://www.
childwelfare.gov/topics/systemwide/well-­being/
Child’s Bureau (2014). Integrating safety, permanency and well-being series.
https://www.acf.hhs.gov/cb/resource/well-­being-­series
Child and Family Services Review, CFSR Information Portal. https://www.cfsrpor-
tal.acf.hhs.gov/
Children’s Bureau, Child & Family Services (CFSRs). https://www.acf.hhs.gov/cb/
monitoring/child-­family-­services-­reviews

References

Bezark, M. (2021). ‘Our arithmetic was unique’: The Sheppard-Towner Act and the constraints of
federalism on data collection before the new deal. Journal of Policy History, 33(2), 183–204.
Child Trends. (2018). Racial and ethnic composition of the child population. https://www.
childtrends.org/indicators/racial-­and-­ethnic-­composition-­of-­the-­child-­population
Cleveland, K. C., & Quas, J. A. (2020). Juvenile dependency court: The role of race in decisions,
outcomes, and participant experiences. In M. C. Stevenson, B. L. Bottoms, & K. C. Burke
(Eds.), The legacy of race for children: Psychology, public policy and law (pp. 71–90). Oxford
University Press.
Fang, X., Brown, D. S., Florence, C. S., & Mercy, J. A. (2012). The economic burden of child mal-
treatment in the United States and implications for prevention. Child Abuse & Neglect, 36(2),
156–165. https://doi.org/10.1016/j.chiabu.2011.10.006
Gerdes, K. E., Segal, E. A., & Lietz, C. A. (2010). Conceptualising and measuring empathy. British
Journal of Social Work, 40(7), 2326–2343. https://doi.org/10.1093/bjsw/bcq048
Hogan, P. T., & Siu, S. F. (1988). Minority children and the child welfare system: An historical
perspective. Social Work, 33(6), 493–498. https://doi.org/10.1093/sw/33.6.493
International Federation of Social Workers. (2014). Global definition of social work. https://www.
ifsw.org/what-­is-­social-­work/global-­definition-­of-­social-­work/
Jimenez, J. (2006). The history of child protection in the African American community:
Implications for current child welfare policies. Children and Youth Services Review, 28(8),
888–905. https://doi.org/10.1016/j.childyouth.2005.10.004
28 1 Introduction to Child Welfare Practice

Kempe, C. H., Silverman, F. N., Steele, B. F., Droegemueller, W., & Silver, H. K. (1962). The
battered-child syndrome. Journal of American Medical Association, 181(1), 17–24. https://doi.
org/10.1001/jama.1962.03050270019004
Klika, J. B., Rosenzweig, J., & Merrick, M. (2020). Economic burden of known cases of child mal-
treatment from 2018 in each state. Child and Adolescent Social Work Journal, 37(3), 227–234.
https://doi.org/10.1007/s10560-­020-­00665-­5
Miller, K. M., Cahn, K., Anderson-Nathe, B., Cause, A. G., & Bender, R. (2013). Individual and
systemic/structural bias in child welfare decision making: Implications for children and fami-
lies of color. Children and Youth Services Review, 35(9), 1634–1642. https://doi.org/10.1016/j.
childyouth.2013.07.002
Mullins, J. L. (2011). A framework for cultivating and increasing child welfare workers’ empa-
thy toward parents. Journal of Social Service Research, 37(3), 242–253. https://doi.org/10.108
0/01488376.2011.564030
Myers, J. E. B. (2011). A short history of child protection in the United States. In J. E. B. Myers
(Ed.), In the APSAC handbook on child maltreatment (3rd ed.). Sage.
National Association of Social Workers. (2013). NASW standards for social work practice in
child welfare. https://www.socialworkers.org/LinkClick.aspx?fileticket=zV1G_96nWoI%3d&
portalid=0
National Conference of State Legislatures. (2020). Family First Prevention and Services Act.
Retrieved from: https://www.ncsl.org/research/human-­services/family-­first-­prevention-­
services-­act-­ffpsa.aspx
Peterson, C., Florence, C., & Klevens, J. (2018). The economic burden of child maltreatment
in the United States, 2015. Child Abuse & Neglect, 86, 178–183. https://doi.org/10.1016/j.
chiabu.2018.09.018
Segal, E. A., Gerdes, K. E., Lietz, C. A., Wagaman, M. A., & Geiger, J. M. (2017). Assessing
empathy. University Press. https://doi.org/10.7312/kehr18115
UNICEF. (2020). What we do. https://www.unicef.org/what-­we-­do
U.S. Department of Health & Human Services. (2020). The AFSCARS report. https://www.acf.
hhs.gov/sites/default/files/cb/afcarsreport27.pdf
Vermont Department for Children and Families. (n.d.). https://dcf.vermont.gov/fsd/career/
characteristics
Wagaman, M. A., Geiger, J. M., Shockley, C., & Segal, E. A. (2015). The role of empathy in
burnout, compassion satisfaction, and secondary traumatic stress among social workers. Social
Work, 60(3), 201–209. https://doi.org/10.1093/sw/swv014
Wildeman, C., Emanuel, N., Leventhal, J. M., Putnam-Hornstein, E., Waldfogel, J., & Lee,
H. (2014). The prevalence of confirmed maltreatment among US children, 2004 to 2011. JAMA
Pediatrics, 168(8), 706–713. https://doi.org/10.1001/jamapediatrics.2014.410
World Health Organization. (2020). Child maltreatment. https://www.who.int/news-­room/
fact-­sheets/detail/child-­maltreatment
Chapter 2
How the Child Welfare System Works

Introduction

The child welfare system is simultaneously a simple and complex system. At the
core, the system seeks to ensure the safety, permanency, and well-being of children.
A child and family often enter the child welfare system when someone makes a
report to child protective services about concerns about abuse or neglect. This
begins a case in the system, which will follow a prescribed route based on assess-
ments of risk and safety. There are different child welfare professionals who will be
involved across the life of a case. These professionals work with other professional
partners (e.g., law enforcement, mental health or substance abuse counselors,
healthcare professionals) to best serve the child and family. The courts oversee
cases and ensure that children’s and parents’ rights are protected.

Current Child Welfare System Description

There is a wide variety of ways child welfare systems are set up in the United States.
At the most foundational level, there are child protective investigators and depen-
dency case managers (also called ongoing case managers, foster care case manag-
ers, and permanency workers). Together, the child protection investigators and case
managers are considered “frontline” workers. They are the ones interacting with
children and families daily.
A child welfare agency becomes involved with a child and family because they
are alerted through a report. This can be done through the hotline or an online
reporting system. A concerned person, perhaps a teacher, nurse, neighbor, or family
member, reports concerns about the safety of a child. In some cases, the caregiver
may also contact a child welfare agency requesting assistance. The report includes
basic information about the child and caregivers as well as the situation. At this

© Springer Nature Switzerland AG 2021 29

J. M. Geiger, L. Schelbe, The Handbook on Child Welfare Practice,
https://doi.org/10.1007/978-3-030-73912-6_2
30 2 How the Child Welfare System Works

point, the report may be “screened in” if there is enough information to investigate
and the definitions of maltreatment have been met. Figure 2.1 explores how cases
progress.
Child protection investigators are assigned cases that are “screened in” by the
hotline. As their title suggests, they investigate the allegations of maltreatment.
They interview the relevant people and assess the home environment. Along with
their team and the courts, they make a determination of children’s safety and of the
substantiation of the report of maltreatment. After the determination of maltreat-
ment has been determined, cases are assigned to dependency case managers, and the
child protection investigator’s role is complete. Dependency case managers work
with children and families to work toward the case plan goals.
While cases are assigned to specific workers, a child welfare professional does
not work in isolation. There is a team with a hierarchical structure that is in place to
ensure the best decisions are made and multiple people sign off on cases. Supervisors
review cases. Many child welfare agencies use a multidisciplinary team, sometimes
called Child Protection Teams, to assess cases and conduct further investigation.
These multidisciplinary teams are typically medically directed and work closely
with law enforcement and the child welfare agency for assessment of maltreatment
and psychological and medical evaluations. Members of the team conduct forensic
interviews and as necessary provide expert court testimony. Multidisciplinary teams
play a large role in providing perspectives from various experts, using a trauma-­
informed approach to court involvement, and improving outcomes (Bruns et al.,
2012; Ezell et al., 2018; Herbert & Bromfield, 2019; Zinn & Orlebeke, 2017).
Despite the benefits of across system collaboration among child welfare and the
juvenile court, there is often a disconnect with values, purpose, and process (Ellett
& Steib, 2005).
Special court processes and units have also been created to address specialized
cases involving substance abuse (e.g., family drug court) and young children (e.g.,
Safe Baby Court Team). These specialized programs have been shown to be effec-
tive in improving permanency outcomes (i.e., reunification) and accessing services
for children and caregivers (Bruns et al., 2012; Chuang et al, 2012).
With the knowledge that infants and young children are more vulnerable to child
maltreatment and what is known about this age being an important period for devel-
opment, variations of “Baby Court” have been implemented in states and jurisdic-
tions across the United States. The approach typically uses one that minimizes
trauma for parents and children by enhancing collaboration in the courts, child wel-
fare, and community settings to reduce time in care and maximizing success in
reunification and permanency (Casanueva et al., 2019; Zero to Three, 2017). These
programs provide training, leadership development, and service coordination with
community partners. Studies have shown these programs to be more effective
in reducing costs, time, and improving child welfare and court process outcomes
(Zero to Three, 2017).
Current Child Welfare System Description 31

Fig. 2.1 Child protection services process

32 2 How the Child Welfare System Works

Practice Conversation
A Call to the Child Abuse and Neglect Hotline
As discussed, there are several reasons someone might call the hotline to
report child abuse and neglect. Many of these reports come from teachers and
other school officials, medical professional, neighbors, family members, and
sometimes strangers. Here is an example an excerpt of a report made by a
child’s teacher.1
Hotline Operator: Thank you for calling the child abuse and neglect hotline,
do you have a report to make?
Caller: Yes, I do.
Hotline Operator: First, I would like to tell you that you may remain anony-
mous on this call, however, it is important for you to ensure you honestly
respond to all of my questions and provide as much information as possible.
If you choose to disclose your identity or relationship with the child, your
identity will remain confidential. The child welfare agency has protocol that
allows them to evaluate this information to make a determination about inves-
tigating the report further.
Caller: OK.
Hotline Operator: Can you tell me first, in what capacity you know the child?
Caller: I am his teacher.
Hotline Operator: OK. Can you tell me about the child and what you saw or
heard that leads you to believe there has been possible abuse or neglect?
Caller: Yes. Juwan is in my 2nd grade class. He is 8 years old. He came to
school today with bruising around his wrists and upper arm. He was wearing
a sweatshirt when he arrived to school, but took it off with a t-shirt under-
neath. That is when I noticed the bruising and at our mid-morning break, I
asked him about what happened to cause the bruising. He told me that he was
playing with his sister and they were making too much noise. His father
grabbed him by the arm and dragged him to his room while he yelled at him.
Hotline Operator: Can you tell me more about what the bruises looked like
and where they were located?
Caller: I noticed mostly dark red bruises on his upper right arm and around
both of his wrists. When I asked him about what happened, at first he said
nothing was wrong, that nothing happened. When I told him I was concerned,
he started to cry and told me what happened. He said his father yells a lot and
he is afraid what will happen if he tells.

1
All names and other personal identifiers in cases and examples throughout this book have
been changed to protect privacy and confidentiality.
Current Child Welfare System Description 33

Hotline Operator: Can you tell me a bit more about the family – who lives
in the home, about other children?
Caller: The child lives with both of his parents and 2 younger siblings, ages
6 and 2.
Hotline Operator: OK, thank you. We will follow up with additional ques-
tions as the investigator is assigned to the case. Before we get off the phone, I
need some more information, including your contact information…

Intake

A report to child protection services is the beginning of the process. Reports can be
made to the hotline or online and include basic information about the child and fam-
ily as well as the allegations of maltreatment. The report is assessed by a child
welfare professional and either screened out or screened in. Cases are screened out
due to having insufficient information or not meeting the criteria of maltreatment.
For cases that are screened in, the next step is an investigation by a child protection
investigator. After the investigation process, maltreatment can be substantiated or
unsubstantiated. When the maltreatment is unsubstantiated, families can be referred
to voluntary services. With a substantiated case, the investigator’s assessments of
risk and safety determine if the child can remain in the home to receive in-home
services or if the child should be removed from the home and placed in an out-of-­
home placement. For children who are removed from their caregivers, there is a
shelter hearing where a judge determines the course of action for the child.

Case Management

Once the investigation is over and the children become legally dependent and
involved with the child welfare system, the case is transferred to a case manager
who will work with the child and family with the goals of safety, permanency, and
well-being. This is done through development of a case plan which outlines what
parents must accomplish before the case can be closed. Case plans are individual-
ized to the circumstances of the family, taking in children’s needs. Chapter 6
describes the processes of engagement children and families and details about how
child welfare professionals work with children and families. Chapter 11 discusses
how child welfare professionals can best serve special populations. The courts
review the progress of the case plan on a regular basis. There are timelines deter-
mined by legislation that dictate the process.
A case is closed when a child is reunified with their caregivers, which happens in
a majority of cases. When reunification is not possible, parental rights may be
34 2 How the Child Welfare System Works

terminated and a child can be adopted or placed in a permanent guardianship.

Occasionally, children are not reunified and do not achieve permanency through
adoptions or guardianships and “age out” of the system. Details about these perma-
nency outcomes are presented in Chap. 10.

Law Enforcement Investigations

In some instances of child maltreatment, law enforcement conducts investigations.

This is a separate process from the child welfare system involvement, although ide-
ally child welfare and law enforcement professionals collaborate. Not all cases
reported to child protective services are investigated by law enforcement and crimi-
nally prosecuted. A recent study estimated that just over a quarter (28%) of cases
reported to child protective services were investigated by law enforcement (Cross,
Chuang, Helton & Lux, 2015). Variation in investigation was great due to type of
maltreatment with more than half (54%) of the cases where sexual abuse was the
primary alleged maltreatment as compared to 24% physical abuse and 11% of
neglect. Likewise, there were differences across agencies, ranging from some agen-
cies having no investigations by law enforcement to others having 70% of cases
investigated.
Law enforcement and child protec-
Practice Highlight
tive services have different roles. Law
Child Advocacy Centers
enforcement’s role is to ensure public
Child advocacy centers (CACs) are
safety and laws are followed, while
programs that are community-based,
child protective services are focusing
child-­friendly that offer multidisci-
on the child and family safety and
plinary services for children and fami-
well-being. When law enforcement is
lies affected by or at risk for child
involved in a case, the role is to con-
maltreatment. CACs bring together
duct an investigation through inter-
professionals and resources from vari-
viewing witnesses and collecting
ous areas of expertise, including child
evidence. The case may be presented
protective services investigators, law
to a district attorney who will deter-
enforcement, attorneys, and medical
mine if there will be charges brought
and mental health professionals to
against the caregiver. Not all child mal-
offer specialized, coordinated, com-
treatment cases are prosecuted, even
prehensive services and supports to
when law enforcement is involved.
children and families (Herbert &
Sometimes child protective services
Bromfield, 2016). Child advocacy
and law enforcement work incredibly
centers can deliver programs that
together. In communities where there
address the needs of children who
is a children’s advocacy center, there
have been sexual abused and their
may be coordination and teamwork
families to reduce children’s symp-
among these systems as well as the
toms and promote their well-being
prosecutor and community services
(Hubel et al., 2014).
providers (e.g., mental health,
Professional Partners 35

medical). Even without a children’s advocacy center, some child welfare agencies
and law enforcement departments work well together and create a memorandum of
understanding that documents how the systems will work together on cases.
Unfortunately, sometimes the two systems do not work well together due to the dif-
ferent perspectives and fears. Law enforcement may be concerned that child protec-
tive services could potentially destroy evidence or interfere with their ability to
create a case that will get a conviction. Child protective services may worry that law
enforcement may not work with the parents and children in an appropriate manner.
However, when the systems work together, there can be positive outcomes, and the
goal should be to have the systems work together for the common goal of helping
children.

Professional Partners

The child welfare system does not operate in isolation; there are multiple profes-
sionals who interact with the child welfare system. These professions include health
care, law enforcement, legal services, and education. Professionals in mental health,
substance misuse, and intimate partner violence are also involved with children and
families involved in the child welfare system. In Chap. 6, more detailed information
about collaborative practice is presented.
Doctors play a significant role in child welfare through their determining the
likelihood that maltreatment occurred. They ultimately are the ones who determine
if the injury or health concern was due to maltreatment. It must be stressed that
healthcare professionals have a responsibility for identifying neglect and not just
abuse (Keeshin & Dubowitz, 2013). Healthcare professionals’ involvement in cases
is not just about determining maltreatment; they also provide assessments and ongo-
ing treatment for children in care. As will be discussed in Chap. 4, children who
experience maltreatment have high rates of problems with their health. When a
child enters foster care, they should receive a health screening evaluation. If it is
determined that a child needs treatment, they should receive it while they are in
care. In some communities, a medical home model is used. In this best practice, a
child who enters foster care will be assessed and treated by the same team of health-
care professionals throughout their entire involvement in the child welfare system
(Espeleta et al., 2020). Pediatricians have the opportunity to have parenting inter-
ventions delivered in their offices, and there is evidence that this is an effective
strategy (Smith et al., 2020).
Law enforcement frequently collaborates with the child welfare system. As dis-
cussed above, sometimes there are parallel cases where law enforcement conducts
investigations and prosecutes case of child maltreatment. Even when this does not
occur, law enforcement may still be involved in the case. A sheriff’s deputy or police
officer is to be present when a child welfare professional is removing a child from
their parents. Also, in many jurisdictions, child welfare professionals are encour-
aged to have a law enforcement escort when there are concerns about safety during
36 2 How the Child Welfare System Works

home visits. This could be in cases where the caregivers have a documented history
of violence and access to guns. (See Chap. 12 for more information about worker
safety.)
The judicial system is an integral part of child protection. Children are only
removed from their parents’ care with the approval of judges. While the case plans
may be developed by child welfare professionals and the interactions with the chil-
dren and families are with the child welfare professionals, the decisions about chil-
dren’s removals are determined within the courts. As will be presented in Practice
Highlight: Courtroom Players to Know, there are various professionals in legal ser-
vices who play a role in child welfare cases.
The education system and child welfare system have not always worked well
together, but with the passage of the federal legislation Every Student Succeeds Act
in 2015, it became a requirement that school districts and child welfare agencies
have agreements and points of contact to facilitate collaboration and best serving
children. Even before this legislation was passed and there were requirements to
work together, teachers, principals, and school personnel have played important
roles in child welfare as they are frequent mandated reporters. With the growing
awareness of the need for the educational and child welfare systems to work
together, there are more collaborations. Additionally, there are more school systems
that are adopting a trauma-informed approach to education. This is happening at all
levels of school. There may be a particular interest in this at the preschool level as
the beginning of a child’s education is tremendously important (Loomis, 2018). In
early childhood education, there is interest in addressing child mental health and
ensuring optimal development early in life. Early childhood education is starting
may incorporate mental health experts to assist in this process (e.g., Davis
et al., 2020).

Mandatory Reporting
Under CAPTA, each state is required to have mandatory reporting legislation
that outlines who is required to report suspected cases of child maltreatment
to the authorities. Penalties for failure to report can be fines, jail time, or both.
Statutes vary by state. In a few states, legislation specifies any person who
believes that a child is being abused or neglected is required to make a report.
In these states, the profession of the person is not taken into consideration.
Other states require any person who believes that a child is being abused or
neglected is required by state law to make a report but also identifies specific
professions where there is a responsibility to report. The majority of states
have mandatory reporting laws that identify specific professions responsible
for reporting suspected child abuse or neglect. The professions are typically
those where there is high contact with children. Common professions that are
identified by state legislation as mandated reporters include social workers,
school personnel (e.g., teachers, principals), doctors, nurses, healthcare work-
ers, therapists, childcare providers, and law enforcement professionals.
Services 37

Mandatory reporting laws extend beyond identifying who is responsible to

report suspected cases of maltreatment. Many state laws also include require-
ment for “institutional reporting,” which applies to circumstances when a
mandated reporter works or volunteers at an institution (e.g., hospital, school)
where they learn of suspected child maltreatment. These institutions are
responsible to have a policy when someone suspects there is maltreatment.
Typically, the policy includes notifying a specific person in the institution and
a report being made to child protective services. State laws also determine if
mandatory reporters may make a report anonymously or if they are required
to provide their name. Most states’ mandatory reporting statues prohibit the
reporters’ name from being released to the alleged perpetrator(s); however, in
some states, reporters can waive their right to confidentiality. Because some
of the professions listed in states’ mandatory reporting laws have “privileged
communication,” which are interactions that are to remain confidential and
legally the professional cannot disclose what was shared with them, most
states’ laws specifically address privileged communication. Some states’ stat-
utes require that mandatory reporters must report child maltreatment even if it
was learned of during privileged communication; other states do not have
such a requirement. In these states, a mandatory reporter learns of suspected
maltreatment during privileged communication is not required to file a report
with child protective services.

Services

There are a wide range of services provided to children and families within the child
welfare system. Referrals can be made to various types of programs including those
addressing employment, housing, mental health, substance misuse, and intimate
partner violence. Details about working with families where there are concerns
about mental health, substance misuse, and intimate partner violence are presented
in Chap. 6. Services should be tailored to the needs of the caregivers, child, or the
family. Some services are optional, while others are required of a case plan. Ideally
services are provided to children and families soon after the maltreatment occurred,
although it must be stressed that interventions can be effective later in life. For
example, there are interventions for adults who were sexual abused as children
(Wilen et al., 2017), which may occur years after the child welfare system was
involved or even if the child sexual abuse had never been known about soon after it
occurred. Regardless of when provided, services ideally will be evidence-based.
Scholars have noted that the evidence-based programs and practices continue to
need to be developed as they play an important role in child maltreatment preven-
tion (Powell, et al., 2015).
38 2 How the Child Welfare System Works

One ongoing concern in child welfare is the availability and accessibility of

services that children and families need. In some communities, especially rural
settings, there may not be services. This means that families have to travel lengthy
distances to access a service, which can add costs in transportation and in time.
The costs can sometimes become prohibitive to someone accessing services.
Fortunately, there are efforts to increase offering virtual services to children who
have experience maltreatment (e.g., MacLoed et al., 2009). Even if services are
available within the community, there may sometimes be long waiting lists because
of the demand for services and limited number of providers. Sometimes services
are sometimes provided in a way that is inconsistent with the needs of the person
needing services. For example, a parent may be referred to anger management
classes that only meet in the evenings, but the parent’s work schedule conflicts
with the time the class is offered. A parent not receiving services does not always
mean that the parent does not want to receive services; there may be facing real
challenges.

Privatization

Several states have privatized portions of the child welfare systems such that the
child welfare professionals are not state employees. Rather they are employees of
a company or nonprofit. Privatization is when the state contracts with agencies to
provide specific services. In some cases, this could be providing case manage-
ment, licensing foster care placements, and managing group homes. Reduction in
costs and the ability to adapt to local communities’ needs drove the movement
toward privatization. Privatization has had varying levels of success across child
welfare systems. Some have been less successful than others. For example, in the
state of Nebraska, after child welfare services were privatized, there was a reduc-
tion in the availability and quality of services (Hubel et al., 2013). Although the
motivation for the state had been to increase efficiency and cost savings, after
privatization, the states’ costs of child welfare services increased by 27%, and the
private agencies spent over $21 million of their own funds as they tried to fulfill
their contracts with the state. There were many factors that contributed to the
problems of privatization in Nebraska including that there was inadequate plan-
ning in part due to a rushed timeline and the agencies had little experience provid-
ing child welfare services and coordinating contracts of the large scale. Lessons
learned from Nebraska and other states who have had various levels of success
can inform states privatizing their child welfare systems. The trend of privatiza-
tion is continuing.
Privatization 39

Note from the Field

The Power of Court Appointed Special Advocates
Brittany Mihalec-Adkins, M.S.Ed.
I started volunteering as a Court Appointed Special Advocate (CASA) when I
was 23 years old. I had no experience parenting and no experience as a prac-
titioner of any kind, and I was nervous that the parents of children on my
caseload would glare at me from across the table and ask me what the heck I
knew about parenting or how long I had been a CASA. And they did – and
honestly: fair enough. I didn’t have parenting stories to share in camaraderie;
I couldn’t tell them that I understood the difficulties of having a baby with
colic, or a toddler who won’t let me sleep, or a teenager who keeps running
away. All I had was the binder I was given in training, and business cards with
my name and email address that parents almost never wanted.
In CASA training, you are taught that your role is to be an unbiased advo-
cate for the best interest of the child – without consideration for what others
in the case (e.g., parents, relatives, caseworkers, etc.) want or think. You are
supposed to be okay with saying things people don’t want to hear, with the
knowledge that you are doing what is best for a child in need. On the bill-
boards that implore passersby to volunteer with CASA, there are pictures of
sad-looking children that say something like “Be my voice,” and indeed,
newly minted CASAs walk into their first court hearings and home visits
dead-set on doing just that – myself included. But the first time I walked into
a parent’s home to visit the first child I had been assigned to advocate for, I
had such a hard time seeing the neglected child in a vacuum portrayed on
those billboards. Yes, I saw the toddler who I knew had been exposed to meth-
amphetamine and marijuana, but I also saw her finger paintings hanging on
the refrigerator, and her pictures on every wall. I saw a toybox with her name
painted on it, and grapes that had been cut in half like they’re supposed to be.
I saw her run to mom for comfort when she bumped her knee, and I saw mom
kiss the bumped knee and say “all better!”. I saw a mom who loved her daugh-
ter, but who was 14 when she became a mom, and who ended up in foster care
shortly after when one parent relapsed and the other went back to prison for
sexually abusing his own children. I saw a mom who needed (but never got)
her own CASA. I saw a mom who genuinely tried not to miss any court-­
mandated appointments, but who also didn’t have a car or a babysitter or
money for a bus pass, if it wasn’t paycheck week. Did I agree with all of
mom’s decisions – past and present? Of course not. But did I think she was the
horrible person that she was sometimes made out to be in case conferences
about her missed appointments or less-than-chipper attitude? Also, of course
not. I felt for this mom. I was reminded by my supervisor no fewer than ten
times that I was not mom’s advocate.
40 2 How the Child Welfare System Works

But it is HARD to advocate for a child without considering the needs and
the potential of the families in which these children are embedded, especially
when there is NO ONE advocating for a mom that is only barely too old to
qualify for a CASA herself. It is hard not to wonder whether you’re a terrible
CASA for not wanting this toddler to be adopted by the upper-middle-class
foster parents who feed her organic foods, limit screen time, and keep a tight
schedule – and instead wanting to give mom a chance to learn to be a mom
who keeps a schedule, serves vegetables, and calls her sponsor when she’s
feeling the urge to use. It is HARD to testify in court that you agree with a
petition to terminate parental rights after you’ve seen mom weep at every
monthly home visit while asking you whether you’re going to “let them keep
her baby forever.” But I know that it would be even HARDER to leave a court
hearing after advocating for a child to be returned to a home where, yes, there
was a mom who loved her child, but where there were other safety concerns
mom was unable or unwilling to solve.
Now in my fourth year as a CASA, I think I have figured out how to recon-
cile all of these feelings, and that is to be open about the empathy I have for
the parents of children I advocate for – open with caseworkers, with judges,
with my supervisor, and most importantly, with parents. I hug moms. I give
dads my cell phone number and text them updates when I visit their children
in group homes. I make time to sit down with parents before court and explain
that I am not going to recommend reunification today and explain WHY. The
first time I did that, I was terrified that it was going to be awkward, but it
wasn’t any more awkward than any other part of the process. Parents have
always been grateful that I take that time with them, in a system that often
doesn’t tell them much about what’s happening – let alone the reasons behind
it. I have come to terms with the fact that it is not my job to advocate for par-
ents, and I tell parents as much. But I also make sure they understand that my
job is to advocate for their child, to want the best for their child – just like they
do. The vast majority of parents have responded surprisingly well to this.
Now, when my cases end – and no matter how they end – I know that I treated
parents with dignity and respect, that I stood firm in my role as a child advo-
cate without demonizing or demoralizing parents, and that even when parents
don’t like or agree with me, they believe that I advocated for their child to the
best of my ability. And that I can live with.

Roles in Child Protection and Foster Care

There are a number of roles within child welfare practice and depending on the state
and/or jurisdiction, titles may be referred to differently. They typically fall into cat-
egories based on the responsibilities they primarily fulfill. See Table 2.1 for a
Roles in Child Protection and Foster Care 41

Table 2.1 Child welfare position and responsibilities

Child welfare
position Responsibilities Example
Intake/ • Conducts interviews A report of a 4-year-old being left alone at home for
investigator and home assessments 2 hours while mother is shopping is received by the
• Prepare documents and hotline. The investigator is assigned and visits the
completes forms home immediately to determine the child’s safety.
• Testifies in preliminaryThe investigator hears the child inside the apartment
and protective hearings and knocks on several neighbors’ doors. The
• May remove and place next-door neighbor offers a key to the apartment
child in safe setting where the child is alone watching television. It is
• Makes referrals for unclear how long the child has been home alone. He
services (child/parent) is wearing a diaper and no clothing. The neighbor
• Participates in family provides the investigator with a number for the
group decision-making mother, who returns home after 30 min. The
team meeting investigator conducts a thorough assessment of the
home while asking the mother and neighbors
several questions. The investigator decides to leave
the child with a grandparent temporarily while they
continue to investigate the case. The investigator
writes the report and makes several referrals for
services
Intact family • Develops and monitors The intact family specialist was assigned to a case
specialist/ family case plan where the biological mother tested positive for
family • Makes referrals for marijuana when she gave birth to her child in the
preservation services hospital. The intact family specialist assessed the
specialist • Visits child and family family home to determine its safety for a newborn.
in home regularly The mother lives with her mother, who helps her
• Conducts home care for the child. The intact specialist made
assessments referrals for home visitation services, substance
• Participates in child abuse counseling, and parenting support. The intact
and family team specialist visits the home every 3–4 days
meetings unannounced to make sure the home is appropriate
• Prepares progress and the newborn is being cared for. They prepare a
report report for the court after 6 months of child welfare
involvement and service engagement
Foster care • Monitors placement, Following an investigation, 12-year-old Annette
specialist services, and overall was placed with relatives after it was determined it
case progress was unsafe for her to stay with her biological
• Develops and monitors parents. Her father was unable to care for her due to
family case plan substance abuse and her mother received a 6-month
• Prepares and distrib- jail sentence for assaulting her boyfriend. The foster
utes court progress care specialist completed an assessment of her
report to case parties aunt’s home and asks them to commit to care for
• Attends court Annette until her mother is able to be reunified with
• Visits child in setting her daughter. Annette’s mother is released from jail
• Participates in child after serving 4 months and begins to engage in
and family team services the foster care specialist has recommended:
meetings counseling, parenting classes, and substance abuse
outpatient treatment. The foster care specialist
receives regular updates regarding service
engagement and progress. She visits with Annette
and her aunt monthly
(continued)
42 2 How the Child Welfare System Works

Table 2.1 (continued)

Child welfare
position Responsibilities Example
Adoption/ • Assesses child’s Tyler, a 9-year-old child had been in foster care for
permanency short- and long-term 2 years. After many attempts, his mother was not
specialist needs able to be reunified with her son. The case plan
• Identifies adoption changed from foster care to severance and adoption.
placement for child After a brief trial, the judge ordered that Tyler be
• Participates in child free for adoption. Once an adoption specialist was
and family team assigned, they did not have to locate an appropriate
meetings family since his current family was willing to adopt
• Prepares necessary him. They had not adopted a child before; therefore,
paperwork for court they had to become certified to adopt, which
• Submits referrals for include several forms and assessments to be
post-adoption subsidies completed by the adoption specialist. The specialist
and services had to determine what services Tyler and his family
were receiving and which would need to continue.
The adoption specialist submitted all of the
paperwork for any subsidies and services they were
eligible for after adoption. The adoption date was
set, and Tyler was legally adopted by his parents.
His birth certificate was reissued with his adoptive
parents being listed as his parents and his new last
name

summary of child welfare professionals’ positions, responsibilities, and examples of

their work. For example, child protection investigators conduct investigations fol-
lowing a report of child maltreatment. These individuals will conduct interviews
and home assessments, prepare documents and complete forms, and prepare for
court testimony as necessary. If necessary, they will also remove a child from an
unsafe home and make arrangements for alternative placement. Once a case has
moved past the investigations stage and a child or children have been removed, an
ongoing, foster care, or placement case manager is assigned to the case. Their role
is to assist with assessing for services and supports and making the necessary refer-
rals for them to be initiated. Child welfare professionals within this role will support
the placement, attend court, monitor services for parents, children, and caregivers,
and complete reports necessary for monitoring case progress. Placement, ongoing,
or foster care child welfare professionals work closely with the family to promote
permanency and may be assigned to specialty cases based on their experience and
training (e.g., older youth, children with medical needs).
For cases where children are deemed safe to stay in the home but perhaps require
support services, there may be a family preservation specialist or intact case man-
ager that will also conduct assessments and make referrals for services and supports
for children and families. These professionals will often have more frequent contact
with the children and families and continue to assess for safety in the home.
When it is not possible for children to return to their family of origin safely and
a case plan changes and is approved by the court to proceed with adoption, the case
may be transferred to an adoption specialist. This professional role includes
Roles in Child Protection and Foster Care 43

preparing documents related to adoption, finding an adoptive family that is a good

fit for the child and their needs, assisting with the transition into a new home (if dif-
ferent from current placement), assessing and accessing services and supports fol-
lowing the finalization of the adoption, and attending court for the adoption hearing.
The majority of case manager positions in child welfare require some college, a
bachelor’s or master’s degree and some experience working with children and/or
families. Many of these positions are filled by trained social workers, which are
those who have a bachelor’s and/or master’s degree in social work from an institu-
tion that is accredited by the Council on Social Work Education (CSWE) and who
follow the National Association of Social Workers (NASW)’s Code of Ethics.
Others may have related degrees (e.g., psychology, sociology, family studies) or
combined education and experience with families and children. Requirements vary
by state and agency, and some may require additional training and experience and/
or licensure. Many child welfare professionals may have participated in one of the
many Title IV-E funded training programs that helps students receive the necessary
training experience in child welfare practice while they are in school. Although
these programs vary, many will offer courses and internships/field placements in
child welfare along with a financial stipend or tuition waiver. Once they have com-
pleted their program, they go on to seek employment at the local child welfare
agency for a specific set of time. In addition to case manager positions, agencies will
often also employ case aides or visitation specialists who supervise visits with chil-
dren and their parents/caregivers, help with transportation, and conduct home visits.
Chapter 12 further discusses supervisor positions and their responsibilities; how-
ever, many supervisors will have had extensive experience working in one or more
of the positions mentioned above to be able to better understand the role, responsi-
bilities, and expectations necessary to fulfill that position in child welfare practice.

Practice Highlight
Courtroom Players to Know
Judge: The judge presides over the courtroom and makes important decisions
about the case, including placement, whether abuse and neglect has occurred,
and permanency. The judge orders services and actions as part of the case.
Children’s representatives: The court may appoint one or all of the follow-
ing child representatives. Each serves a different role, depending on the case;
however, all may be appointed as well depending on the need. Whether these
individuals are a party to the case depends on state statues, which will dictate
whether the child welfare professional is required to provide information
about the case.
Attorney: A child’s attorney represents the child and advocates for their
desires. The attorney also provides information about the case and the
proceedings.
44 2 How the Child Welfare System Works

Guardian ad litem (GAL): A guardian ad litem (GAL) is an attorney or a

layperson that represents the child’s best interests, which may or may not
be in line with the child’s wishes.
Court Appointed Special Advocate (CASA): It is a trained volunteer
appointed by the court to represent the best interests and advocate for the
child’s needs and desires. CASAs typically only have one to two cases at
any given time and therefore can spend a greater amount of time with the
child and on the case.
Parents’ attorney is a legal representative that may be appointed to the par-
ent to provide information and advocate for the parents’ wishes at the begin-
ning of a case. Even when parents are married or in a relationship, an attorney
for each parent is often assigned.
Agency attorney is a legal representative for the child welfare agency. This
attorney may be employed by a government agency such as the county, state,
or city depending on the jurisdiction and how it is structured. This attorney
represents the agency and therefore the child welfare professional as an
employee of that agency.
Child welfare professional is the individual who has investigated a case of
maltreatment or who is managing an ongoing case with the child welfare
agency. The child welfare professional works closely with all of the key play-
ers in court as well as the child, their family, other professionals, and
caregivers.
Bailiff or court staff may be law enforcement or security staff but may also
serve in the role of scheduler and coordinator for the courtroom.

Navigating the Dependency Court System

One of the most challenging parts about being a child welfare professional is having
to manage the legal requirements and maintaining relationships with individuals
involved with the legal side of child welfare work. See Fig. 2.2 for an overview of
the typical flow of a dependency case. For example, understanding the legal system,
ensuring legal requirements, communicating with legal personnel, and testifying are
some of the most difficult parts of being in child welfare as a caseworker. There are
a number of lawyers, a judge, volunteers (e.g., Court Appointed Special Advocates
[CASAs], mentors), and other individuals involved with each case and specific
timelines, dates, and laws to adhere to. These individuals and legal statutes may
Navigating the Dependency Court System 45

Case opened Due to the severity of a case, child welfare

agency files application for emergency
order for custody and shelter

Dependency petition filed Courts grant

by child welfare agency with emergency Courts do not grant
the courts order emergency order

Courts place Legal counsel is assigned

case on the
docket
Guardian ad litem is assigned to child

Adjudication hearing

Child is adjudicated Child is not adjudicated Case is closed

dependent dependent

Court Court hearing

hearing on on permanency
disposition

Child remains with family, is reunified with

Permanency
family, is adopted, is placed in permanent
Reviews or
guardianship, is emancipated, ages out of
regular basis
care, or is adjudicated delinquent

Fig. 2.2 Typical flow of a dependency case

vary by state and jurisdiction and child welfare professionals must understand
where they practice. One way to better understand the individuals and statutes is to
spend time at the dependency court to observe different types of hearings and differ-
ent court personnel.
46 2 How the Child Welfare System Works

Practice Highlight
Types of Hearings and the Child Welfare Professional’s Role
Protective/Dispositional Hearing: The court determines whether the parents
are able, willing and fit to parent the child. The court will also determine
whether it is in the child’s best interest to be found “dependent” or a ward of
the court, and whether the child can remain home, return home at the hearing,
or placed under the care of another person. At this hearing, the child welfare
professional should be prepared to discuss:
• Why the child cannot be returned home today
• Parameters for visitation with parents and/or siblings (no visitation, fre-
quency, and duration) and recommendations
• Specific services offered to or engaged in by the parents
• Details concerning evaluations completed with parents, child, caretakers,
and any recommendations
• Details regarding current and/or proposed placement of the child
• Child’s special needs or need for service
• Details about concurrent permanency planning
Review or Permanency Hearings: The court reviews evidence on the prog-
ress made toward returning a child home. If it appears that the parents are not
working to correct the conditions necessary for reunification, the court reviews
other permanency options. The child welfare professional should prepare and
submit the most recent court report and/or service plan to the court and all
parties prior to the hearing. At these hearings, the child welfare professional
should be prepared to discuss:
• Why the child cannot be returned home today
• How the services in the case plan are related to the conditions that required
court intervention are being corrected
• Specific services offered to parents to correct conditions and whether ser-
vices are being completed or not
• History of child’s placement (number, length of time, provider, and reason
for change)
• Child’s special needs or need for service
• Details about concurrent permanency planning
• Parameters for visitation with parents and/or siblings (no visitation, fre-
quency and duration) and recommendations
• Any recommendations regarding permanency and/or placement
Contested Hearings on Motions: The party making the motion has the bur-
den of persuading the court to take action described in a motion between
review hearings. The evidence needed might involve testimony. Some exam-
ples of such hearings include motions for visits, return home, motions to
extend, or vacate an order of protection.
Navigating the Dependency Court System 47

Status Reports: These reports are given at any state of the proceedings or
hearings and typically involve a legal matter such as status on service prog-
ress, compliance with a court order, visitation, etc.
Termination of Parental Rights: This hearing occurs once a decision at a
review hearing has been made to change the case plan goal to terminate
parental rights and pursue adoption. This is done when it deemed that a child
cannot return to their parents’ care and a need for a permanent goal is in
place. Termination is typically a multistep process. Although any party to the
case can file for termination of parental rights, it is typically the attorneys
representing the child welfare agency that will file the motion, once they
have evidence that reunification is not possible, that the parents have not
ameliorated the circumstances that brought the child into care (e.g., com-
pleted services, etc.), and determined that termination is in the best interest
of the child. There must be “clear and convincing” evidence as the burden of
proof in this case, and there may be stricter rules of evidence. Child welfare
professionals should be prepared to provide documentation and testimony
related to:
• What the circumstances were that brought the children into care, requiring
court intervention and the impact it has had on the child’s welfare
• Documentation of services offered and engaged in by each parent along
with progress with such services
• Details concerning evaluations for parents and children and
recommendations
• Details concerning visitations between parent and child
• Details concerning child’s current placement
• Child’s special needs and/or need for services
• Child’s relationship with each parent
Family Conference: The family conference is more of a meeting than a hear-
ing and is designed to save time with have all the parties gathering to review
the case plan, problem solve, and discuss services. In addition to providing the
most recent case/service plan, the child welfare professional should also be
prepared to discuss:
• The reason the child cannot return home today
• Family strengths and needs and what services could be provided to improve
circumstances that brought the child into care
• Efforts to locate parents and assessing their service needs
• Child’s special needs and needs for services
• Details regarding visitation with parents and siblings
48 2 How the Child Welfare System Works

Preparing for and Testifying in Court

Testifying in court can be a stressful experience for anyone, under any circum-
stances. However, experts say that if witnesses are honest and prepared for the ques-
tions they will be asked, they will typically experience less stress during their
testimony. Most child welfare agencies provide training on the dependency court
process and how to testify for new child welfare professionals. Some also provide
an opportunity to practice testifying in a mock court room or using language typi-
cally used in testifying.
There are often a number of individuals present in the courtroom during hear-
ings. Depending on the type and purpose of the hearing, child welfare professionals
may be required to provide testimony. Proceedings are not like they are on televi-
sion or the movies. At the beginning of a hearing, the parties (those who are part of
the case, such as attorneys, parents, etc.) and other attendees gather in the court-
room. When the judge enters the room, all parties must stand until the judge gives
permission to sit. In most cases, the person who is talking will stand when talking
to the judge or “the court.” The person talking will address the court and not other
parties when providing information or
an argument. These are formal hear-
ings and judges often have varying Practice Tip
styles and rules for their courtroom. Preparing for Court
For example, some judges only allow Depending on their position, child
the attorneys to answer questions, welfare professionals will spend vary-
whereas others allow comments and ing amounts of time in court. To pre-
questions from their clients and/or pare for court, child welfare
guests in the gallery. Typically, the professionals should:
judge will state the purpose for the • Know the history of the case.
hearing and allow the parties to offer • Review the service plan prior to the
information and/or evidence, such as court date.
reports. After everyone spoken, the • Know what services have been pro-
judge may enter orders and set a fol- vided, completed, and in progress
low-up hearing date. In the cases where for each parent.
a child welfare professional may need • Bring extra copies of the report/ser-
to testify includes preliminary hearings vice plan to the hearing.
that require them to describe the reason • Be aware of the purpose of the
a child removal from the home is nec- hearing.
essary or during a trial. During a trial, a • Talk to the agency’s attorneys
number of individuals may testify, about any issues or concerns.
including parents, family members, • Discuss the case with supervisor
child welfare professionals and their prior to the hearing.
supervisors, psychologists or other • Bring any necessary documents to
mental health professionals, and pro- court that might be relevant.
fessionals who supervise visits or offer • Communicate and share necessary
services to the parents, child, or reports with all parties prior to the
caregivers. hearing.
Parents’ Rights 49

When preparing to provide testimony, it is helpful to meet with the child welfare
agency’s attorney (e.g., district attorney or state attorney) to review questions to
prepare for and/or anticipate from a parent’s attorney. It is helpful to review the case
file and reports so that the child welfare worker can feel confident in providing
accurate and thorough testimony.

Practice Highlight
Examples of Questions for Caseworkers in Dependency Court Hearings
Caseworkers may be asked questions like the following when they are in court:
• Was the family assessed for services?
• What services were offered?
• What services have been completed?
• Where is the child placed? How long have they been there? Which family
members have been assessed for placement?
• What are the child’s needs (medical, educational, and social-emotional)?
What services are they receiving? Has the child been assessed?
• What is your recommendation regarding a) temporary custody? b) case
plan? c) concurrent permanency plan?
• Are there visits with the parents and/or siblings? Please provide a report of
these visits (e.g., frequency, duration).

Parents’ Rights Reflection

Observations During Court Hearings
The adults and children and involved in In many states, it is possible to observe
dependency court hearings have rights court. This can help to learn about the
to protect them as outlined by the law. process. When observing court, these
Parents and children involved in such questions can help to guide under-
cases have similar but different rights standing of what is happening:
which differ by jurisdiction. States,
Who is asking the questions?
courts, or child welfare agencies often
What types of questions are asked?
publish literature for parents and chil-
Who is in the courtroom and where
dren to better understand their rights at
are individuals seated?
different points throughout a depen-
Who is permitted in the court hearing?
dency case. This helps them to under-
Who is asked to offer their thoughts or
stand their responsibilities and what
concerns?
they are entitled to. When a child is
Was evidence submitted?
removed from the care of their parent,
What type of hearing is it?
the parent has the right to an attorney
How long did the hearing take?
and if the parent cannot afford to hire
What, if any, orders were given?
an attorney, the judge in the case will
How do the parties address each other
appoint one to represent the parent.
and the judge?
Biological/legal parents have the right
50 2 How the Child Welfare System Works

to attend and participate in all conferences, meetings, and hearings, unless their
parental rights have been legally terminated. For meetings outside of the court pro-
ceedings, parents may be excluded if it is deemed unsafe. Parents have a right to
understand what is happening in court. It is their attorney’s responsibility to explain
the purpose of each hearing, what is expected of the parent during and outside of the
hearing as it relates to the case, give sound advice to the client, and to be reasonably
responsive to the parent as their client. Parents involved in dependency cases also
have the right to an interpreter if necessary. If a parent speaks a language other than
English and does not understand what is happening, they may request an interpreter
for proceedings and discussions with their attorney and the child welfare agency
representatives. Parents have the right to know what is required so that they may be
reunited with their children and to be provided with the necessary services and sup-
ports in order to complete such tasks outlined by the judge.

Children’s Rights

Similarly, children involved in dependency court cases have rights. They have the
right to go to court, as deemed appropriate by the judge. Although it varies by state,
children 10 years or older have the option to attend court, and their case worker
should inform them of hearings and provide transportation for them to attend.
Children have the right to be involved in their case and provide input on decisions
about placement, services, case planning, and permanency. Children have the right
to stay at their school. The child welfare agency should make arrangements as
required by law to allow the child to remain in their school and arrange for transpor-
tation. Children have a right to visitation with their parents and their siblings. Some
states have specific policies about the frequency and duration of such visits as well.
If not automatically provided, children have the right to an attorney to advocate for
their wishes in court. Some states provide a guardian ad litem, who could be an
attorney or other professional to advocate for their best interests; however, an attor-
ney appointed to them would advocate for what they would like with regard to
things like placement, visitation, and services, especially if it differs from the guard-
ian ad litem or the child welfare agency.

Conclusion

The child welfare system is often challenging to understand and navigate. It requires
professionals and families to interact with multiple systems and is guided by federal
and state policies. There are a number of key players that serve various roles in cases
that are important in child welfare work. Part of child welfare work involves time
preparing for and attending court hearings. The child welfare professional is a key
player in hearings and ensuring that the case proceeds appropriately, which may
involve testifying. These situations can often be undesirable, but necessary, and the
more experience one has and the more prepared one is, can improve this experience.
Conclusion 51

Acknowledgments The authors thank Brittany Mihalec-Adkins, M.S.Ed, for the contribution to
Chap. 2.

Discussion Questions
1. How are child maltreatment reports made? Who are the most common reporters
of child maltreatment and why?
2. Without looking at the flowcharts in the chapter, describe the process in child
protection services starting with a report to child protective services.
3. Name three different roles in child protection.
4. What are three ways child welfare professionals can prepare for court?
5. What types of questions might attorneys ask child welfare professionals in court?

Suggested Activities
1. Attend a dependency court hearing if they are open to the public in your com-
munity. Be sure to be aware and follow all of the rules of the court (e.g., confi-
dentiality, respect, and appropriate dress). Write a reflection of your experience.
Include observations of the type of hearing, who was in attendance and who was
speaking, what decisions and findings that were made. Make note of your pres-
ence, who you spoke with, and what it was like to go through security, navigate
the courtrooms and people.
2. Interview one of the identified courtroom key players (e.g., judge, GAL, CASA,
attorney, etc.) about their role and work in the courtroom. Ask them about posi-
tive experiences and challenging cases. Ask about their relationships with child
welfare professionals and how they work together.
3. Go online and find a flow chart or document that shows how the child welfare
system in your state or jurisdiction is structured. Note the names of the depart-
ments/units, and the roles for those who work in the child welfare system, the
types of hearings, and the typical case flow process. Compare to the description
in this chapter.
4. Read Finno-Valasquez, He, Perrigo, and Hurlburt (2017) write a paper exploring
why some communities that are demographically similar have different rates of
maltreatment and different reporting rates of child maltreatment.
Finno-Velasquez, M., He, A. S., Perrigo, J. L., & Hurlburt, M. S. (2017).
Community informant explanations for unusual neighborhood rates of child
maltreatment reports. Child and Adolescent Social Work Journal, 34(3),
191–204. (Available: https://rdcu.be/cb8Uh).

Additional Resources
American Professional Society on the Abuse of Children: https://www.apsac.org/
Badeau, S., & Gesiriech, S. (2003). A child’s journey through the child welfare sys-
tem. Washington, DC: The Pew Commission on Children in Foster Care. https://
w w w. g a s c o r e . c o m / d o c u m e n t s / AC h i l d s J o u r n e y t h r o u g h t h e % 2 0
ChildWelfareSystem.pdf
52 2 How the Child Welfare System Works

Child Welfare Information Gateway. (2013). How the child welfare system works.
Washington, DC: U.S. Department of Health and Human Services, Children’s
Bureau. https://www.childwelfare.gov/pubs/factsheets/cpswork/
Child Welfare Information Gateway. (2011). Understanding child welfare and the
courts. Washington, DC: U.S. Department of Health and Human Services,
Children’s Bureau. https://www.childwelfare.gov/pubs/factsheets/cwandcourts/
National Center for State Courts, Dependency Courts Resource Guide: https://
www.ncsc.org/topics/children-­f amilies-­a nd-­e lders/dependency-­c ourt/
resource-­guide
National Drug Court Institute, Family Treatment Court Planning Guide: https://
www.ndci.org/resources/family-­treatment-­court-­planning-­guide/
A family’s guide to the child welfare system. Washington, DC: National Technical
Assistance Partnership for Child and Family Mental Health at Georgetown
University Center for Child and Human Development. https://cbexpress.acf.hhs.
gov/index.cfm?event=website.viewArticles&issueid=53&sectionid=5&arti
cleid=2072

References

Bruns, E. J., Pullmann, M. D., Weathers, E. S., Wirschem, M. L., & Murphy, J. K. (2012).
Effects of a multidisciplinary family treatment drug court on child and family outcomes:
Results of a quasi-experimental study. Child Maltreatment, 17(3), 218–230. https://doi.
org/10.1177/1077559512454216
Casanueva, C., Harris, S., Carr, C., Burfend, C., & Smith, K. (2019). Evaluation in multiple sites
of the Safe Babies Court Team approach. Child Welfare, 97(1), 85–107.
Chuang, E., Moore, K., Barrett, B., & Young, M. S. (2012). Effect of an integrated family
dependency treatment court on child welfare reunification, time to permanency and re-entry
rates. Children and Youth Services Review, 34(9), 1896–1902. https://doi.org/10.1016/j.
childyouth.2012.06.001
Cross, T. P., Chuang, E., Helton, J. J., & Lux, E. A. (2015). Criminal investigations in child pro-
tective services cases: An empirical analysis. Child Maltreatment, 20(2), 104–114. https://doi.
org/10.1177/1077559514562605
Davis, A. E., Barrueco, S., & Perry, D. F. (2020). The role of consultative alliance in infant and
early childhood mental health consultation: Child, teacher, and classroom outcomes. Infant
Mental Health Journal. https://doi.org/10.1002/imhj.21889
Ellet, A. J., & D. Steib, D. (2005). Child Welfare and the Courts: A Statewide Study with
Implications for Professional Development, Practice and Change. Research on Social Work
Practice, 15(5), 339–352. doi: https://doi.org/10.1177/1049731505276680.
Espeleta, H. C., Bakula, D. M., Sharkey, C. M., Reinink, J., Cherry, A., Lees, J., et al. (2020).
Adapting pediatric medical homes for youth in foster care: Extensions of the American
academy of pediatrics guidelines. Clinical Pediatrics, 59(4–5), 411–420. https://doi.
org/10.1177/0009922820902438
Ezell, J. M., Richardson, M., Salari, S., & Henry, J. A. (2018). Implementing trauma-informed prac-
tice in juvenile justice systems: What can courts learn from child welfare interventions? Journal
of Child & Adolescent Trauma, 11(4), 507–519. https://doi.org/10.1007/s40653-­018-­0223-­y
Herbert, J. L., & Bromfield, L. (2019). Multi-disciplinary teams responding to child abuse:
Common features and assumptions. Children and Youth Services Review, 106, 104,467. https://
doi.org/10.1016/j.childyouth.2019.104467
References 53

Herbert, J. L., & Bromfield, L. (2016). Evidence for the efficacy of the Child Advocacy Center
model: A systematic review. Trauma, Violence, & Abuse, 17(3), 341–357. https://doi.
org/10.1177/1524838015585319
Hubel, G. S., Campbell, C., West, T., Friedenberg, S., Schreier, A., Flood, M. F., & Hansen,
D. J. (2014). Child advocacy center based group treatment for child sexual abuse. Journal of
Child Sexual Abuse, 23(3), 304–325. https://doi.org/10.1080/10538712.2014.888121
Hubel, G. S., Schreier, A., Hansen, D. J., & Wilcox, B. L. (2013). A case study of the effects
of privatization of child welfare on services for children and families: The Nebraska expe-
rience. Children and Youth Services Review, 35(12), 2049–2058. https://doi.org/10.1016/j.
childyouth.2013.10.011
Keeshin, B. R., & Dubowitz, H. (2013). Childhood neglect: The role of the paediatrician.
Paediatrics & Child Health, 18(8), e39–e43. https://doi.org/10.1093/pch/18.8.e39
Loomis, A. M. (2018). The role of preschool as a point of intervention and prevention for
trauma-exposed children: recommendations for practice, policy, and research. Topics in Early
Childhood Special Education, 38(3), 134–145. https://doi.org/10.1177/0271121418789254
MacLeod, K. J., Marcin, J. P., Boyle, C., Miyamoto, S., Dimand, R. J., & Rogers, K. K. (2009).
Using telemedicine to improve the care delivered to sexually abused children in rural, under-
served hospitals. Pediatrics, 123(1), 223–228. https://doi.org/10.1542/peds.2007-­1921
Powell B.J., Bosk E.A., Wilen J.S., Danko C.M., Van Scoyoc A., & Banman A. (2015) Evidence-­
based programs in “real world” settings: finding the best fit. In: Daro D., Cohn Donnelly
A., Huang L., Powell B. (eds) Advances in child abuse prevention knowledge. child mal-
treatment (Vol. 5: Contemporary Issues in Research and Policy). : Springer. https://doi.
org/10.1007/978-­3-­319-­16327-­7_7
Smith, J. D., Cruden, G. H., Rojas, L. M., Van Ryzin, M., Fu, E., Davis, M. M., et al. (2020).
Parenting interventions in pediatric primary care: A systematic review. Pediatrics, 146(1).
https://doi.org/10.1542/peds.2019-­3548
Wilen, J. S., Littell, J. H., & Salanti, G. (2017). Psychosocial interventions for adults who were
sexually abused as children. The Cochrane Database of Systematic Reviews, 2017(1) https://
www.ncbi.nlm.nih.gov/pmc/articles/PMC6464780/
Zero to Three. (2017, December). The evaluation is in: The Safe Babies Court Team™ approach
is changing lives. Washington DC.
Zinn, A., & Orlebeke, B. (2017). Juvenile court judicial expertise and children’s perma-
nency outcomes. Children and Youth Services Review, 77, 46–54. https://doi.org/10.1016/j.
childyouth.2017.03.011
Chapter 3
Child Development and Well-Being

Introduction

For child welfare professionals to understand child maltreatment, it is important first

to understand normative child development, family roles, relationships, and child
and family well-being. In order to assess the needs of children and their families,
child welfare professionals must understand basic patterns of human behavior and
development, the family life cycle, how children develop attachments, and why these
attachments are important for children’s healthy development. This information also
helps child welfare professionals understand how certain experiences can impede
normal, healthy child and family development, and we can work alongside children
and families in important prevention and intervention efforts in child welfare practice.

Domains of Child Development

Child development can be understood in five major domains: (1) physical, (2) cog-
nitive, (3) emotional, (4) social, and (5) sexual. Physical development refers to the
child’s size and ability to perform physical tasks (e.g., lifting one’s head, crawling,
walking, running, etc.). Cognitive development refers to a child’s ability to make
sense of the world, understand speech, speak, read, write, and complete age-­
appropriate academic tasks. Emotional development is a child’s ability to recognize,
manage, and regulate emotions or feelings, while social development is how a child
relates to other people, including their peers and adults. Sexual development refers
to becoming sexually mature and experiencing specific physical changes associated
with the body’s ability to procreate.
Child development researchers have defined normative development, or what we
should typically expect to observe among these domains for children in specific age
groups (see Table 3.1 for details about normative development and areas of

© Springer Nature Switzerland AG 2021 55

J. M. Geiger, L. Schelbe, The Handbook on Child Welfare Practice,
https://doi.org/10.1007/978-3-030-73912-6_3
Table 3.1 Child development: normative observations and observations requiring attention
56

Strengths and landmarks of Developmental issues (not Developmental observations

Stage Age Routine observations development problems) requiring attention
Infancy Birth–2 years • Perceptual abilities • Good health • Some difficulties warming up • Lack of physical growth
• Reflexes • Well-developed senses • Sleep irregularities • Insecure attachment
• Weight gain and growth • Shows preferences • Infant is perceived as fussy • Colicky
(height) • Recognizes primary caregivers • Limited interest in eating • Over-arousal or under-
• Sleep patterns • Demonstrates responsiveness • Object permanence arousal in the infant
• Rhythms and capacity for to caregivers • Limited vocalization • Parent depressed or has
self-regulation • Play develops within • How infant sleeps (on stomach) other mental illness
• Temperament attachment relationships • Teen parents • Lack of supports and good
• Fit between infant tempera- • Ability to entertain self for • Poor parental preparation for child care
ment and parenting style brief periods of time by the infant • Serious health problems in
• Attachment and strategies 6 months • Preparation of siblings for the child
for maintaining relationships • Flexible attention arrival of infant • Serious parental healthcare
• Parents’ nurturing capacities • Reaches physical milestones concerns
• Parental supports for fine motor, crawling, and • Infant neglect or abuse
• Child-care resources grasping • Poor fit between infant
• Regular sleep, wakefulness, temperament and parenting
feeding, and elimination styles
Early 2–3 years • Gross and fine motor skills • Parallel play (2.5) • Stuttering • Persistent soiling and
childhood (toddler) • Toileting • Collateral peer play (3), • Occasional soiling or wetting wetting
3–5 years • Speech cooperative play (3–4) • Messy play • Persistent eating problems
(preschool) • Use of mental symbols • Bedtime ritual • Won’t put things away • Disturbed sleep patterns
• Peer relationships and • Two- and three-word speed • Stubbornness • Nonspeaking
siblings (2), creative use of speech • Aggressive and possessive play • Inappropriate play behavior
• Play preferences (3–4) • Refuses new foods • Excessive body rocking,
• Preschool • Successful toilet training (2–3) • Immature behavior when ill or finger sucking, or tics
• Limits, discipline, and daily • Accepts limits (2–3) sick
routine • Development of special talents • Asserts independence and
• Dreams and night terrors, (e.g., music, dance) fusses
fears • Self-talk to guide behavior • Occasional temper tantrums
3 Child Development and Well-Being

• Interest and skill • Some leadership capacity in • Unreasonable fears (short-lived)

development groups (3–4)
Middle 6–12 years • Peer relationships and • Enjoys reading • Oversensitive to criticism • Persistent fearfulness
childhood behavior • Comfortable away from home/ • Prefers play to school and home • Lying
• Adaptation to school with peers responsibilities • School failure
• Family relationships • Development of moral • Short-term fears • Language and speech
• Interests and skills thinking • Noncompliance with parental problems
• Physical development • Good at catching a ball request • Victimized by bullies
(prepubertal changes), • Can solve simple puzzles • Doesn’t always share teacher- • Inappropriate sexual
interests, and abilities • Friendship development with child conflicts behavior
• TV/ movie/computer same sex (8–10) • Poor table manners • Overdependence
viewing habits • Participates in a peer group • Excessive aggressive behavior • Running away
Domains of Child Development

• Sleep and dreams (9–11) • Talking back • Fire setting

• Daily routine established • Physically active • Moodiness • Persistent thumb sucking
• Independent self-care • Developing preferences for • Temper outbursts • Strange, bizarre, or
• Academic achievement and friends and activities (5–7) • Secretiveness withdrawn behavior
classroom behavior • Sexuality awareness • Lack of communication
• Reading/literacy skills • Cruelty to animals
• Reasoning abilities • Lack of friends
• Disturbed sleep patterns,
enuresis
• Persistently emotional over
small things
(continued)
57
Table 3.1 (continued)
58

Adolescence Puberty– • Brain development and • Increased resilience • Excessive concern with body • Eating disorders
14 years (early abstract thought • Development of autonomy and image • Depression
15–17 years • Peer groups independence • Spending too much time alone • Pregnancy
(middle) • Body image • Increased influence of peers • Negative peer influence • Sex abuse and rape
18–22 years • Sense of morality • Enhancing parent-­adolescent • Decreased interest in school • Substance abuse
(late) • Independence relationships • Academic difficulties • Violent behaviors and
• Sexual identity • Peer support • Moodiness exposure to violence
• Romantic involvements • Egocentrism • Sexual behavior • Firearm exposure/use
• Focus on physical • Transition to middle school • Conduct disorder and
appearance • Parent conflict delinquency
• Increased caloric intake • Late maturing girls • Anxiety
• Hormonal changes • Risk behaviors
• Menstruation (girls)
3 Child Development and Well-Being
Factors that Impede or Delay Normative Development 59

development that might require attention). Developmental milestones are behaviors

exhibited throughout the phases of development that are indicative of normal devel-
opment that are based on average development. However, there is quite a bit of
variability, and children may attain milestones at different rates. Milestones reached
within a 6-month period are considered “within normal limits.” Children are consid-
ered “delayed” in a developmental domain when 90% of other children are perform-
ing the task. Although it may vary, eligibility for early intervention services that
address developmental delays requires at least a 30% delay.

Factors that Impede or Delay Normative Development

When humans are presented with the

Research Brief
right conditions, they will progress
Prenatal Drug Exposure and Its
through predictable stages of develop-
Impact on Development
ment. However, sometimes children
In the United States, it is estimated
face conditions that negatively affect
that almost 15% of women use
or delay growth and development and,
tobacco, 11.5% consume alcohol, and
therefore, may later influence their
8.5% use illicit substances while preg-
ability to adjust later in childhood,
nant (Oh et al., 2017). Although states
adolescence, and adulthood. There are
have different laws about child wel-
conditions that are out of the control
fare and criminal regulations about
of the child and at times, their parents.
prenatal alcohol and substance use,
A child may face genetic or congeni-
approximately 39% of child welfare
tal conditions. A child could be at risk
agencies reported parental alcohol or
for development delays because the
other drug use as a contributing factor
mother did not receive prenatal care
for removal of a child (AFCARS, 2020).
or used drug or alcohol while preg-
Extensive research has been con-
nant. Children may experience envi-
ducted on the impact of prenatal alco-
ronmental threats such as unsafe
hol and substance exposure on child
living conditions, poverty, crime, vio-
development. In the short term, chil-
lence, or pollution. Various types of
dren may experience birth anomalies
accidents or other experiences of
(e.g., physical deformities), delayed
trauma can lead to a delay or interrup-
fetal growth, withdrawal, and neu-
tion in normative child development.
robehavioral problems. Long-term
Extensive research has shown that
effects of prenatal substance exposure
experiences of child maltreatment can
include delays and impairments in
interfere with child development (e.g.,
achievement, cognition, physical
Cicchetti et al., 2000; Trickett &
growth, and language development.
McBride-Chang, 1995; Zielinski &
Bradshaw, 2006).
60 3 Child Development and Well-Being

Consider the example of Layla,1 a

Research shows severe negative con-
13-year-old Caucasian girl who lives
sequences for infants and children
with both of her biological parents, who
exposed to alcohol in particular.
give her adequate love and support, in a
Estimates show that 6–9 per 1000 live
safe neighborhood and who attends a
births are infants exposed to alcohol
local school. She lives in a fairly homo-
with a diagnosis of fetal alcohol spec-
geneous community, where most of her
trum disorder (FASD; May et al.,
peers and their families look the same as
2014). A number of factors influence
her and have similar average experi-
the presentation of FASD in children,
ences. Like her peers and other children,
including pattern and timing of alco-
she has a number of strengths and chal-
hol use, genetics, amount of alcohol
lenges. Her parents noticed at a young
consumed, the use of other substances,
age that she presented with difficulties
mother’s health and nutrition, and the
in her social development and sought
mother’s age. Prenatal alcohol and
out early intervention services in their
drug use are often difficult to detect
community. At the age of 4, she was
and are not routinely screened for bio-
diagnosed with autism spectrum disor-
logically. The majority of prevention
der and struggles with making friends
efforts focus on education, social sup-
and interacting with others. Since her
port, counseling, and, for extreme
diagnosis, she has received services in
cases, inpatient treatment, as
the community and at school. Her father
appropriate.
works in the home and has a very flexi-
ble schedule that allows him to take her
to appointments and attend meetings at school to ensure her needs are being met.
Now, consider the example of Destiny, a 13-year-old child with similar qualities
and experiences, with the exception of one factor: she and her family live in poverty.
Her parents struggle to keep steady jobs. The family has moved several times and
has been homeless on a few occasions. As a result of moving, Destiny has changed
schools, creating an unstable environment. Destiny has been eligible for services at
the same time Layla was; however, she did not begin to receive services until she
was finishing the fourth grade due to the changes in schools and her parents being
unaware of available support and the school not having the same resources as the
one in Layla’s more affluent neighborhood. Destiny’s behavior was often perceived
as negative and disruptive by teachers and caregivers and often attributed to the new
environment and instability in housing and schools.
Clearly, there are multiple factors that mitigate the experiences of a child and lead
to impaired and/or delayed development, particularly in the case where a child requires
additional supports and services. Given what is known about trauma associated with
community violence, natural disasters, and child maltreatment, for example, develop-
ment should be viewed within the context of the child’s and family’s experiences in
multiple developmental domains. (See Chap. 5 for more information about trauma.)
Human development is a dynamic process. It can be very predictable and also
extremely variable. Developmental progress is based on various physical,
emotional, and cognitive tasks that build upon each other. Table 3.2 outlines

1
All names and other personal identifiers in cases and examples throughout this book have been
changed to protect privacy and confidentiality.
Factors that Impede or Delay Normative Development 61

Table 3.2 Developmental tasks in first 24 months

Age Physical Cognitive Language Social/emotional
0–3 months • Sucking and • Learns to focus • Coos • Grasps fingers
other reflexes • Can discriminate • Develops • Focuses on faces
• Can turn head some individual differentiated cry • Begins to smile
to one side voices • Turns head toward at people
• Turns head to • Begins to sounds • Can briefly calm
food source follow things self
with eyes and • Tries to look at
recognize caregiver
people at a
distance
• Can act bored
(crying/
fussiness) if
activity doesn’t
change
3–6 months • Rolls over • Lets people • Begins to babble • Smiles spontane-
from stomach know if sad or • Babbles with ously at people
to back happy expression and • Likes to play
• Keeps head • Responds to copies sounds with people and
steady and affection heard might cry when
does not fall • Reaches for toy • Cries in different playing stops
back when with one hand ways to communi- • Copies move-
pulled to • Uses and hand cate different ments and facial
sitting position and eyes needs/emotions expressions
• Beginning to together
reach for and • Follows moving
grasp objects things with
• Can lift eyes
shoulders or • Watches faces
lift head to closely
look around • Recognizes
when on familiar people
stomach at a distance
• Can sit with
support
6–9 months • Rolls over in • Looks around • Responds to • Knows familiar
both directions at things nearby sounds by making faces and begins
• Begins to sit • Brings things to sounds to know if
without support mouth • Strings vowels someone is a
• When standing, • Shows curiosity together when stranger
supports about things babbling and likes • Likes to play
weight on legs and tries to get taking turns with with others,
and might things that are parent while especially
bounce out of reach making sounds caregivers
• Rocks back • Begins to pass • Responds to own • Responds to
and forth, things from one name other people’s
sometimes hand to the • Makes sounds to emotions and
crawling other show joy and often seems
backward displeasure happy
before moving • Begins to say • Likes to look at
forward consonant sounds self in a mirror
(continued)
62 3 Child Development and Well-Being

Table 3.2 (continued)

Age Physical Cognitive Language Social/emotional
9–12 months • Stands, • Watches the • Understands “no” • May be afraid of
holding on path of • Makes a lot of strangers
• Can get into a something as it different sounds • May be clingy
sitting position falls • Copies sounds and with familiar
• Sits without • Looks for gestures of others caregivers
support things they see • Uses fingers to • Has favorite toys
• Pulls to stand someone hide point at things
• Crawls • Plays
peek-a-boo
• Puts things in
their mouth
• Moves things
smoothly from
one hand to the
other
• Picks up things
like cereal
between thumb
and index
finger
12 months • Gets to a • Explores things • Responds to • Is shy or nervous
sitting position in different simple spoken with strangers
without help ways (shaking, requests • Cries when
• Pulls up to banging, • Uses simple caregiver leaves
stand, walks throwing) gestures (e.g., • Has favorite
holding on to • Finds hidden shaking head or things and people
furniture things easily waving) • Shows fear at
(cruising) • Looks at the • Makes sounds with times
• May take a right picture or changes in tone • Hands someone a
few steps thing when it’s • Says mama and book when wants
without named dada to hear a story
holding on • Copies gestures • Tries to say words • Repeats sounds
• May stand • Starts to use others say or actions to get
alone things correctly attention
(e.g., brushing • Puts out arm or
hair) leg to help with
• Bangs things dressing
together • Plays simple
• Puts things in a games
container and
takes them out
• Lets things go
without help
• Pokes with
finger
• Follows simple
directions
(continued)
Factors that Impede or Delay Normative Development 63

Table 3.2 (continued)

Age Physical Cognitive Language Social/emotional
18 months • Walks alone • Knows what • Says several single • Likes to hand
• May walk up ordinary things words things to others
steps and run are • Says and shakes as play
• Pulls toys • Points to get the head “no” • May have temper
while walking attention of • Points to show tantrums
• Can help others someone what he • May be afraid of
undress self • Shows interest wants strangers
• Drinks from in toy/doll by • Shows affection
cup pretending to to those they
• Eats with a feed know
spoon • Points to one • Plays simple
body part pretend, such as
• Scribbles on feeding a doll
own • May cling to
• Can follow caregivers
one-step verbal • Points to show
commands others something
interesting
• Explores alone
but with
caregiver nearby
24 months • Stands on • Finds things • Points to things • Copies others
tiptoe even when when they are • Gets excited
• Kicks a ball hidden named when with other
• Begins to run • Begins to sort • Knows names of children
• Climbs onto shapes and people and body • Shows more and
and down colors parts more
from things • Completes • Says sentences independence
without help sentences and with 2–4 words • Shows defiant
• Walks up and rhymes in • Follows simple behavior
down stairs familiar books instructions • Plays mainly
while holding • Plays simple • Repeats words beside other
on make-believe overheard in children but
games conversation begins to include
• Builds towers • Points to things in other children
of 4 or more a book
blocks
• Might use one
hand more than
the other
• Follows 2-step
instructions
• Names items in
a picture book
Adapted from Centers for Disease Control and Prevention (CDC). Developmental Milestones.
https://www.cdc.gov/ncbddd/actearly/milestones/index.html
64 3 Child Development and Well-Being

common developmental tasks in the first 24 months of life. These tasks create a
foundation for future development to occur, leading to successful or challenging
experiences as a result. Children’s development occurs within the context of their
relationships, particularly those with their caregivers, as well as the environment.
All people learn how to behave in response to others, how to communicate effec-
tively as it relates to their needs, as well as socially. These interactions are the foun-
dation for humans to learn, adapt, and grow, and the development of skills is in
response to the environment to ensure optimal functioning and adaptation.
Even before the birth of a child, the relationship between the parent and child is
being developed. The circumstances and expectations related to the conception of
the child can influence this relationship and the environment in which the child may
enter. Although common for many women, pregnancy and birth can be a positive or
negative experience in terms of physical comfort (or discomfort), illness, ability,
and changes. The mother must adapt physically, emotionally, and psychologically
to the changes resulting from pregnancy and birth. Culture, family, and past experi-
ences influence the present experience. Prenatal exposure to drugs and alcohol can
have a significantly negative effect on the developing fetus that lasts long after birth
and throughout child development.

Supporting Healthy Child Development

Child welfare professionals can help to support healthy child development by first,
being aware of appropriate physical, social, emotional, and cognitive development
among children of all ages, particularly young children. For professionals working
with families involved with the child welfare system and families who are at greater
risk for child maltreatment, being able to identify a developmental delay or interrup-
tion in development can lead to early intervention for assessment and referral for
any necessary services and supports for children and families. Early intervention
programs can work with the child welfare system to ensure optimal child develop-
ment (Allen et al., 2012). Early intervention is central for better outcomes, and
ensuring children’s access to services is a protective factor (Stepleton et al., 2010).
There are a number of assessment tools as well as activities and supports child
welfare professionals can offer parents and caregivers to support their well-being.
Child welfare professionals can encourage parents to track developmental mile-
stones and seek appropriate well-checks with medical professionals. We can pro-
vide resources to promote healthy development and reduce the risk for child
maltreatment. For example, there are applications parents/caregivers can download
on their electronic devices to track child development or download a checklist of
when to seek help. The Centers for Disease Control and Prevention (CDC, 2020)
also has information about who to contact if a parent or caregiver is concerned a
child is not meeting expected milestones.
Developmental Monitoring, Screening, and Evaluation 65

Developmental Monitoring, Screening, and Evaluation

As child welfare professionals, it is important to understand not only normative

child and human development but also what signs there are for non-normative
development and signs of child maltreatment that may manifest in a child’s behav-
ior. Child welfare professionals should be aware of the latest recommendations for
medical and dental routine assessments and know ways to make referrals if a child
requires additional monitoring, screening, or evaluation for developmental concerns.
Like all experiences in one’s life, trauma and adversity also shape one’s develop-
ment. Trauma is associated with a number of negative outcomes and impacts vari-
ous developmental competencies related to one’s interpersonal, intrapersonal,
regulatory, and neurocognitive competencies (Blaustein & Kinniburgh, 2010) nec-
essary for healthy development. We will discuss further how trauma is defined and
manifested by age group and discuss the impact of various traumatic experiences,
particularly complex and chronic trauma exposure for children who experience
child maltreatment.

Recommendations for Child Developmental Monitoring, Screening,

and Evaluation
Medical Examination: Well-child visits should occur regularly for children
Within first week (3–5 days)
1 month
2 months
4 months
6 months
9 months
12 months
15 months
18 months
24 months
2 ½ years
Every year between age 3 and 21
These visits serve various purposes, including children obtaining neces-
sary immunizations to prevent illnesses, track child growth and development
to ensure they are meeting necessary milestones, discuss any concerns a care-
giver may have, and promote optimum health of the child over time
(AAP, 2018).
Dental Examination
Ages 6 months to 1 year. The American Academy of Pediatric Dentistry
(2020) recommends scheduling a child’s first dental exam after the first tooth
erupts and no later than the first birthday. Also expect the baby’s teeth and
gums to be examined at well-baby checkups.
66 3 Child Development and Well-Being

Toddlers, school-age children, and adolescents. The American Academy of

Pediatric Dentistry recommends scheduling regular dental checkups, with the
most common interval being every 6 months. However, the dentist might rec-
ommend fewer or more-frequent visits depending on the child’s risk factors
for oral health problems.
Eye Examination
The American Optometric Association (2019) recommends the following
schedule for eye examinations:
Once between 6 and 12 months old
At least once between age of 3 and 5 years
Once before first grade and annually thereafter

Attachment, Bonding, and Development

Attachment Theory

Attachment theory has been used to understand child development as well as child
maltreatment. Research over the past several decades has established a clear rela-
tionship between the child-caregiver relationship and child development. Attachment
begins at birth and is especially salient during the first 3 years of life (Bowlby,
2008). At birth and the early years, an infant relies completely on their caregiver,
and the caregiver’s response to meeting the child’s needs is the foundation for the
attachment relationship (Bowlby, 2008). For this attachment relationship to occur,
caregivers must provide appropriate, consistent, and responsive care to the child. As
needs are expressed and met, infants develop a sense of trust and attachment to their
parents or caregivers even if their parents or caregivers do not adequately meet
their needs.
The attachment relationship involves both the caregiver and the infant and is
reciprocal. The caregiver acknowledges the infant’s needs when communicated
through crying and other means and consistently meets these needs appropriately
and responsively. When needs are met, the infant and the caregiver are satisfied.
Various factors can affect the attachment relationship such as culture, infant charac-
teristics (i.e., temperament), caregiver characteristics (i.e., sensitivity, patience,
responsive), and the environment (safety, support, relationships) in which the rela-
tionship and individuals exist. Cultural variations in attachment development may
also exist. For example, some cultures value a multiple mother or multigenerational
caregiving environment for children which can influence the infant-caregiver envi-
ronment through support and parent’s ability to care for the child.
From the research conducted by John Bowlby and Mary Ainsworth, four types of
attachment styles have been identified within two types of attachment: secure and
Attachment, Bonding, and Development 67

Table 3.3 Attachment styles

Attachment style Parenting approach Adult characteristics and behavior
Secure Aligned with the child; in tune Ability to create and maintain healthy
with child’s emotions relationships; set and enforce appropriate
boundaries; display appropriate emotions
Insecure-avoidant Unavailable or rejecting Avoids close relationships or emotional
connections with others; critical; rigid,
intolerant
Insecure-resistant/ Inconsistent and/or Anxious, insecure, controlling, blaming,
ambivalent inappropriate communication erratic, unpredictable behaviors and
emotions
Insecure-­ Unresponsive to child’s needs; Chaotic behaviors, insensitivity; abusive,
disorganized/ frightening or traumatizing distrustful; insecure
disoriented parental behaviors

insecure (Belsky, 2002). Mary Ainsworth led research on attachment using the
“strange situation” which involved the observation of various caregiver-child inter-
actions following a series of separations and reunions (Ainsworth et al., 1978) in a
laboratory setting. Attachment has continued to be studied in both laboratory and
community settings, and there is evidence that childhood attachment may impact
later life (e.g., Menon et al., 2020).
Table 3.3 describes the four types of attachment styles: secure, insecure-­avoidant,
insecure-resistant/ambivalent, and insecure-disorganized/disoriented. Secure
attachments involve the child using the caregiver as a secure base. The child can
explore freely, feels comfortable being away from the caregiver, but will check back
or ensure that the caregiver is available and nearby. When separated from the care-
giver, the secure child may react with little to extreme distress; however, when
reunited, the child responds positively. Insecure-avoidant attachments are character-
ized by the child avoiding the caregiver, showing little to no interest in the caregiver
as they explore their surroundings. When the caregiver leaves, the child shows little
distress, and when reunited, the child does not show interest in the caregiver.
Insecure-resistant/ambivalent child is preoccupied with the caregiver when they are
present and has extreme difficulty separating from the caregiver. While in the pres-
ence of the caregiver, the child does not explore on their own but instead relies on
the caregiver during this time. When separated, the child is extremely distressed and
continues to be preoccupied with the caregiver when reunited. Insecure-disorganized/
disoriented attachment is characterized by a child who uses a disorganized or disori-
ented pattern of dealing with separation and displays odd behaviors with confusion
or failure when approaching the caregiver. These children are the most distressed
when they are separated from the caregiver.
Longitudinal research has shown that having a caring, responsive caregiver leads
to more “organized” and “secure” attachment to the primary caregiver, which serves
as a protective factor for infants and children, whereas attachment insecurity has
been shown to be a risk factor for psychopathology and negative behavioral condi-
tions. In summary, child welfare professionals should understand that (1) the quality
68 3 Child Development and Well-Being

of the infant/child-parent attachment is a powerful predictor of a child’s later social

and emotional development; (2) there is always an attachment relationship between
a caregiver and child; however, what we assess for is the quality of the relationship;
(3) children develop a hierarchy of attachments with different caregivers (mother,
father, babysitter, grandparent) based on their relationship and needs being met by
that individual; and (4) children can recover from negative or insecure attachment
relationships through the development of secure, healthy attachment relationships
(e.g., foster and adoptive parents). Figure 3.1 provides ways to assess parent-child
attachment by developmental stage.

CHILD (Birth to One Year) PARENT/CAREGIVER

Eye Contact Respond to Vocalization
Response to Caregiver Adapt Voice Tone
Show Interest Uses Physical Touch
Effort to have Physical Contact Uses Face to Face Contact
Receive Comfort Respond to Child’s Cues
Vocalize Often Able to Comfort Child
Show Discomfort Initiate Interactions with Child
Regulate States Identify Positive Qualities about
Recognize Caregiver Child

CHILD (One to Five Years)

Environmental Exploration
Check-in with Caregiver PARENT/CAREGIVER
Respond to Caregiver
Aware of child’s cues
Occupy Self
Respond to child’s affection
Make eye contact with others
Set limits for child
Use appropriate emotions
Use appropriate discipline
Response to Pain/Pleasure
Provide comfort as needed
Speak to others
Promote autonomy
Show normal fears
Interact with child/play
Respond to separation
Enjoy physical closeness

CHILD (Five Years-Adolescent)

PARENT/CAREGIVER
Pride in Self
Celebrate Accomplishments Show interest in child’s activities
Awareness of Limits Understand child’s range of
Try new Tasks emotions
Regulate and Show Emotions Provide Support when Needed
Show Confidence in Abilities Fairness among Siblings
React Appropriately to Physical Appropriate Discipline
Contact Enjoy Time with Child
Positive Interactions with Peers Set Limits and Boundaries
and Siblings Provide Opportunities to Learn
Show Guilt, Shame

Fig. 3.1 Assessing parent-child attachment

Attachment, Bonding, and Development 69

Parent-Child Bonding

Bonding refers to the initial tie that develops between newborn babies and their
mothers. It is based on the innate physiological drive of mothers and their babies to
recognize each other and be emotionally linked to each other. By recognizing and
connecting with each other, parents (often the mother) develop a strong desire or
need to provide care for the child. The child responds in ways that require the care
from their parent and relies on their parent to give them what they need physically
and emotionally. This bond will typically develop during pregnancy for mothers and
possibly for babies and continue through the early stages of development and rela-
tionship. Immediately after birth and in the early stages, it involves close contact,
feeding, holding, verbal sounds and words, and warmth. Mothers often describe this
experience as an intense, extremely special relationship with their newborns. It is
important to note that bonding is not attachment and they involve different circum-
stances. The presence of bonding is not necessarily predictive of any positive or
negative outcomes.

Attachment Disorders

There are several short- and long-term consequences of an impaired attachment

experience or relationship in infancy and early childhood, including challenges
associated with interpersonal, emotional, social, and healthy relationship formation
and maintenance (e.g., Baer & Martinez, 2006). Children who experience secure
attachments feel as those the world can meet their needs and are able to form healthy
relationships and can explore these relationships and the world around them com-
fortably. Children who experienced an insecure attachment relationship may inter-
pret the world as hostile or unsafe, be fraught with anxiety, be aggressive or overly
defensive, or ambivalent to those around them. In childhood, these children may be
impulsive, have difficulty modulating their emotions and behaviors, or respond
appropriately in various social situations (Fearon et al., 2010). Insecure children
may form maladaptive coping behaviors such as substance abuse.
A severe form of an insecure attachment may result in reactive attachment disor-
der (RAD), a diagnosis in the Diagnostic and Statistical Manual of Mental
Disorders, fifth Edition (DSM −5), when a child’s normal attachment processes are
disrupted. It usually results from extreme cases of maltreatment and multiple rejec-
tions. Children are often severely withdrawn and depressed, or may be extremely
destructive or aggressive, or may vacillate between both extremes (usually requiring
therapeutic intervention). Some children who have been abused/neglected and are in
foster care have never formed secure attachment to caregivers. These children often
behave in ways to compensate for their lack of attachment with manipulation,
chronic anxiety, problems with authority, hostility, poor peer relationships, poor
70 3 Child Development and Well-Being

self-esteem, and self-isolation. Parents and caregivers can promote attachment and
reduce behavior problems through positive interactions, strong nurturing and
engagement, allowing children to grieve and mourn, providing structure in the
home, and appropriately touching the child.

Family Roles

Each family is different, with different members, experiences, traditions, and roles
that are determined by the family members themselves. As families grow and learn
from each other, each member often will serve a specific role in the family. These
roles include positive and negative characteristics, including but not limited to
behaviors, mood, financial support, food preparers, etc. Typically, parents provide
more of a caretaker role, and children learn to be responsible to the family in other
ways, such as through chores, caring for younger children, and self-care. These
roles are dependent on age, resources, and culture. Understanding these roles helps
us as child welfare professionals to understand family dynamics, how families oper-
ate, and the expectations of each family member.

Parenting Styles

With parents having such an important role and influence on child development, it
is important to understand what is known about the ways in which parents serve
within the role and the impact on child’s behavior, growth, and development.
Extensive research has been conducted on parenting styles and child development
and outcomes. However, despite examining the relationship between these vari-
ables, it is difficult to make actual cause-and-effect links between a parent’s style of
parenting and child’s behavior in adolescence and adulthood. Some children with
similar upbringings with the same parents in the same household can have very dif-
ferent outcomes, and children who grow up in different households can have very
similar personalities.
In the 1960s, psychologist Diana Baumrind (1967) conducted a study with more
than 100 preschool-age children and their parents and identified 4 important dimen-
sions of parenting which are (1) disciplinary strategies, (2) warmth and nurturance,
(3) communication styles, and (4) expectations of maturity and control. Based on
these dimensions, Baumrind determined that the majority of parents display one of
three parenting styles. Further research by Maccoby and Martin (1983) added a
fourth parenting style.
Parenting Styles 71

Practice Highlight
Overview of Parenting Styles
Authoritarian Parenting
Parents displaying this type of parenting style expect children to follow strict
rules and failure to do so often results in punishment. Authoritarian parents
typically do not provide reasons for the rules, have high, often unrealistic
demands, and are not responsive to their children.
Authoritative Parenting
Similar to authoritarian parents, those with an authoritative parenting style
have rules and consequences for their children but involve their children more
in establishing the rules and consequences. They are more responsive and
provide a rationale for rules and consequences, while listening to the child’s
perspective. When rules are not followed, authoritative parents are more nur-
turing and forgiving rather than punitive.
Permissive Parenting
Permissive parents have very few demands of their children. These parents
rarely establish rules or discipline their children. They have no to low expecta-
tions of children and do not require responsible behavior of their children.
Permissive parents are nurturing; however, they do not provide structure that
involves learning and discipline.
Uninvolved Parenting
An uninvolved parenting style is characterized by few demands, low respon-
siveness, and little communication. While these parents may fulfill the child’s
basic needs, they are generally detached from their child’s life. In extreme
cases, these parents may even reject or neglect the needs of their children.

Since Baumrind’s studies, researchers have conducted a number of studies to

determine what impact the different parenting styles have on children’s personality,
emotions, and behaviors. Findings suggest that authoritarian parenting styles gener-
ally lead to children who are obedient and proficient but lack in areas of happiness,
social competence, and self-esteem. Authoritative parenting styles often result in
happy, capable, confident, and successful children, whereas children with permis-
sive parents have shown to be unhappy, struggle with self-regulation, and may have
difficulty with authority. Uninvolved parenting styles rank lowest in that children
often lack self-control, self-esteem, and are less competent than their peers. These
findings may be grossly overgeneralized, when we know that many social circum-
stances can mediate these relationships. Further, the majority of these studies are
correlational, and a number of factors can contribute to these outcomes. There is no
one “best” way to parent, and parents make these decisions and have behaviors that
reflect their generation, experiences, culture, and education.
72 3 Child Development and Well-Being

Child Discipline

Child discipline is conceptualized as training that is expected to elicit specific

behaviors. The American College of Pediatricians presents child discipline as cen-
tral to the success of child-rearing. The process and practices are often controlled by
caregivers, typically parents, and are dependent on multiple factors, including par-
enting style, parents’ experiences of discipline as a child, culture, and public norms
and expectations.
Earlier, the chapter discussed the roles within a family and how these roles serve
a key role in child development. A fundamental goal of parenting is to teach and
support a child in developing character traits such as respectfulness, self-regulation,
integrity, and honesty. Child discipline and parental guidance evolve over time and
are highly dependent on a child’s developmental stage and ability. Discipline often
involves training through teaching, enforcement, reinforcement, and modeling of
acceptable patterns of behaviors. Discipline should also include healthy caregiver-­
child interactions involving encouragement and correction. The purpose of child
discipline is to ensure healthy moral, emotional, and physical development as well
as safety.
Acceptable means of child discipline have varied greatly in the past centuries,
and the “best” way to discipline a child can be quite controversial. For example, the
Old Testament eluded to strict corporal punishment, which was accepted by many
cultures across the world for many centuries. Further, much of how children were
disciplined stems from society’s view of the child’s role and use to a family. Until
the twentieth century, children were often viewed as “less than” adults, and children
were therefore dissuaded from challenging, questioning, or rebelling against author-
ity – their parents and other adults. This harsh, physical discipline often took place
in school settings in addition to the home and some public spaces.
Over time, research has shown that harsh physical punishment is not effective in
changing children’s negative behavior in the long term (Gershoff, 2008). Further,
other means such as positive reinforcement, treating children more respectfully, and
granting more freedom to learn appropriate behavior along with natural conse-
quences has become more popular in recent decades. For example, in the 1940s, Dr.
Benjamin Spock encouraged parents to more “open, understanding, reasonable, and
consistent because children are driven from within themselves to grow, explore,
experience, learn, and build relationships with other people” (Spock, 1946).
Society in the United States continues to have a divided attitude toward spanking
and corporal punishment among children, while it is illegal in more than 50 coun-
tries worldwide. Despite not having national policy that outlaws corporal punish-
ment, the American Academy of Pediatrics (Sege & Siegel, 2018) issued a position
against spanking and harsh words. Research shows that spanking, slapping, and
other forms of physical and verbal punishment are not effective in reducing negative
child behavior and can in fact damage a child’s long-term physical and mental
health. The American Academy of Pediatrics (2020) offers guidelines about appro-
priate discipline techniques that correspond to child development stage and age,
Difficult Developmental Phases 73

which include using positive reinforcement rather than punishments, positive mod-
eling of desired behaviors, assigning responsibilities for self-care and chores, and
educating children about appropriate emotion identification and expression.

Challenging Child Behaviors

There are several difficult developmental phases that can exacerbate caregivers’
frustrations and difficulties managing child behavior, which can lead to physical or
emotional abuse. These difficult phases can provoke anger, distress, confrontation,
and can become dangerous or deadly for the child living in a high-risk family. The
majority of these behaviors are out of the child’s conscious control and are develop-
mentally appropriate and variable. Child welfare professionals should be prepared
to discuss this with parents and caregivers and offer practical alternatives and sup-
port to avoid violent responses. These alternatives include using behavior modifica-
tion, setting clear boundaries and rules, appropriate child discipline, and offering
rewards for desirable behavior, for example, having a discussion with parents about
how behavioral patterns emerge and how caregivers can help to modify a child’s
behavior. Parents can be counseled and supported on how behavior is learned and
shaped by consequences (i.e., depending on whether consequence is positive or
negative, it will be repeated or not). Many parents have not been provided with
adequate parenting education about child development along with strategies to man-
aging difficult circumstances, especially new, first-time parents. Child welfare pro-
fessionals can serve as a support by providing education regarding normative
development, information about attachment and bonding, resources for supportive
programs and groups, and empathy in lieu of criticism and judgment. It is also
important to realize that many caregivers parent children as they were parented.
Therefore, when a parent has been shown love and support from a caregiver, they
learn to do this with their children. Conversely, those who have been shown harsh
punishment, abuse, and neglect often learn these contexts for caregiving. It is very
important, however, to note that if a parent experienced maltreatment as a child that
is not to say they will also be an abusive parent; most children who were maltreated
do not grow up to abuse and neglect their children (Schelbe & Geiger, 2017).

Difficult Developmental Phases

Examples of difficult developmental phases include colic, night crying, separation

anxiety, normal negativism, normal exploratory behavior, poor appetite, and toilet
training resistance. There are specific strategies that parents can use to reduce the
stress associated with these difficult developmental phases, including education,
behavior modification, and accessing support from other adults. Child welfare pro-
fessionals can be supportive of parents and caregivers experiencing these phases
74 3 Child Development and Well-Being

with their child by being knowledgeable of these strategies and providing resources
and information to parents and caregivers.
Colic is described as fussy, unexplained crying with an infant. Colic occurs one
or more times a day and lasts anywhere from 20 min to 2 h and begins in the first
month of life, usually within the first week of life. The cause is unknown, and it
resolves spontaneously within 3 months (or sooner). Parents have difficulty sooth-
ing their baby and will often bring the child to a healthcare professional for help.
Colic or excessive crying that a parent is unable to resolve with holding, rocking,
feeding, or other means of soothing is the most common precipitant of serious phys-
ical abuse. It is one of the most challenging parenting experiences of newborns and
is one of the most common reasons for parents seeking medical advice in the child’s
first 3 months of life. Colic can also impact the parents’ ability to bond with the
child because of feelings of inadequacy and anger, leading to developing behavioral
problems as the child grows (Krugman, 1993). Physicians and other helping profes-
sionals often recommend rhythmic calming techniques are effective in calming col-
icky babies which forms the core of the 5 S’s approach.
Experts have developed various strategies to help calm babies, such as using the
“5 S’s” (e.g., swaddling, shushing, swinging), which if used at night they can
improve sleep or reduce crying; and, when the “5 S’s” are done correctly and in
combination, they offer significant potential to promptly reducing infant crying and
promote sleep (Karp, 2015). It is important to also remind parents about the impor-
tance of feeding a hungry baby, changing wet diapers, and comforting a baby who
is cold and crying as a result of these factors. Soothing music accompanied with
parental attention (including eye contact, talking, touching, rocking, walking, and
playing) may be effective in some infants and is never harmful. Child welfare pro-
fessionals can encourage parents to discuss their feelings and concerns with each
other to obtain support as well as emphasize the responsibility of the whole family
in the care of a baby with colic.
Similar to colic is night crying. A common myth is that infants should be able to
sleep through the night by 3–4 months of age. Research suggests that the average
age for infants to sleep through the night is 3–6 months and in fact sleeping through
the night (at least 5–6 h). Many babies do not sleep for more than 6 hours at a time
at night until later. Infants not sleeping for extended periods of time (5–6 h) at night
can have a profound effect on caregivers and can lead to diminished judgment,
abuse, and/or neglect. Professionals recommend that parents keep a regular daytime
and bedtime routine for babies (e.g., bath, reading a book, etc.); create a comfort-
able, safe, quiet, and dark space for the child to sleep; be consistent; encourage
self-soothing; and acknowledge that there may be setbacks. It is also reassuring for
parents to know that babies will eventually sleep through the night.
Toilet training can also be an extremely frustrating experience for parents/care-
givers if there is resistance from the child, failure, or regression in toilet training.
Parents and caregivers often have expectations for children in terms of when a child
should achieve a particular developmental task, such as toilet training. When a child
does not achieve this task easily and/or promptly, parents can become frustrated.
With toilet training failure, children usually resist when parents try to toilet train
Difficult Developmental Phases 75

their child too quickly or in too forceful a manner. Children can become daytime
wetters, daytime soilers, or stool holders if the parents continue a harsh approach to
toilet training. Children are at risk of becoming injured if parents are forceful in
their attempts (e.g., injuries to the genital area, burns). Child development experts
recommend that parents assess readiness. Although early toilet training is ideal,
child readiness is a more common measure of success than timing (i.e., age). Most
children are ready by 24–30 months; however, some children are ready earlier and
some later. Parents should be encouraged to help the child practice using the potty,
establishing a routine for using the toilet, reward the child for cooperation and suc-
cess, and respond supportively to accidents.
Other difficult developmental phases include separation anxiety, normal explor-
atory behavior (approximately 1 year when children begin to walk and explore their
surroundings easier but could hurt themselves or become injured if the environment
is not safe), normal negativism, and normal poor appetite. People often refer to the
“terrible twos” with toddlers who are experiencing a lot of cognitive, physical, and
emotional growth. Children begin to communicate verbally during this stage and
learn how to respond to others, which is often negatively. The word “no” is many
children’s first word, and they often respond negatively to requests and other ques-
tions at this stage. In response, parents can provide the child with choices to increase
the sense of freedom and control (i.e., what they will wear that day, what they want
to play with, or eat). Children between the ages of 18 months and 3 years old experi-
ence a decrease of appetite in between physical growth spurts. They often prefer one
to two meals a day, versus a family’s typical four meals a day and tend to eat more
at one of those meals. It’s important to note that for young children in particular,
abuse often occurs when a caregiver or parent has an expectation for how a child
should behave and when he/she does not comply or learn quickly enough.

Research Brief
Maltreatment Prevention Through Early Care and Education
Programming
Christina Mondi-Rago, PhD.
Child maltreatment most commonly occurs during infancy and early child-
hood and is overwhelmingly perpetrated by caregivers (AFCARS, 2020).
There is a critical need for interventions that will prevent child maltreatment
and enhance caregiver capacities, and that can be feasibly implemented at
large scales with high-risk populations. Early care and education (ECE) pro-
grams represent a particularly promising venue for accomplishing these aims.
ECE programs offer comprehensive educational and family support services
to young children and families in institutional settings (e.g., public schools,
childcare centers). Many ECE programs (e.g., Project Head Start, the Child-­
Parent Center Program) were originally developed during the “War on
Poverty” of the 1960s, with the goal of enhancing the well-being and school

(continued)
76 3 Child Development and Well-Being

readiness of low-income children. Decades later, these programs serve mil-

lions of young children and families across the country.
A number of studies have reported that ECE program graduates experience
lower rates of physical discipline (e.g., spanking) and child maltreatment than
children who did not participate in such programming (Love et al., 2005;
Magnuson & Waldfogel, 2005; Pratt et al., 2016; Zhai et al., 2013). For exam-
ple, participation in Early Head Start has been linked to small but significant
reductions in child welfare system involvement over time. These long-term
impacts appear to be driven by other positive post-program outcomes in the
domains of parenting (e.g., emotional responsiveness, warmth, supportive-
ness), family conflict, and child development (e.g., cognitive and self-­
regulation skills; Green et al., 2014). Participation in the Child-Parent Center
preschool program has also been linked to lower rates of child maltreatment
and child welfare system involvement over time. These effects are partially
explained by increased parental involvement, reduced school mobility, and
increased enrollment in supportive school environments following early inter-
vention (Mersky et al., 2011; Reynolds & Robertson, 2003). Overall, these
findings indicate that ECE programs may reduce rates of child maltreatment
by increasing parenting skills, enhancing child development, reducing con-
flict around children’s behaviors and academic achievement, and building net-
works of support for vulnerable families (Klein et al., 2016).
ECE programs hold great promise to reduce rates of child maltreatment;
however, there is a critical need to expand access among high-risk popula-
tions. According to a recent study, less than one-third of young children (ages
5 and younger) who are under the supervision of the US child welfare system
are enrolled in center-based ECE programs. Among child welfare system
supervisees, young children with physical abuse histories are half as likely to
be enrolled in ECE programs (Klein et al., 2016). Thus, ECE programs should
make concerted efforts to recruit and children who are involved in the child
welfare system.

Supporting Healthy Parent-Child Relationships

Parenting is a challenging and rewarding. It requires effort and hard work but also
provides joy, happiness, and a sense of purpose for many. It is important for child
welfare professionals to acknowledge both the challenges and the rewards, as well
as the differences in experiences, feelings, and styles of parenting among caregivers
and families. By acknowledging and normalizing emotions and thoughts that may
differ from what is typically expected of parents allows parents to feel seen, heard,
and understood, especially in times of difficulties in their parenting journey. For
example, it is common for parents to feel inadequate, disappointed, imperfect at
Supporting Healthy Parent-Child Relationships 77

times, or to not feel loved or love for their children or other family members. Some
parents feel as though they might be judged if they ask for help or for a break from
their daily responsibilities and duties. Some parents feel shame and guilt when they
overreact or respond negatively to their child, when this is very common. As child
welfare professionals, it is important for us to listen and provide the support caregiv-
ers need, while also offering some ideas and advice, as appropriate to help guide
toward healthy parent-child interactions and relationships. It is also important to
note that these interactions and relationships change over time, particularly through
children’s developmental stages.
A positive parent-child relationship is important because it nurtures the physical,
emotional, and social development of the child. It is a unique bond that involves trust,
understanding, and safety. Our knowl-
edge about attachment and bonding
Tips for Positive Parenting
tells us that it lays the foundation for
the child’s personality, life choices, and Foster warm, loving interactions:
behaviors. Healthy parent-child rela- Treat every interaction as an opportu-
tionships help children to exhibit posi- nity to show love and connect through
tive and confident social behaviors, eye contact, smiles, physical contact,
improves social and academic skills, and kind words.
and problem-solving skills. There are Provide boundaries, rules, and con-
many ways that parents can form a last- sequences: Ensure consistent and
ing connection with their children, for appropriate structure. Communicate
example, telling a child “I love you” expectations and follow-through.
regularly, in different scenarios, and at Listen and show understanding and
every age. Parents can also show their empathy: Teach, model, and acknowl-
love and care by playing and spending edge appropriate emotions. Teach
time with their children, being avail- emotional self-regulation and be avail-
able, eating meals together, and able when they need a parent.
acknowledging their children’s individ- Model and help with problem-solv-
ual qualities through one-on-one time. ing: Be a role model for working
Parents should also be encouraged to through difficult times, provide and
care for themselves so that they can be practice effective problem-solving
the best parents they are able to be. skills and building solutions.

Note from the Field

Giving Advice to Parents
When I first started my career in child welfare, I was in my mid-20s and I
didn’t have children. Sure, I had a lot of experience with nieces and nephews
and with babysitting, but I had not given birth and not had to parent a child on
my own. I remember feeling nervous about giving advice about parenting and
worrying that I would inadvertently pass judgment about someone else’s par-
enting. How could I really know what it was like to be a parent? How could I

(continued)
78 3 Child Development and Well-Being

understand how challenging it could be to have enough money and support to

provide good care to a child? What I learned over time was that I could learn
as much as I could about child development, positive parenting techniques,
and community resources available to best support children and their caregiv-
ers. By supporting the parents, you could improve outcomes for the kids.
Most importantly, I had to listen to the parents, show empathy and under-
standing, and give them the opportunity to also learn and improve. It takes
time to get better and to recover from the trauma often experienced by parents
who become involved with the child welfare system. It takes support and
guidance, understanding, and compassion. Many of the parents we work with
don’t have the positive role models in their lives and have to unlearn what they
know about parenting and how to show love. Once I prioritized this approach,
it didn’t matter that I didn’t have kids of my own yet. The parents and children
I worked with didn’t care if I had kids – they just wanted to be heard, respected,
and cared for.

Conclusion

Child welfare professionals serve an important role in the lives of children and fami-
lies. They are often a critical resource when a family is struggling or facing chal-
lenges related to child development, parenting, or family roles. Child welfare
professionals must have a clear understanding of how families may operate, what
healthy and unhealthy child development may look like, parenting styles and behav-
iors, and how to provide the support and guidance caregivers may need across child
development. This knowledge and support can oftentimes ensure safety for children
and families during difficult times.

Acknowledgments The authors thank Christina Mondi-Rago, PhD, for the contribution to
Chap. 3.

Discussion Questions
1. Why is it important for child welfare professionals to understand stages of child
development?
2. What are three healthy discipline techniques?
3. In what ways can a child welfare worker assess parent-child attachment and
relationship?
4. At what age are children most at risk for child maltreatment? Why?
5. What are two ways child welfare professionals best support new parents?

Suggested Activities
1. Arrange to spend time with a friend or family member who has young children.
If you do not know anyone with young children, consider observing children and
Conclusion 79

parent interactions in public such as at a grocery store, mall, playground, or pub-

lic event. Especially when observing in public, remember to respect privacy and
to be safe. Observe their interactions (e.g., physical, emotional, verbal) and how
the parent meets the child’s needs. How do they speak to each other? How do
they show affection and emotions?
2. Choose a stage of development (infancy, toddler, pre-school, elementary age,
adolescence) and outline the ways they present emotionally, physically, cogni-
tively, and socially. Explain to a friend, peer, or field instructor.
3. Explore early intervention programs in your state and region that promote
healthy development for young children. Find pamphlets and/or other forms of
media (website, handouts, etc.) that talk about the program’s goals and focus.
Look for ways they promote family engagement and offer resources. Explore
how they address diversity.
4. Read Corr and Santos (2017) and discuss potential barriers to collaboration
across child welfare and early intervention systems. Identify reasons why these
barriers exist and solutions to reducing any potential barriers.
Corr, C., & Santos, R. M. (2017). “Not in the same sandbox”: Cross-systems
collaborations between early intervention and child welfare systems. Child
and Adolescent Social Work Journal, 34(1), 9–22. (Available: https://rdcu.
be/cb8T8).

Additional Resources
Kids Health, A Guide for First-time Parents: https://kidshealth.org/en/parents/
guide-­parents.html
Baby Navigator—what every parent needs to know: https://babynavigator.com/
Centers for Disease Control and Prevention, Developmental Milestones: https://
www.cdc.gov/ncbddd/actearly/milestones/index.html
Center on the Developing Child at Harvard University, Applying the Science of
Child Development in Child Welfare Systems: https://developingchild.harvard.
edu/resources/child-­welfare-­systems/
Child Welfare Information Gateway, Early Childcare and Childhood Services:
https://www.childwelfare.gov/topics/preventing/prevention-­p rograms/
earlychildhood/
Child Welfare Information Gateway, Impact on Child Development: https://www.
childwelfare.gov/topics/can/impact/development/
March of Dimes, Caring for your Baby: https://www.marchofdimes.org/baby/
caring-­for-­your-­baby.aspx?gclid=CjwKCAiA-­_L9BRBQEiwA-­bm5ftrgfobcja_
76T6MOgXrfBNpiIU1svXcELAH5pMtVPWaa-­nbB1u8ShoCVmwQAvD_BwE
National Center on Substance Abuse and Child Welfare, Children and Families
Affected by Parental Substance Use Disorder (SUDs): https://ncsacw.samhsa.
gov/topics/parental-­substance-­use-­disorder.aspx
80 3 Child Development and Well-Being

References

Ainsworth, M. D., Blehar, M., Waters, E., & Wall, S. (1978). Patterns of attachment. Erlbaum.
Allen, A. D., Hyde, J., & Leslie, L. K. (2012). “I don’t know what they know”: Knowledge trans-
fer in mandated referral from child welfare to early intervention. Children and Youth Services
Review, 34(5), 1050–1059. https://doi.org/10.1016/j.childyouth.2012.02.008
American Academy of Pediatric Dentistry. (2020). Oral health policies & recommendations (The
reference manual of pediatric dentistry). https://www.aapd.org/research/oral-­health-­policies%
2D%2Drecommendations/
American Academy of Pediatrics. (2020). What’s the best way to discipline my child? https://www.
healthychildren.org/English/family-­life/family-­dynamics/communication-­discipline/Pages/
Disciplining-­Your-­Child.aspx
American Academy of Pediatrics. (2018). AAP schedule of well-child care visits. https://www.
healthychildren.org/English/family-­l ife/health-­m anagement/Pages/Well-­C hild-­C are-­A -­
Check-­Up-­for-­Success.aspx
American Optometric Association. (2019). Championing children’s eye care. https://www.aoa.org/
news/inside-­optometry/aoa-­news/championing-­childrens-­eye-­care?sso=y
Baer, J. C., & Martinez, C. D. (2006). Child maltreatment and insecure attachment: A meta-­
analysis. Journal of Reproductive and Infant Psychology, 24(3), 187–197. https://doi.
org/10.1080/02646830600821231
Baumrind, D. (1967). Child-care practices anteceding three patterns of preschool behavior. Genetic
Psychology Monographs, 75, 43–88.
Belsky, J. (2002). Developmental origins of attachment styles. Attachment & Human Development,
4(2), 166–170. https://doi.org/10.1080/14616730210157510
Blaustein, M., & Kinniburgh, K. (2010). Treating traumatic stress in children and adolescents:
How to foster resilience through attachment. In Self-regulation, and competency. Guilford.
Bowlby, J. (2008). A secure base: Parent-child attachment and healthy human development.
Basic Books.
Centers for Disease Control and Prevention. (2020). Concerned about your child’s development.
https://www.cdc.gov/ncbddd/actearly/concerned.html
Cicchetti, D., Toth, S. L., & Maughan, A. (2000). An ecological-transactional model of child mal-
treatment. https://doi.org/10.1007/978-­1-­4615-­4163-­9_37
Fearon, R. P., Bakermans-Kranenburg, M. J., Van IJzendoorn, M. H., Lapsley, A. M., & Roisman,
G. I. (2010). The significance of insecure attachment and disorganization in the development of
children’s externalizing behavior: A meta-analytic study. Child Development, 81(2), 435–456.
https://doi.org/10.1111/j.1467-­8624.2009.01405.x
Gershoff, E. T. (2008). Report on physical punishment in the United States: What research tells us
about its effects on children. Center for Effective Discipline.
Green, B. L., Ayoub, C., Bartlett, J. D., Von Ende, A., Furrer, C., Chazan-Cohen, R., et al. (2014).
The effect of early head start on child welfare system involvement: A first look at longitudinal
child maltreatment outcomes. Children and Youth Services Review, 42, 127–135. https://doi.
org/10.1016/j.childyouth.2014.03.044
Karp, H. (2015). The happiest baby on the block; fully revised and updated second edition: The
new way to calm crying and help your newborn baby sleep longer. Bantam.
Klein, S., Merritt, D. H., & Snyder, S. M. (2016). Child welfare supervised children’s participa-
tion in center-based early care and education. Children and Youth Services Review, 68, 80–91.
https://doi.org/10.1016/j.childyouth.2016.06.021
Krugman, R. (1993). Child abuse and neglect. World Health, 46(1), 22–23. https://doi.org/10.1001/
archpedi.1993.02160290023009
Love, J. M., Kisker, E. E., Ross, C., Raikes, H., Constantine, J., Boller, K., et al. (2005). The effective-
ness of early head start for 3-year-old children and their parents: Lessons for policy and programs.
Developmental Psychology, 41(6), 885–901. https://doi.org/10.1037/0012-­1649.41.6.885
References 81

Maccoby, E. E., & Martin, J. (1983). Socialization in the context of the family: Parent-child
interaction. In Mussen (series ed.) & Hetherington (vol. ed.), Handbook of child psychology:
Socialization, personality and social development (Vol. 4, pp. 1–101).
Magnuson, K. A., & Waldfogel, J. (2005). Preschool child care and parents’ use of physical disci-
pline. Infant and Child Development, 14(2), 177–198. https://doi.org/10.1002/icd.387
May, P. A., Baete, A., Russo, J., Elliott, A. J., Blankenship, J., Kalberg, W. O., et al. (2014).
Prevalence and characteristics of fetal alcohol spectrum disorders. Pediatrics, 134(5), 855–866.
https://doi.org/10.1542/peds.2013-­3319
Menon, M., Katz, R. C., & Easterbrooks, M. A. (2020). Linking attachment and executive function
systems: Exploring associations in a sample of children of young mothers. Journal of Child
and Family Studies, 29(8), 2314–2329. https://doi.org/10.1007/s10826-­020-­01759-­5
Mersky, J. P., Topitzes, J. D., & Reynolds, A. J. (2011). Maltreatment prevention through early
childhood intervention: A confirmatory evaluation of the Chicago child-parent center preschool
program. Children and Youth Services Review, 33(8), 1454–1463. https://doi.org/10.1016/j.
childyouth.2011.04.022
Oh, S., Gonzalez, J. M. R., Salas-Wright, C. P., Vaughn, M. G., & DiNitto, D. M. (2017).
Prevalence and correlates of alcohol and tobacco use among pregnant women in the United
States: Evidence from the NSDUH 2005-2014. Preventive Medicine, 97, 93–99. https://doi.
org/10.1016/j.ypmed.2017.01.006
Pratt, M. E., Lipscomb, S. T., & Schmitt, S. A. (2016). The effect of head start on parenting
outcomes for children living in non-parental care. Journal of Child and Family Studies, 24,
2944–2956. https://doi.org/10.1007/s10826-­014-­0098-­y
Reynolds, A. J., & Robertson, D. L. (2003). School-based early intervention and later child mal-
treatment in the Chicago longitudinal study. Child Development, 74(1), 3–26. https://doi.
org/10.1111/1467-­8624.00518
Schelbe, & Geiger. (2017). Intergenerational transmission of child maltreatment. Springer. https://
doi.org/10.1007/978-­3-­319-­43824-­5
Sege, R. D., & Siegel, B. S. (2018). Effective discipline to raise healthy children. Pediatrics,
142(6). https://doi.org/10.1542/peds.2018-­3112
Spock, B. (1946). The common sense book of baby and child care (pp. 258–259). Duell, Sloan
and Pearce.
Stepleton, K., McIntosh, J., & Corrington, B. (2010). Allied for better outcomes: Child welfare and
early childhood. Center for the Study of Social Policy.
Trickett, P. K., & McBride-Chang, C. (1995). The developmental impact of different forms of
child abuse and neglect. Developmental Review, 15(3), 311–337. https://doi.org/10.1006/
drev.1995.1012
Zhai, F., Waldfogel, J., & Brooks-Gunn, J. (2013). Estimating the effects of head start on parenting
and child maltreatment. Children and Youth Services Review, 35(7), 1119–1129. https://doi.
org/10.1016/j.childyouth.2011.03.008
Zielinski, D. S., & Bradshaw, C. P. (2006). Ecological influences on the sequelae of child
maltreatment: A review of the literature. Child Maltreatment, 11(1), 49–62. https://doi.
org/10.1177/1077559505283591
Chapter 4
Identifying Child Maltreatment

Introduction

Child maltreatment is comprised of multiple types of abuse and neglect. Abuse is

purposeful, specific, and repeated mistreatment from a caregiver. Neglect is the fail-
ure of a caregiver to meet the child’s basic needs, such as food, shelter, security,
clothing, and hygiene. Conceptually, the types of maltreatment can be divided into
physical abuse, sexual abuse, psychological and emotional abuse, and neglect. The
definition of maltreatment within Child Abuse Prevention and Treatment Act
(CAPTA) Reauthorization Act of 2010 is “Any recent act or failure to act on the part
of a parent or caretaker which results in death, serious physical or emotional harm,
sexual abuse or exploitation”; or “An act or failure to act which presents an immi-
nent risk of serious harm.”
The key elements of child maltreatment definition include the following: 1) the
victim is a child, a person under age 18; 2) the perpetrator is a caregiver who has
care, custody, or control of the child; 3) risk of harm must be sufficient; 4) actual
harm does not necessarily need to occur; and 5) acts of omission are considered.
The legal definitions of maltreatment vary slightly by state. Likewise, research
operationalizes maltreatment differently. For example, in some studies maltreat-
ment may be measured by adult retrospectively reporting maltreatment as a child
and include any physical punishment including spanking, whereas other research
may rely only upon official court records of substantiated maltreatment. These dif-
ferent definitions have implications as they can greatly impact the prevalence of
maltreatment. There are calls to think of maltreatment holistically and incorporate
more issues of child adversity when addressing maltreatment (e.g., Van Scoyoc
et al., 2015). The sections below describe types of maltreatment broadly, although it
must be stressed that states have different definitions.
Child maltreatment has a wide range of short- and long-term consequences.
These will look different in children across their life span depending on many fac-
tors at different levels (i.e., the child, the parent, the family, and the community).

© Springer Nature Switzerland AG 2021 83

J. M. Geiger, L. Schelbe, The Handbook on Child Welfare Practice,
https://doi.org/10.1007/978-3-030-73912-6_4
84 4 Identifying Child Maltreatment

The various risk and protective factors can help to understand how to work with
children and families as well as how to prevent child maltreatment. It is important
to remember that both risk and protective factors are not static; child welfare pro-
fessionals can work with families to reduce risks factors and increase protective
factors.

Physical Abuse

About one in five cases reported to child protection services includes physical abuse
(US DHHS, 2020). Physical abuse is any non-accidental injury inflicted on a child
which causes or poses a substantial risk of death, disfigurement, impairment of
physical or emotional health, or loss or impairment of any bodily function. The
intent of the caregiver is not considered in the definition of physical abuse. For
example, if a caregiver grabs a child’s arms forcefully and twists giving the child a
spiral fraction in her arm, it is irrelevant if the caregiver intended to break the child’s
arm. Therefore, excessive corporal punishment may be considered physical abuse.
Physical abuse also includes acts of
torture where caregivers deliberately
Practice Highlight
and/or systematically inflict cruel or
unusual treatment which results in the Factors Related to Increased
child’s physical or mental suffering. Concern of Abuse for Fractures
The lists of activities of injuries • Absence of credible history
resulting from physical maltreatment explaining fracture
are practically inexhaustive. Caregivers • Child is young age
may physically abuse a child through • Additional injuries in addition to
biting, pinching, hitting, choking, fracture
smothering, shaking, throwing, vio- • Delay in seeking medical treatment
lently pushing, or shoving into fixed • Caregiver’s explanation does not
objects. Injuries may include bruises, make medical or physical sense
cuts, bites, bone fractures, and burns. • Specific types of fractures
One type of injury worth specific men- • Specific fractures raise concern
tion is abusive head trauma. Fatalities • Multiple fractures (especially
due to abusive head trauma are esti- bilaterally)
mated to be greater than 20%, and two- • Repetitive fractures
thirds of survivors experience • Hands and feet fractures
significant disability (Duhaime, 2008; • Posterior (rear) rib fractures
Chiesa & Duhaime, 2009). Another • Certain clavicle fractures
common cause of fatal child abuse is • Should blade (scapula) fractures
abdominal injuries, which are most fre- • Fractures in various stages
quently caused by punching or kicking. of healing
Female genital mutilation and giving • Spine fractures
controlled substances are considered • Breastbone (sternum) fractures
physical abuse in some jurisdictions. • Skull fractures
Physical Abuse 85

Signs and Symptoms of Physical Abuse

There are multiple indicators of physi-

cal abuse. The physical indicators Practice Tip: Understanding
include injuries to the child including Non-accidental Bruises
bruises, lacerations, fractures, burns, Bruises are a natural consequence of
head injuries, and internal injuries. injury to our body; however, not all
While an injury alone is insufficient to are accidental. To determine whether a
determine if maltreatment occurred, bruise is accidental is to understand
there are several things to consider that the physical indicators based on sev-
make the injury more likely to be more eral factors such as the age of the
non-accidental. child, location of the injury, serious-
The way that parents present the ness of the injury, and the explanation
child’s injuries can also be indicative for the injury. Often bruising on an
of maltreatment. Delay in treatment is infant who is not ambulatory (not
one red flag that the injury may be due crawling or walking yet), on the poste-
to maltreatment. An explanation of rior side of the body or non-bony areas
what caused the injury that is inconsis- can be concerning and possibly not
tent with the injury is another indicator. accidental. Investigators must look for
For example, a parent may say that the patterns in bruises – does it reflect an
child sustained injuries when falling instrument (e.g., iron)? Or does it have
off a bicycle, but the child has bruises a certain color that shows healing?
on the back of their legs that likely When dating a bruise, consider the
would not have occurred from a bike following guidelines (these vary by
accident. Likewise, an explanation that individual):
is not plausible could raise concerns
that a child was abused or neglected. Less than 1 day – red, red/blue
Going back to the parents stating the 1–2 days – black/blue to blue/
child was hurt in a bike accident, it brown, purple
may not be plausible for a young child 3–5 days – yellow/green to brown
who lacks the motor skills to be on a 5–7 days – yellow and fading
bicycle. There are specific patterns of Over one week – yellow/brown
bruising that are indicators of maltreat- and fading
ment. Sometimes it is possible to see
what caused the bruise as is in the case
when an outline of a hand or shoe is
present. Bruises that are bilateral (on both sides of the body) are more likely to be
non-accidental. This could be bruises on each arm that come from being forcefully
grabbed or on the backs of thighs from being hit with a switch. Injuries on certain
parts of the body are more likely to be intentional. For example, bruises on the ear
are nearly always intentional due to being struck; a child hitting their head rarely
causes bruising to the ears. Another indicator is when there are multiple injuries in
various stages of healing.
Behavioral indicators fall into two categories. Children who are physically
abused may be extremely passive, accommodating, and engaging in submissive
86 4 Identifying Child Maltreatment

behaviors. Alternatively, children experiencing physical abuse may have notably

aggressive behaviors and express hostility toward others. Another indicator of phys-
ical abuse is there may be developmental delays in children who have been physi-
cally abused.

Practice Tip
Common Indicators Mistaken for Abuse
Coining or Cupping: A common healing remedy used by several Asian cul-
tures. The child’s skin is rubbed with a coin or cup, which may be heated that
causes blood to rise to the surface and resemble a bruise or burn.
Impetigo: A rash caused by bacteria that forms round, crusted spots that
appear typically on hands and face. The rash may resemble cigarette burns;
however, impetigo wounds are concave, where cigarette burns are convex.

Sexual Abuse

Approximately 10% of reports to child protective services involve sexual abuse (US
DHHS, 2020); however, it is estimated that 1 in 4 girls will be sexually abused
before they turn 18 as well as between 1 in 6 or 1 in 13 boys (Finkelhor et al., 1990;
Pereda et al., 2009). Sexual abuse includes all sexual contact and activities between
an adult responsible for a child and a child. It may include activities of sexual pen-
etration, sexual touching, oral sex, exposure, voyeurism, pornographic photogra-
phy, or sexual gestures. Sexual abuse can be categorized as sexual battery, sexual
molestation, and sexual exploitation.
Sexual battery involves the oral, anal, or vaginal penetration by, or union with,
the sexual organ of a child; the forcing or allowing a child to perform oral, anal, or
vaginal penetration on another person; or the anal or vaginal penetration of another
person by any object. This includes digital penetration, oral sex (cunnilingus, fel-
latio), coitus, and copulation.
Sexual molestation involves sexual conduct with a child when such contact,
touching, or interaction is used for the caregiver’s arousal or gratification of sexual
needs or desires. Sexual molestation is when either the caregiver or child intention-
ally touches genitals or intimate parts, including the breasts, genital area, groin,
inner thighs, and buttocks, or the clothing covering them. Exceptions are if the
touching is considered a normal caregiver responsibility or action or if the touching
intended for a valid medical purpose. Thus, changing a diaper would not be consid-
ered sexual molestation, although the caregiver is intentionally touching the child’s
genitals and intimate parts.
Sexual exploitation is the caregiver’s sexual use of a child for sexual arousal,
gratification, advantage, or profit. It also includes any other sexual acts intentionally
conducted in the presence of a child. Commercial sexual exploitation of children
Sexual Abuse 87

(CSEC), a form of human trafficking, is also considered sexual exploitation,

although some states have a separate category for this type of abuse. Chapter 11
provides information about working with children who have experienced human
trafficking.

Sexual Abuse Disclosure

A child’s disclosure of sexual abuse should be taken seriously, regardless of when

and how it is made. Sexual abuse can take place for years before a child discloses.
Rarely do children make false disclosures about child sexual abuse. Children may
recant their disclosures of sexual abuse. They may do so for various reasons
including pressure from the perpetrator or others. They may change their disclo-
sure and say the abuse did not occur because they perceive negative consequences
(e.g., a stepfather moving out of the house, not being allowed to spend time with
a family member, family members being upset). In many regards, the recanting
may be the child’s attempt to restore the status quo in the family and return to
“normal.” Children can be conflicted about sexual abuse because it often occurs
in the context of a relationship with someone they care about, and they may enjoy
the attention from the perpetrator or the gifts that the perpetrator gives as bribes
to keep the secret. A child’s recanting of the abuse does not mean that it did
not occur.

Understanding Child Sexual Abuse

In most sexual abuse, there is a predictable pattern that involves five stages:
engagement, sexual interactions, secrecy, disclosure, and suppression. The
initial stage, engagement, is when the perpetrator selects and “grooms” the
child. As time progresses, the perpetrator will engage the child in sexual activ-
ity, typically starting with a lesser behavior and escalating to a more serious
behavior. Once there is sexual behavior, the perpetrator focuses on secrecy
and ensuring that the child keeps the activities secret. This allows the sexual
abuse to continue. Secrecy can be facilitated through rewards and threats. The
period can last for weeks, months, or years. The next stage is disclosure which
occurs when either accidentally or intentionally the child or perpetrator lets
someone know the sexual activity is occurring. Following disclosure there is
often a period of suppression during which time the sexual abuse is mini-
mized or denied. The suppression can be from the perpetrator, the child, or
family members. There may be pressure from the perpetrator for the child and
family to suppress the information.
88 4 Identifying Child Maltreatment

Signs and Symptoms of Sexual Abuse

There are multiple indicators of sexual abuse. The physical indicators include the
child having a sexually transmitted infection/disease; early, unexplained pregnancy;
problems with urination, including bladder or urinary tract infections; painful bowel
movements; suspicious stains, blood, or semen on a child’s underwear, clothing, or
body; and bruising or injuries of the genitals or genital area. Children may also express
behavioral indicators including acting out sexually or engaging in sexual activity.
They may have knowledge about sex that is inappropriate for their age. Children who
are sexually abused may exhibit general indicators of emotional distress and be with-
drawn and express a fear of being touched. The psychological indicators of sexual
abuse also include low self-esteem, anger, fear, anxiety, and depression.

Emotional Abuse

Approximately 10% of cases reported

Myths About Emotional Abuse
to child protective services are emo-
tional abuse (US DHHS, 2020), Children may say, “Sticks and stones
although it is widely understood that may break my bones, but words will
there is underreporting of this type of never hurt me” in response to name
maltreatment. Emotional abuse often calling and mean things said about
occurs with other forms of maltreat- them. The thought is pervasive in
ment; children who have been physi- regard to emotional abuse. However, it
cally abused or neglected frequently is a myth that emotional abuse does
also experience emotional abuse. not hurt children. Words can hurt.
Emotional abuse, also called psycho- Attacking a child’s self-worth and
logical abuse, occurs when the care- undermining her through verbal
giver is belittling, humiliating, assaults can be damaging. There are
rejecting, undermining a child’s self- many deeply held myths about emo-
esteem, and generally not creating a tional abuse including the child
positive atmosphere for the child. deserves the verbal abuse because of
Emotional abuse falls into several basic his behavior, including being noncom-
categories: spurning, terrorizing, pliant or disagreeing with the care-
exploiting/corrupting, isolating, and giver. This is related to the belief that
ignoring. the abuse only occurs because the
Spurning is a caregiver’s verbal and caregiver is angry due to the child
nonverbal acts that reject and degrade a making him angry.
child. This may include belittling, Emotional abuse extends beyond a
degrading, ridiculing, and other verbal pattern of name-calling, belittling,
tactics that demean a child. Spurning insulting, or criticizing a child. It
can occur when a caregiver constantly includes rejecting, isolating, terrorizing,
shames a child or singles the child out ignoring, corrupting, and over-pressur-
to criticize or punish. It also includes ing a child. It is a myth that emotional
humiliating a child in public. abuse is not as bad as hitting a child.
Emotional Abuse 89

Caregivers terrorize a child through

Emotional abuse can negatively
actions or comments that threaten or
impact a child’s development.
scare a child. Examples could include
Research suggests that emotional
caregiver’s threats to physically hurt,
abuse is as damaging as violent abuse
kill, abandon, or place the child or
in terms of mental and behavioral
child’s loved ones/objects in recogniz-
health outcomes.
able dangerous situations. Terrorizing
Children who experience emo-
also includes placing a child in danger-
tional abuse may experience negative
ous, unpredictable, or chaotic circum-
long-­term outcomes including depres-
stances or threatening to do so, for
sion, anxiety, low self-esteem, and
example, leaving or threatening to
problems in relationships. Emotional
leave a child along the roadside or dan-
abuse can greatly impact a child even
gling a child over the edge of a bridge.
if it does not cause broken bones.
The threats or actions do not always
need to be toward the child as directing
the threats or actions toward a loved one (e.g., sibling, parent, friend, pet) or a favor-
ite possession (e.g., toy, doll) can also serve to terrorize a child.
Exploiting or corrupting is when a caregiver encourages or supports the child
engaging in illegal or deviant behaviors or developing inappropriate or maladaptive
behaviors. The behaviors could include those which are self-destructive, antisocial,
criminal, or deviant, for example, prostitution, substance abuse, violence, stealing,
or fighting. The caregiver may encourage or support these behaviors through the
caregiver’s modeling, permitting, or encouraging. Exploiting or corrupting also
occurs when a caregiver facilitates developmentally inappropriate behavior (e.g.,
parentification or infantilization) that is damaging to a child.
Another form of emotional maltreatment is isolation. A caregiver isolates a child
through keeping a child away from other appropriate relationships and denying the
child opportunities to connect with others outside the home. Isolating may include a
caregiver confining a child or restricting the child’s movement. It may also include
placing rigid limitations on a child’s interactions with peers and others in the community.
Ignoring broadly defined is a caregiver denying emotional responsiveness and
failing to express affection, caring, and love for the child. It may be a caregiver ignor-
ing the child or pretending the child is not there. The caregiver’s failure to respond
and detached involvement can be intentional, lack of motivation, or an incapacity.

Signs and Symptoms of Emotional Abuse

Children can have a range of reactions to emotional abuse, and likewise there are a
range of signs and symptoms. There interactions with others may be outside typical
behaviors; they may be withdrawn and not engage with other or alternatively may
desperately seek affection. They may have developmental emotional development
and/or act inappropriately emotionally. Children who are emotionally abused may
be depressed and have low self-esteem or self-confidence. They may avoid certain
settings or interactions. School-aged children who are emotionally abused may per-
form poorly in school.
90 4 Identifying Child Maltreatment

Neglect

Approximately 75% of all reports of child maltreatment are neglected (US DHHS,
2020). Other types of abuse may occur with neglect. Sixty-five percent of neglected
children suffer from another form of maltreatment, and 45% suffer from three or
more forms (US DHHS, 2020). Neglect occurs when a caregiver deprives or fails to
provide a child with basic needs. This includes depriving a child of physical, emo-
tional, medical, mental health, or educational needs. Neglect also includes when a
caregiver provides inadequate supervision of a child where a child is either unsuper-
vised or under the care of someone unable to supervise due to his or her condition.
Neglect can be considered failure to meet “minimal parenting standards” for provid-
ing supervision, food, clothing, shelter, medical care, or other basic needs. Neglect
consists of caregiver acts of omission, the failure to do something, rather than acts
of commission, where caregivers do something. Neglect includes when a child is in
an environment that increases the child’s likelihood of harm to the health or well-­
being of the child. It includes physical neglect, inadequate supervision, abandon-
ment, educational neglect, and medical neglect.
Neglect tends to be a persistent chronic condition with families often being
referred multiple times to child protection. It does not require a “critical event” to be
present even though a “critical event” usually triggers a report and investigation.
Repetitive “subthreshold events” may harm a child more than isolated “critical
events.” A critical event could be a toddler found wandering in the street wearing
only a diaper that needed to be changed. Prior to this critical event, the child may
have been routinely experiencing subthreshold events in the home such as not having
their diaper changed, not being adequately fed, not being supervised. These ongoing
subthreshold events may not have been known to others as the toddler was in the
home and not visible to others; however, the impact of the neglect remains the same.

Poverty or Neglect?
Consider the following examples that Jerry Milner, the Associate
Commissioner at the Children’s Bureau, and David Kelly (2020) present:
• “The children of a young, single mother were removed solely due to an
eviction. She had hoped that the system would rally to help her find decent,
safe housing only to be told ‘you must comply with this or that in your case
plan in order to regain custody.’”
• “Parents were required to pay for certain services or drug testing they
could not afford and had that inability to pay used against them as failure
to comply with a case plan, preventing them from regaining custody of
their children.”
In these cases, the parents’ lack of resources interfered with their ability to
meet the goals of the case plan. Poverty was the underlying reason that the
children were removed from their parents’ care and contributed to their
remaining in out-of-home placement.
Neglect 91

Consider how the following examples compare to those above:

• “A judge ordered a child welfare agency to pay for a necessary repair to a
septic tank that would otherwise leave a home uninhabitable and a family
separated.”
• “A parent attorney successfully argued that supplemental security income
death and disability payments be made to a mother positioning herself for
reunification instead of the child welfare agency so that she would not lose
her apartment.”
• “A community adoption agency took on the prevention mantle by rallying
around a family at risk of losing its children by lining up safe child care,
bringing meals to the family, and securing rent to head off an impending
eviction.”
In these examples, there is a recognition that helping parents address
poverty-­related needs, it may be possible to help reduce child welfare system
involvement and if (and how long) children are in out-of-home placements.
The issue of housing is paramount, and child welfare should collaborate with
programs addressing family housing stability (e.g., Gubits et al., 2018).
Milner and Kelly (2020) conclude, “If we truly care about children and
families, it’s time to stop confusing poverty with neglect and devote ourselves
to doing something about it.”

Neglect can be either situational or chronic. In situational situations, the care-

giver fundamentally can provide and care for the child yet due to temporary circum-
stances is unable to, in many cases due to being overwhelmed. This could be due to
a divorce, death, disability, or other set of conditions that interfere with the caregiver
providing for the child. In chronic neglect, there are enduring issues where the par-
ent has serious and continuous difficulties that interfere with providing for a child.
There may be ongoing issues related to substance misuse, mental health, or cogni-
tive ability issues that contribute to the caregiver not providing for the child. With
situational neglect, short-term interventions may be adequate for ensuring the
neglect ends, and the caregiver can provide for the child. With chronic neglect, lon-
ger interventions may be necessary to change the complex issues that are contribut-
ing to the neglect.
Most children who live in poverty are not neglected; however, neglect is strongly
associated with poverty. Children who live in homes where there is low income,
unemployment, use of public assistance, or housing instability are more likely to
experience neglect. A recent study found that children living in households that file
for a foreclosure have a higher probability of being involved in the child welfare
system (Berger et al., 2015). In addition to these family-level economic risks,
neglect is also associated with neighborhood poverty and higher neighborhood rate
of unemployment (Morris et al., 2019) meaning a child living in a neighborhood
with high levels of poverty is at risk for maltreatment. The contexts of
92 4 Identifying Child Maltreatment

neighborhoods are associated with parenting practices; lower affluence is associated

with more parental aggression (Shuey & Leventhal, 2017). Social cohesion within
a neighborhood is also related to neglect (Maguire-Jack & Showalter, 2016).
The risks and dangers of neglect have frequently been minimized and over-
looked, yet it is a serious form of maltreatment. Indeed, the long-term outcomes of
neglect are more severe than other types of maltreatment. There are multiple risks
of harm associated with neglect. There are increased risks of physical injury and
poisoning due to inadequate supervision. Children who are neglected may have
health problems due to untreated medical issues. This is not surprising due to family
instability being associated with poorer children’s health (Smith et al., 2017). They
may also experience cognitive and psychosocial developmental delays due to their
environment. Annually many child fatalities related to neglect occur due to drown-
ing and unsafe sleeping. There is a need to better understand how best to address
neglect and understand the macro-level forces that contribute to it (Bullinger, Feely,
Raissian, & Schneider, 2019).
Physical neglect is the caregiver’s failure to protect from harm or danger and
provide for the child’s basic physical needs, including shelter, food, and clothing.
Physical neglect excludes these failures caused primarily by financial inability
unless relief services had been offered and refused. A child experiences physical
neglect when their caregiver does not provide a safe environment that is free from
violence and hazards, for example, a young child living in a home where there is a
swimming pool without any fencing preventing the child’s access or a home envi-
ronment where a child is exposed to dangerous toxins. It could also be a home that
is unhygienic and has feces or trash throughout the house. Physical neglect is the
most widely recognized and commonly identified form of neglect.
Inadequate supervision refers to situations in which the child is without a care-
taker or caretaker is inattentive or unsuitable and the child is in danger of harming
self or others. It includes placing a child or failing to remove a child from a situation
that requires judgment or actions beyond the child’s level of maturity, and that
results in bodily injury or a substantial risk of immediate harm. As such, the child’s
maturity and ability to respond to a crisis are relevant. The lack of supervision can
occur due to different circumstances. For example, the parent could be physically
absent because of working and leaving a child who is too young to care for them-
selves home alone. Alternatively, the parent could be in the home but not able to
appropriately supervise because of their substance abuse. For example, they could
be using substances or hung over and not attending to the child’s needs.
Abandonment is when a caregiver leaves a child in a situation where the child
would be exposed to a substantial risk of physical or mental harm, without arrang-
ing for necessary care for the child, and demonstrates an intention not to return. It
should be noted that some states have “safe-haven” laws that allow a parent to sur-
render an infant at certain places (i.e., hospitals, police station, or fire station) some-
times referred to as “safe surrender sites.” In most laws, there is an age limit for the
child to be surrendered. In these states, a parent surrenders their child who is under
the age limit outlined in the statute at a safe surrender site would not be considered
as having abandoned their child by state policies.
Signs and Symptoms of Neglect 93

Educational neglect is when a parent fails to provide a child with access to edu-
cation. This could include not enrolling a child in school, allowing a child to go to
school or not facilitating the child’s attendance at school when children are younger.
Caregivers may not want their child to attend school because the child could report
the abuse or neglect experienced at home. Educational neglect can occur in the
homeschool settings when the caregiver fails to meet the standards set by the state.
Educational neglect can also include a caregiver not addressing the educational
issues or needs of a child. For example, a caregiver of a child who has been diag-
nosed with a learning disorder refuses to have the child receive treatment recom-
mended by professionals.
Medical neglect occurs when a parent or caregiver who does not ensure a child
receives necessary medical care, especially when it is needed to treat a serious ill-
ness or injury, such that the child is a risk for death, injury, or disfigurement or the
child’s development and functioning will be impaired. The caregiver may refuse to
have the child receive treatment or may ignore medical recommendations for treat-
ment. Examples include a caregiver not following physician orders for a child to
undergo chemotherapy, a caregiver not giving the child with diabetes the needed
insulin, or a caregiver not taking a child in need of medical attention to see a health-
care provider. Some definitions of medical neglect also include meeting the mental
health needs of a child and withholding necessary mental health treatment falls into
the category of medical neglect.

Signs and Symptoms of Neglect

There are multiple indicators of neglect. Children who are neglected may be unre-
sponsive and uninterested in their surroundings. They may have difficulty relating
to others. They may not interact with others and when they do may be withdrawn.
Conversely, some children who experience neglect may be aggressive and have tem-
per tantrums. Due to not having a caregiver provide limits and boundaries, a child
may exhibit “out of control” behavior. A child may be unable to concentrate and
appear to be hyperactive with a short attention span. The child may engage in vari-
ous behavior problems and display signs of anxiety and emotional distress.
Additionally, physical indicators of stress, such as physical illness or regressive
behaviors, may be present in children who are neglected.
In homes where neglect is present, some children assume adult roles and respon-
sibilities related to caring for themselves and siblings. In this role reversal, the child
may take on a parent role in the family, where the child rather than the parent is
making adult decisions and responsible for the household, including caring for the
parent. This is called parentification. A child experiencing neglect may feel respon-
sible for the parent, although in some cases, a child may express fear of the parent.
Neglect may cause children to be hungry. To try to feed themselves, older children
may steal food or hoard food. As children may have a hard time concentrating and
engaging, children may not do well in school.
94 4 Identifying Child Maltreatment

Children who are neglected may experience physical health or mental health
issues. They may have problems in school, which may stem from not attending
school or not being able to focus while in school due to a range of issues (e.g., hav-
ing poor nutrition impacting their ability to think, living in a chaotic home environ-
ment which disrupts sleep, not having an adult enforce a bedtime, having
responsibilities to care for younger siblings, or having developmental delays cogni-
tively which impacts learning). Children who are neglected may have mental health
problems or emotional and behavioral problems. They may be withdrawn or act out.
They may have problems connecting with peers and adults. Children who are
neglected may not be properly supervised and may live in an environment where
there are hazards and problems with sanitation. Children may have poor personal
hygiene and be unbathed. They may wear clothing that is dirty or inappropriate for
the season. Children may exhibit signs of hunger.

Practice Highlight
How Do Doctors Decide if the Injury Was due to Maltreatment?
Doctors conduct a physical exanimation and may run labs and testing (e.g.,
blood work, MRI, X-rays). They will talk with the caregivers and child. They
rely on their medical training and take multiple factors into consideration
including:
• Age and developmental status of the child
• Caregiver’s presentation of the child’s medical history
• Changes in report or history provided by caregivers
• Inconsistencies among information provided by caregivers
• Social context where injury occurred
• Likely biases and motivations of witnesses
• Likelihood the injuries could be accidental
• Investigation conducted by CPS and law enforcement

Polyvictimization

Approximately 15.5% of children who experience abuse and neglect experience

two or more types of child maltreatment (U.S. DHHS, 2020). David Finkelhor and
colleagues at the Crimes Against Children Research Center (CCRC) have con-
ducted numerous studies to understand the pathways, consequences, and prevalence
of violence against children, including maltreatment. Studies have shown that vic-
tims of polyvictimization or multiple forms of violence are often more symptomatic
than those who experience one type of abuse (Finkelhor et al., 2007). Research
using the Developmental Victimization Survey (DVS), a 3-wave longitudinal study
of children in the United States showed that 59% of polyvictims were abused by
Polyvictimization 95

family and non-family members, 50% were abused by adults and peers, and 40%
were sexually abused (Finkelhor et al., 2009). Further examination showed that sev-
eral risk factors predisposed children to polyvictimization, including living in a dan-
gerous community, residing with family experiencing a higher level of violence and
conflict, and families that were experiencing issues such as unemployment, finan-
cial problems, and substance abuse (Finkelhor et al., 2009). Polyvictims are also
overrepresented among certain groups, including boys, African American children,
and children in single-parent, stepparent, and other adult caregiver families. As
described throughout this chapter, different forms of maltreatment can elicit similar
and different manifestations in symptomology among children. Knowledge about
the potential for increased symptomology among children who experience multiple
forms of violence points to the importance of intervention from professionals in
schools, child welfare systems, and the community to be aware of the individual and
collective impact of maltreatment experiences.

Research Brief
Implementation Science for Child Welfare
Leah Bartley, PhD.
As child welfare professionals consider the best approaches for working with
a child, family, or focus population, they often consider the evidence behind
an intervention or approach. Evidence-based practice in child welfare requires
the combination of best research evidence, best clinical experience, and align-
ment with a child’s or family’s values and assets (IOM, 2001). We cannot
underestimate the importance of a match between an evidence-based pro-
gram’s intention and the unique needs and assets of the families and commu-
nities we serve. But focusing solely on the program or best intervention will
not lead to the positive and improved outcomes we hope to achieve; it requires
care and attention to the program’s implementation and the context in which
it is implemented (Metz & Bartley, 2012; Mildon & Shlonsky, 2011).
The field of implementation science studies the “methods to promote the
systematic uptake of research findings and other evidence-based program into
routine practice…” (Eccles & Mittman, 2006, p. 1), and the fundamental goal
of implementation science is to integrate research and practice in way that
improve outcomes (Estabrooks et al., 2018). Implementation science includes
both research and practice; implementation research aims at identifying what
approaches work best in translating research into practice settings and imple-
mentation practice aims at adapting and applying implementation strategies
based on the context and settings to achieve and sustain positive outcomes
(Ramaswamy et al., 2019).
There are key concepts that have emerged from implementation science.
Implementation frameworks are organizing models that detail factors likely to
influence the implementation process (Nilsen, 2015). Common components

(continued)
96 4 Identifying Child Maltreatment

across frameworks include recognizing the developmental or phased process

of implementation, identifying needs and understanding current practice,
assessing evidence and fit of a potential outcome, and considering relevant
implementation outcomes (Meyers et al., 2012). An implementation strategy
is a systematic process to adopt and integrate evidence-based programs into
the real world (Powell et al., 2012). Strategies can represent discrete (i.e., a
single strategy, such as supervision) multifaceted (i.e., combination of more
than one strategy, such as training and knowledge assessments) and blended
(i.e., comprehensive and multilevel, such as community development teams
that lead implementation overtime). Practitioners and leaders can use imple-
mentation frameworks to consider what strategies (e.g., coaching or learning
communities) to use when considering implementation of evidence-based
programs. They can also use frameworks to identify structures such as teams
or leader groups to support implementation. They can also use frameworks to
consider relevant stage-based activities and identify the appropriate outputs
and outcomes that are developmentally appropriate for the given implementa-
tion phase (Birken et al., 2018).
There are also emerging competencies for implementation science
researchers and practitioners. Researcher competencies focus on the knowl-
edge and skills required to carrying out rigorous dissemination and imple-
mentation research and include activities such as identify and apply
implementation theories and approaches or identify and describe practice-­
based considerations (Padek et al., 2015). Implementation practitioner com-
petencies reflect the skills and abilities of those developing the capacity of
practitioners and organizations to effectively use and integrate evidence-based
programs. Implementation practitioner competencies may include skills and
knowledge related to co-creation, ongoing improvement, and sustaining
change (Metz et al., 2020). Implementation science offers child welfare pro-
fessionals the strategies and potential to ensure programs meet the needs of
vulnerable children and families so that ultimately they benefit.

Understanding Maltreatment

While a lot is known about maltreatment, the etiology—what causes m ­ altreatment—

remains unclear. Research has yet to pinpoint the mechanisms that lead to abuse and
neglect, although risk factors and protective factors have been identified.

Risk Factors

Risk factors for child maltreatment occur at the individual, family, and community
level. These risk factors often occur together. See Fig. 4.1 for visual representation
of the relationship among levels of risk factors. Even in the presence of multiple risk
Understanding Maltreatment 97

Fig. 4.1 Risk factors may be at individual, family, and community levels

factors, maltreatment may not occur; risk factors may increase the likelihood of
maltreatment, yet they are not deterministic. Risk factors can be present without
maltreatment occurring. Nor are risk factors fixed; characteristics can change over
time, often with interventions. Additionally, protective factors can buffer or mitigate
the risks present.
At the individual level, there are characteristics of the child as well as the parent
that function as risk factors. It must be stressed that though there are child charac-
teristics that increase the risk for maltreatment, children are never to be blamed for
causing maltreatment. Children do not cause abuse or neglect. There are several
characteristics of children that make them more vulnerable to child maltreatment
including their age and having a disability or medical needs. Young children are
more at risk for child maltreatment due to their inability to care for themselves,
developmental stages that are stressors to parents, as well as the fact that young
children may be out of the public’s view as they are not in school. Most children
entering child welfare are ages 0–5. Children younger than 1 year have the highest
rates of victimization. The majority of child fatalities occur in children under the
age of 3. Children with disabilities are more likely to experience maltreatment
as well.
There are a range of parental characteristics that are risk factors. Parental sub-
stance misuse and mental illness are two risk factors commonly associated with
child maltreatment. Parental substance misuse can interfere with a parent’s ability
to care for a child and provide a safe environment. The use of drugs and alcohol can
negatively impact a parent’s decision-making and lower inhibition. The money and
time that is spent to obtain and use the substances can also create circumstances
where children are neglected and placed in dangerous situations, including being
unsupervised. The presence of drugs and alcohol also can be dangerous, especially
with young children who could ingest substances that are poisonous.
98 4 Identifying Child Maltreatment

Practice Highlight
Understanding Surveillance Bias
Kaela1 was in foster care when she became pregnant. After giving birth, her
foster mom helped her raise her son. Kaela loved her son deeply and was com-
mitted to give him the life that she never had. She wanted him to be able to
have a stable life, full of opportunities, and above all, she desired for him
never to be involved with the child welfare system. Kaela often felt her foster
mom and caseworker did not think that she was a good parent. As she
approached age 18 and was eligible to leave foster care, she was torn about
what to do. If she went into extended foster care, she would be able to con-
tinue living with her foster mom and have some support from the foster care
system including get a clothing allotment, a monthly bus pass, and a stipend
to continue her education. However, staying in care also meant that she would
not be completely autonomous because she would still have a caseworker,
whom was critical of her parenting her son. Ultimately, Kaela decided that she
would prefer to be on her own as she was concerned that if she stayed in foster
care, her caseworker would have her son taken away from her. At age 18,
Kaela left foster care with her young son and moved in with one of her aunts.
After a conflict arose, she moved among other family members. Despite being
homeless, Kaela attempted to go to school so she could get a better paying
job. A few months after leaving foster care, Kaela was reported to child pro-
tective services. She suspected that it was her caseworker or former foster
mom who made the report, which she felt was punishment for her leaving care
when they had wanted her to go into extended foster care. Kaela’s son was
placed in foster care with her former foster mom. While she never used the
term “surveillance bias,” Kaela vehemently felt that had she never been in
foster care or if she had stayed in extended foster care, she would have never
been reported to child protective services.

1
All names and other personal identifiers in cases and examples throughout this book have
been changed to protect privacy and confidentiality.

Research on the role of parental mental illness in causing child maltreatment is

inconclusive, although it is seen as a risk factor. The strongest evidence exists that
maternal depression contributes to child maltreatment. Early childbearing is a
known risk factor for maltreatment; young parents are more likely to abuse or
neglect their children. A parental history of child maltreatment is another risk factor
for maltreatment. While it is widely believed that parents who abuse or neglect their
children were always abused or neglected as children, research has found this not to
be the case (e.g., Thornberry et al., 2012; Stith et al., 2009), although a recent study
found that a maternal history of child maltreatment was associated with increased
risks of child maltreatment, especially when the mother experienced multiple types
of child maltreatment (Bartlett et al., 2017). It must be stressed that most children
Understanding Maltreatment 99

who were maltreated do not grow up and maltreat their children. Having experi-
enced maltreatment is a risk factor, but it is not inevitable that someone who was
abused or neglected will continue the cycle of violence when they have children.
The context of the family plays a role in child maltreatment. There are multiple
family characteristics that are risk factors for child maltreatment. The presence of
intimate partner violence increases the likelihood of a child being abused or
neglected.
It should be noted that witnessing intimate partner violence is also considered a
form of maltreatment in some states. Poverty is another family-level risk factor.
Children who live in low socioeconomic status household experience higher rates of
child maltreatment. As described below, some of this may be related to surveillance
biases. The relationship between poverty and maltreatment is complicated as both
share multiple risk factors. It is further complicated as both can be intergenerational
(e.g., Robertson & O’Brien, 2018). Housing insecurity (Warren & Font, 2015) and
economic insecurity (e.g., income losses, housing hardship, and cumulative mate-
rial hardship) have been found as a predictor of child maltreatment (Conrad-Hiebner
& Byram, 2020). Job loss in economically disadvantaged communities is associated
with reports for child maltreatment (Schenck-Fontaine et al., 2017). Thus, provid-
ing concrete economic supports may be an effective strategy in decreasing child
maltreatment (Rostad et al., 2017). When a family has high levels of social isola-
tion, there is a great risk of child maltreatment. Family structure has been identified
as important in understanding child maltreatment. Children in households catego-
rized as single parent headed or households with nonbiological parents (e.g., step-
parents, paramours) experience higher rates of child maltreatment. There are lower
rates of child maltreatment within households with two biological parents present.
Child maltreatment can occur in any community, yet there are some communi-
ties where it is more prevalent. Some of this may be due to surveillance bias, which
means that there is a higher likelihood of something being detected because of
observation or surveillance. In child welfare, there are concerns that surveillance
bias occurs in some neighborhoods, specifically lower-income neighborhoods,
because families are receiving public assistance or because there are more social
service providers who make more reports to child protective services. Neighborhoods
where there are higher rates of poverty and unemployment can be considered a risk
factor for maltreatment (Morris et al., 2019). Likewise, there is a relationship
between child maltreatment reports and eviction; as eviction notices increase in a
neighborhood, reports of child maltreatment increase (Bullinger & Fong, 2020).
Lower social capital in neighborhoods appears to be related to child maltreatment
(Abner, 2014).

Protective Factors

The presence of protective factors can mitigate negative effects of risk factors, dis-
rupt the cumulative effect of risk factors, and avoid the consequence of risk factors.
Protective factors reduce the risk of maltreatment and increase child and family
100 4 Identifying Child Maltreatment

well-being. The five protective factors at the family level that the Center for the
Study of Social Policy identified through a rigorous process including a review of
research are referred to as “Strengthening Families” and include the following:
parental resilience, social connections, concrete support in times of need, knowl-
edge of parenting and child development, and social and emotional competence of
children (Center for the Study of Social Policy, n.d.). (See Chap. 7 for details about
Strengthening Families.) Parental resilience is the ability for a parent to “bounce
back” from challenges. Those with higher resilience can problem solve and build
relationships with others. Social connection is the connection with others (e.g., fam-
ily, friends, community members) who can provide support through giving advice
or tangible assistance. Positive friendships, connections, and networks are impor-
tant to the protective factor of concrete support in times of need. This factor is based
on a family’s ability to meet basic living needs (i.e., food, clothing, shelter), and if
there is a crisis, the family can access services to avoid a disruption in their needs
being met. Knowledge of parenting and child development is when parents have
accurate information about their children’s behaviors and needs at each age and
promote their children’s well-being and development. Social and emotional compe-
tence of children is when children communicate emotions effectively, interact posi-
tively with others, and self-regulate.
Protective factors strengthen family and can be integrated into work with all
families in various ways. Most states in the United States use a Strengthening
Families framework to prevent abuse and neglect. It is important to note that there
are other models based on protective factors that also are used throughout the coun-
try. For example, the Essentials for Childhood, developed by the CDC, focuses on
safe, stable, and nurturing relationships and environments (CDC, 2014). More
information about Essentials for Childhood is provided in Chap. 7. The
Administration on Children, Youth and Families identified protective factors based
on research for specific populations they serve (e.g., youth in or aging out of foster
care, children exposed to domestic violence, victims of child maltreatment, preg-
nant and parenting youth, and runaway and homeless youth; Development Services
Group 2013). These models of protective factors incorporate individual- and
community-­level factors that can contribute to reducing child maltreatment.

Research Brief
Youth in Care with Disabilities
Leah Cheatham, PhD, JD
Youth with disabilities are notably overrepresented within the child welfare
system. Estimates suggest that over half of youth in the child welfare system
carry a physical, cognitive, or emotional disability diagnosis (Slayter,
2016) — a rate of disability five times higher than within the general popula-
tion (Brault, 2012). Yet, understanding the reason for this overrepresentation
is complicated. Some suggest youth with disabilities are at increased risk for
abuse and neglect (Sullivan & Knutson, 2000), while others point out that the
Consequences of Maltreatment 101

experiences of abuse and neglect leading youth into the child welfare system
may impose serious challenges to their mental health (Salazar et al., 2013),
increasing the likelihood that youth will experience mental health disability
during or after their time in care. Both propositions may, unfortunately, be
correct.
Further complicating this issue is the fact that many youth with disabilities
in the child welfare system carry more than one disability diagnosis. Complex
medical diagnoses, which often include emotional challenges, require spe-
cialized care and can pose a barrier to youth achieving permanency within the
child welfare system. Hence, many youth with disabilities find themselves
among those “aging out” of the foster care system. While many youth aging
out of foster care face challenges during the transition to adulthood (e.g.,
Okpych et al., 2017), youth aging out with disabilities—particularly emo-
tional disabilities—are less likely to be successful during this transition period
than their peers without disabilities (Cheatham et al., 2020).
Given the challenges faced by youth with disabilities in the child welfare
system (and beyond), it is imperative that child welfare practitioners develop
competencies to support youth with disabilities. These competencies could
include developing familiarity with federal laws protecting the rights and
opportunities of youth with disabilities (e.g., IDEIA, 2004 & Section 504 of
the Rehabilitation Act, 1973); understanding and applying principles of
trauma-informed care; and gaining comfort coordinating with parents, teach-
ers, and other support systems to make needed accommodations for youth
with disabilities during their time in care. Through continued attention to the
needs of this sizeable population, we can ensure that all child welfare-involved
youth, regardless of disability diagnoses, have the ability to thrive.

Consequences of Maltreatment

Maltreatment has both short- and long-term consequences for children.

Consequences fall within the categories of development, health, mental health, and
behaviors and can vary with the different types of maltreatment. Maltreatment is a
form of trauma or toxic stress that is often chronic. It can impact a child’s neurobiol-
ogy. Specifically, the brain structure and functioning can be changed (e.g., Gold
et al., 2016; Xerxa et al., 2020). A recent study demonstrated that child maltreat-
ment can impact the prefrontal lobe of the brain (Jedd et al., 2015), and the changes
can continue through adolescence (Hein et al., 2020). Childhood violence exposure
and social deprivation are linked to adolescent threat and reward neural function.
Likewise, gene expression can change. The entire nervous system can be put in a
state of overdrive with high levels of cortisol release. The allostatic load of a child
who is maltreated is frequently increased. With the elevated stress, the body’s stress
response system goes into overdrive. The higher levels of stress-related chemicals
flooding the body impact children in both the short and long term.
102 4 Identifying Child Maltreatment

Research has clearly identified that child maltreatment can impact children’s
behaviors, health, and well-being in the short term. For example, it may be related
to experiencing bullying (Kennedy, 2018). While there is a significant amount of
knowledge about this, new ideas and the mechanisms are still being explored. For
example, an innovative recent study looked at sleep in children who had been mal-
treated and found that less sleep predicted increased internalizing and externalizing
behaviors (e.g., Zajac et al., 2020).
Long-term child maltreatment increases the likelihood of chronic disease and
various other issues including mental health problems and substance misuse. With
mental health, there are countless studies looking at the impact of childhood mal-
treatment. For example, a recent systematic review of 35 studies found child mal-
treatment predicted perinatal depression as well as post-traumatic stress disorder,
both of which can be considered risk factors for child maltreatment (Choi &
Sikkema, 2016). Child maltreatment is also a predictor of intimate partner violence
(e.g., Street, 2015). These long-term outcomes highlight how consequences of mal-
treatment potentially can span generations.
Factors that influence the consequence of maltreatment include severity, fre-
quency, duration, and timing of the maltreatment. Maltreatment that is more severe,
frequent, and lasts for a longer period of time has been found to have more damag-
ing results on children both in the short and long term. For example, greater severity
of child abuse has been found to be related to more PTSD symptomology, and
higher levels of attachment anxiety and attachment avoidance (Busuito et al., 2014).
When maltreatment occurs in a developmental period also affects the consequences.
Maltreatment in early childhood during the critical periods of brain development
can have serious consequences. See Chap. 5 about the negative consequences of
adverse childhood experiences broadly on development and well-being. Children
under the age of 3 may be most susceptible to maltreatment both from a develop-
mental perspective because of the critical developmental period and their vulnera-
bility as they are unable to care for themselves. Additionally, the reality that young
children may be absent from the public eye and maltreatment may occur longer as
it is not coming to the attention of authorities. There are also differences in the con-
sequences by maltreatment type. Of all the types of maltreatment, the long-term
consequences of neglect are the most severe.

Consequences of Physical Abuse

The short-term consequences of physical abuse are evident in physical injuries as

well as emotional and behavioral issues. However, physical abuse can have long-­
term consequences. Specifically, abuse can result in physical disabilities. For exam-
ple, a head injury could cause permanent cognitive damage, or an injury to the spine
could cause paralysis. In addition to the physical consequences, those who have
experienced physical maltreatment may have problems with relationships in the
future, specifically around trusting others or intimate partner violence. Another
long-term consequence is drug and alcohol use and potentially mental health con-
cerns such as depression or low self-esteem.
Consequences of Maltreatment 103

Consequences of Sexual Abuse

Children who have experienced sexual abuse may experience a range of negative
outcomes. They may engage in problematic sexual behavior. In the long term, chil-
dren who were sexually abused may have mental health problems including depres-
sion and anxiety. They may experience feelings of guilt, shame, and self-blame and
often experience dissociation or repression of the memories. They may have eating
disorders. Children who experienced sexual abuse may have sexual problems and
problems with intimacy and relationships. Survivors of sexual abuse may experi-
ence difficulty in establishing and maintaining interpersonal relationships due to
issues related to trust, fear of intimacy, fear of being different, establishing healthy
boundaries, or becoming involved with abusive relationships.

Note from the Field

Familial Consequences After Child Sexual Abuse
Kesha was sexually abused by her father and reported the abuse to her teacher.
During the investigation and after the abuse was substantiated, the child wel-
fare agency required her father to move out of the home. A criminal investiga-
tion was also underway. Kesha’s mother had a difficult time believing what
her daughter had reported. During her therapy sessions, Kesha also disclosed
that her teenage brother had also been sexually abusing her for some time. Her
mother was then asked to decide whether her son or her daughter would move
so that they could be separated and receive treatment. She asked that Kesha be
placed in foster care during the case. Her mother continued to deny the abuse
and refuse any treatment. Kesha struggled emotionally and behaviorally. She
had a hard time focusing in school and just wanted to go home. She could not
understand why her brother could stay at home and that she had to leave. Her
mother continued to refuse treatment and refuse to comply with the child
welfare agency. Her brother was mandated to receive treatment, and her father
was charged with sexual abuse and was incarcerated. Therapists had a very
difficult time engaging Kesha’s mother in family therapy, which was so des-
perately needed to begin to heal this family. This case illustrates how damag-
ing not only the abuse experienced can be but also how complex and
challenging the associated emotions, family ties, and relationships can be
when sexual abuse occurs within a family.

Consequences of Emotional Abuse

Consequences of emotional abuse span a child’s physical, behavioral, emotional,

developmental domains. Emotional or psychological abuse may be seen by some as
insignificant, but it has serious consequences. The saying “sticks and stones may
104 4 Identifying Child Maltreatment

break my bones, but names will never hurt me” is wrong. Being called names and
other forms of emotional abuse can be damaging to children. The short- and long-­
term consequences of emotional abuse are significant and lasting. Children who
were emotionally abused may experience mental health problems such as depres-
sion and anxiety and may have low self-esteem. Research has found that women
who experienced emotional abuse may have prolonged emotional arousal and poor
physiological regulation of emotion (Bernstein et al., 2013). Children who experi-
ence emotional abuse also may have problematic relationships and a difficulty
expressing empathy.

Consequences of Neglect

Neglected children often experience worse outcomes than physically or sexually

abused children over a range of developmental, psychological, and physical param-
eters. Many child fatalities due to maltreatment are the result of neglect. Specifically,
deaths may be related to inadequate supervision where a child dies due to something
that could have been avoided (e.g., drowning, poisoning, falling). They may also die
because of being in a hazardous environment (e.g., drugs, unhygienic environment).
Especially for young children, failure to thrive could be a cause of death related to
neglect as well. Failure to thrive is a serious medical condition where a child does
not grow as she or he should. The insufficient weight gain or inappropriate weight
loss is accompanied with delayed development. For infants, failure to thrive is asso-
ciated with chronic neglect.
Neglect impacts brain development. Of great concern is when neglect occurs
early in a child’s life. As much of brain development happens in the first 3 years of
a child’s life, neglect during this time can be especially damaging. Neglect can cause
developmental and cognitive delays. The lack of adequate nutrition and stimulation
within the environment can stunt multiple types of child’s development. Children
who are neglected are often smaller in size and have poorer motor skills and lan-
guage delays. They may have poor social skills, passive, and a lack of emotions.
Neglect has different impacts with children of different developmental periods,
and it can be especially harmful to young children. Children who are neglected may
not have attachment to caregivers and may develop anxious, insecure attachments in
other relationships. With attachment issues, children may be less likely to explore
their environment, which is central to their development, and development of self-
efficacy. Thus, children may experience problems with brain, motor, and physical
development. Other effects include serious health problems and malnutrition.
Toddlers who experience neglect may have impaired cognitive and physical devel-
opment. They may experience malnutrition and significant health problems.
Behaviorally, toddlers may be withdrawn and passive. They may have limited cop-
ing skills where they become easily frustrated and angry. They may be noncompli-
ant and undisciplined. They may also indiscriminately seek attention and affection
from adults.
Consequences of Maltreatment 105

Neglect impacts older children as well. School-aged children may experience

multiple various types of consequences of neglect. Like younger children, they may
experience developmental delays and health problems as well as attachment prob-
lems. They may have delayed or impaired speech and have significant learning defi-
cits and delays. Related to this is children may have problems concentrating and
limited curiosity. Children experiencing neglect may be severely withdrawn or may
act out violently. They often have low self-esteem. Neglected adolescents may exhibit
low self-esteem and are at high risk for truancy, running away, and substance use.
They may work and learn at levels below average and have poor attendance at school.

Note from the Field

Why Lack of Supervision is so Dangerous
When I worked in child welfare, methamphetamine abuse was rampant where
I lived. If I could guess, meth abuse by parents was the most common reason
a child was removed from their parent’s care. It wasn’t always a case of a par-
ent using drugs in the same room as their child or using meth during preg-
nancy, or living in a home where meth was being manufactured (all of which
are dangerous, of course), but parents leaving their kids unattended (physi-
cally, by leaving them alone) or by being high and unaware of the child’s
needs and safety. When approached, most parents would argue that their drug
use was not harming their children because they were using in another room
or going to a friend’s house to use substances or drink alcohol. What was
occurring was that young children were put at risk because they were unsu-
pervised. There were cases of children not being fed, diapers not being
changed, dirty homes, and lack of clothing. There were also situations where
young children were left alone at home or left under the care of others who
abused or also neglected the child. I saw babies abandoned minutes after their
birth because their mother needed to leave the hospital to use again. I saw
families broken because of the addictive nature of drugs and alcohol.
One case I remember clearly was the case of Angela, a 3-year-old toddler
who was left alone at the motel where they were staying while her biological
mother went to use meth with her neighbor. The motel was located on a busy
street only a few hundred yards from a freeway entrance. It is unknown how
long the toddler was left alone, but she was able to open the front door and
climb down the stairs. She made her way to the busy street and walked along
until she almost reached the freeway. A motorist about to enter the freeway
saw the child on the side of the road with only a shirt and a diaper on and
pulled over to see where her caregiver might be. It was amazing that she had
not been struck by a car or stepped on something sharp.
Another case involved a 5-year-old child who walked out the back door
and climbed the gate to the pool at the apartment complex where the family
lived. He did not know how to swim but wanted to get in the pool. When his
brother went to look for him to play, he noticed a splash in the water and
screamed for help. He couldn’t get in to the pool area, but a neighbor heard
him and rushed over to help.
106 4 Identifying Child Maltreatment

Neglect can have serious long-term effects in adolescence and adulthood. In ado-
lescence, there may be engagement in non-prosocial behavior such as delinquent
behavior, crime, violence, and drug use and abuse. Adolescents may have academic
issues including poor performance, truancy, suspension, and not graduating. The
problems may continue into adulthood with increased criminal behavior and lower
occupational levels. Likewise, adults may have ongoing issues with criminal behav-
iors and lower occupational levels. They may also have cognitive issues with lower
IQ and reading problems.
Multiple factors influence the severity of the impact of neglect. The age at which
the neglect occurs can influence the extent to which a child is impacted. Neglect in
early childhood is the most damaging, as children at that age are unable to care for
themselves. When neglect occurs in infancy, children are especially at risk for death
and serious consequences. The length of time that the neglect occurred as well as
the frequency of the neglect occurred are also factors which influence the impact of
neglect on children, with longer periods of time and more frequent neglect creating
more damage and more negative outcomes. The relationship that the child has with
the caregiver impacts the severity of outcomes. A positive relationship with the
caregiver can mitigate some of the negative outcomes. For example, a parent could
be attentive, caring, and attached to a child, yet they live in a hazardous environment
where the child is not always appropriately supervised. In general, having support
can serve as a protective factor and decrease the likelihood of poor outcomes due to
neglect. There is evidence that a child’s personality also factors into the impact the
neglect has on a child. This is not to say that a child is responsible for the outcomes;
rather it is to acknowledge there are individual characteristics that contribute to
resilience.

Societal Consequences

It is estimated that each victim of child maltreatment will incur more than
$830,000 in costs over their lifetime to treat the consequences of their maltreatment
(Peterson et al., 2018). The consequences of child maltreatment extend beyond indi-
vidual children who experience abuse and neglect. Society is impacted economi-
cally and socially. There is a significant economic burden to states with the overall
costs varying in each state due to the number of cases of maltreatment a state has
(Klika et al., 2020). The most recent estimate is the costs each child who is maltreat-
ment will incur over the lifetime to $830,928 (in 2015 dollars; Peterson et al., 2018).
The cost of a child fatality due to maltreatment is over $16.6 billion per child. With
these estimates, the economic burden of the lifetime costs of child maltreatment that
occurred in 2015 was $428 billion (Peterson et al., 2018). When these recent costs
of maltreatment were applied to the number of child maltreatment cases substanti-
ated in 2018 as well as the child fatalities that occurred in the same year, the costs
were approximately $592 billion (Klika et al., 2020).
Cultural Considerations 107

While the financial cost of maltreatment is astounding, there are costs that extend
beyond the economic burden. Child abuse and neglect is a violation of children’s
basic human rights, and when a society condones the violation of human rights, all
citizens are potentially jeopardized. Human rights are the foundation of strong,
healthy communities. When children’s rights are violated, it not only impacts cur-
rent society but also the future as the children potentially grow up with ongoing
problems due to the maltreatment inflicted upon them.

Prevention

Considering the costs to children, families, and communities, investing in preven-

tion of child maltreatment is important. Chapter 7 explores prevention in depth.
Prevention not only includes stopping maltreatment from happening but also miti-
gating the impact of maltreatment and ensuring that does not reoccur. It is cost-­
effective to focus on prevention as the costs—both financial and personal—are
tremendous. There is growing recognition in federal policy, specifically the Family
First Prevention Services Act, about the need to prioritize child maltreatment pre-
vention. While child welfare professionals are often seen only as working in the
aftermath of abuse and neglect, they also play an important role in prevention.

Cultural Considerations

Throughout all of child welfare, the issues of culture need to be considered.

Especially considering the longstanding history of racial disparities (see Chap. 1),
child welfare professionals should make cultural considerations in the identification
and assessment of various types of maltreatment. For example, several cultural heal-
ing practices may leave markings on children that could be perceived to be from
maltreatment. “Coining,” an ancient healing practice used in several Southeast
Asian cultures, involves an intense rubbing of the skin, which can leave red marks
or abrasions. Another ancient healing practice of multiple cultures that has increas-
ingly been used in the United States by natural healers is “cupping” which can leave
circular bruising, typically on a person’s back. It is important that culturally healing
practices are not mistaken for child maltreatment.
Each culture has specific understandings of what child maltreatment is. Different
cultures interpret caregivers striking a child differently. For example, in some cul-
tures, it is never appropriate for a child to be hit, whereas in other cultures, striking
a child with an open hand or with specific objects is perceived to be a form of disci-
pline. Even within cultures, there may be variation and context that should be taken
into consideration, as a recent study of Black families in the United States empha-
sized (Scott & Pinderhughes, 2019). While physical discipline, also called corporal
punishment, is accepted in many countries around the world, the World Health
108 4 Identifying Child Maltreatment

Organization (2015) launched a Global Initiative to End All Corporal Punishment of

Children in 2015 citing that corporal punishment was the most common form of
violence against children, and it “violates children’s right to respect for their human
dignity and physical integrity, as well as their rights to health, development and
education, and is associated with a wide range of negative health, developmental
and behavioral outcomes for children that can follow them into adulthood” (p.1).
The American Academy of Pediatrics has issued a statement that spanking is harm-
ful and recommends that caregivers do not use any forms of physical discipline
(Sege, Seigel, Council on Child Abuse and Neglect, & Committee on Psychological
Aspects of Child and Family Health, 2018).

Ongoing Debates in Child Welfare

There are many ongoing debates and hot topics within child maltreatment and child
welfare besides how to handle caregivers physically disciplining their children.
Specifically, the debates are often about if a behavior constitutes maltreatment and
at what point can and should the child welfare system get involved as well as what
is the appropriate course of action. It is clear that it is a debate when different states
respond differently. One current ongoing debate is about prenatal exposure to sub-
stances such as opioids. While some states see this is maltreatment, other states
argue that if mothers’ substance use during pregnancy is criminalized, then women
who are using drugs may not disclose to their doctors their drug use or may avoid
prenatal care out of fear of their healthcare providers reporting them to child wel-
fare. Another debate is around children witnessing intimate partner violence and to
what extent it constitutes child maltreatment, who is held responsible, and how to
respond. While it is widely recognized that a child’s exposure to intimate partner
violence can be damaging, states respond differently. An ongoing debate related to
neglect is the religious exemption for seeking medical treatment. In some states,
caregivers may withhold necessary medical treatment of their children for religious
reasons. In these cases, if a caregiver holds views from a recognized religious group
that does not support a medical treatment, then it is not recognized as medical
neglect if the caregiver does seek treatment. Not all states grant this exemption, and
there are concerns that in the states where exemptions are granted, there are higher
rates of child fatalities due to not receiving necessary medical care.
At the center of these debates are research, values, and rights. There is often
ample research that indicates that something is not optimal and in fact damaging
(e.g., witnessing intimate partner violence); yet, the value of allowing the autonomy
of the family and rights of the parents is protected. Social norms and deep-seeded
beliefs, sometimes within different cultures, may be counter to what the research
supports (i.e., spanking is harmful). Additionally, some of the logistics of how the
child welfare system can respond and where to “draw the line” as many of the
behavior occur on a continuum or there are complicated interrelated issues. For
example, there are many things a woman can do during a pregnancy that could be
Conclusion 109

harmful to a child (i.e., smoking, drinking alcohol, not getting prenatal care), and
these are not considered child maltreatment yet in many states prenatal exposure to
substances is. At what point does the child welfare system have the right to inter-
vene when children are being harmed by the mother’s actions or inactions? The
understanding of children’s safety and well-being continues to evolve and so will
the child welfare system.

Conclusion

Child maltreatment consists of different types of child abuse and neglect: physical
abuse, sexual abuse, psychological and emotional abuse, and neglect (physical, edu-
cational, emotional, and medical). While what causes child maltreatment remains
unknown, research has identified risk and protective factors. The consequences of
child maltreatment are great and impact a person’s well-being both in the short and
long term. Additionally, child maltreatment is costly to society. In addition to priori-
tizing the response to child maltreatment, child welfare professionals should empha-
size prevention efforts.

Acknowledgments The authors thank Leah Bartley, PhD, and Leah Cheatham, PhD, JD, for their
contributions to Chap. 4.

Discussion Questions
1. What are the four types of child maltreatment? Briefly describe how prevalent
are they, what are the signs and symptoms, and what are the consequences.
2. When assessing for child physical abuse, how do you know when a fracture or
bruise is accidental?
3. In what ways does child neglect present? What makes child neglect so challeng-
ing to assess and address?
4. What are three risk factors for child maltreatment?
5. In what ways does culture play a role in child maltreatment assessment and
treatment?

Suggested Activities
1. Sign up for a listserv or alerts to keep up to date on issues related to child mal-
treatment, prevention, and treatment:
APSAC Alerts: https://www.apsac.org/apsacpublications
Children’s Bureau Listserv: https://www.acf.hhs.gov/cb/get-­updates
2. Visit Prevent Child Abuse America’s website and read about new initiatives,
research, and updates: https://preventchildabuse.org/latest-­activity/
3. Choose a controversial topic about child maltreatment (spanking, witnessing
intimate partner violence, prenatal drug exposure, child marriage, religious
exemptions for medical neglect) and write a narrative about how different states
110 4 Identifying Child Maltreatment

and countries handle these types of cases. Discuss recommendations and

thoughts with a peer or field instructor.
4. Read Bulllinger et al. (2019) and write a reflection paper about the importance of
understanding neglect and incorporating macro-level forces into both research
and prevention efforts.
Bullinger, L. R., Feely, M., Raissian, K. M., & Schneider, W. (2019). Heed
Neglect, Disrupt Child Maltreatment: a Call to Action for Researchers.
International Journal on Child Maltreatment: Research, Policy and Practice,
1–12. (Available: https://rdcu.be/cb8VP).

Additional Resources
American Professional Society on the Abuse of Children: https://www.apsac.org/
Childhelp. https://www.childhelp.org/
Child Welfare Information Gateway, Recognizing Child Abuse and Neglect: https://
www.childwelfare.gov/pubPDFs/signs.pdf
Child Welfare Information Gateway, Definitions of Child Abuse and Neglect https://
www.childwelfare.gov/topics/systemwide/laws-­policies/statutes/define/
Child Welfare Information Gateway, How you Can Help Someone Who is Being
Abused or Neglected: https://www.childwelfare.gov/pubs/kids-­tipsheet/
Child Abuse Medical Provider Program, Documenting Child Abuse and Neglect
with Photographs: https://champprogram.com/pdf/photo-­documentation-­pocket-­
guide-­dec-­2008.pdf
HelpGuide, Child abuse and neglect: https://www.helpguide.org/articles/abuse/
child-­abuse-­and-­neglect.htm
Prevent Child Abuse America: preventchildabuse.org

References

Abner, K. S. (2014). Dimensions of structural disadvantage: A latent class analysis of a neigh-

borhood measure in Child Welfare data. Journal of Social Service Research, 40(1), 121–134.
https://doi.org/10.1080/01488376.2013.852651
Bartlett, J. D., Kotake, C., Fauth, R., & Easterbrooks, M. A. (2017). Intergenerational transmission
of child abuse and neglect: Do maltreatment type, perpetrator, and substantiation status matter?
Child Abuse & Neglect, 63, 84–94. https://doi.org/10.1016/j.chiabu.2016.11.021
Berger, L. M., Collins, J. M., Font, S. A., Gjertson, L., Slack, K. S., & Smeeding, T. (2015). Home
foreclosure and child protective services involvement. Pediatrics, 136(2), 299–307. https://doi.
org/10.1542/peds.2014-­2832
Bernstein, R. E., Measelle, J. R., Laurent, H. K., Musser, E. D., & Ablow, J. C. (2013). Sticks
and stones may break my bones but words relate to adult physiology? Child abuse experi-
ence and women’s sympathetic nervous system response while self-reporting trauma. Journal
of Aggression, Maltreatment & Trauma, 22(10), 1117–1136. https://doi.org/10.1080/1092677
1.2013.850138
Birken, S. A., Rohweder, C. L., Powell, B. J., Shea, C. M., Scott, J., Leeman, J., Grewe, M. E.,
Kirk, M. A., Damschroder, L., Aldridge, W. A., II, Haines, E. R., Straus, S., & Presseau,
J. (2018). T-CaST: An implementation comparison and selection tool. Implementation
References 111

Science, 13. Retrieved from: https://implementationscience.biomedcentral.com/arti-

cles/10.1186/s13012-­018-­0836-­4#citeas. https://doi.org/10.1186/s13012-­018-­0836-­4
Brault, M. W. (2012). Americans with disabilities: 2010. Current Population Reports, 70–131.
http://www.census.gov/prod/2012pubs/p70-­131.pdf
Bullinger, L. R., Feely, M., Raissian, K. M., & Schneider, W. (2019). Heed neglect, disrupt child
maltreatment: a call to action for researchers. International journal on child maltreatment:
research, policy and practice, 1–12.
Bullinger, L. R., & Fong, K. (2020). Evictions and Neighborhood Child Maltreatment Reports.
Housing Policy Debate, 1–26. https://doi.org/10.1080/10511482.2020.1822902
Busuito, A., Huth-Bocks, A., & Puro, E. (2014). Romantic attachment as a moderator of the associ-
ation between childhood abuse and posttraumatic stress disorder symptoms. Journal of Family
Violence, 29(5), 567–577. https://doi.org/10.1007/s10896-­014-­9611-­8
Centers for Disease Control and Prevention. (2014). Essentials for childhood: Creating safe, sta-
ble, nurturing relationships and environments for all children. Retrieved from: https://www.
cdc.gov/violenceprevention/childabuseandneglect/essentials.html
Cheatham, L. P., Randolph, K. A., & Boltz, L. D. (2020). Youth with disabilities transitioning
from foster care: Examining prevalence and predicting positive outcomes. Children and Youth
Services Review, 110. https://doi.org/10.1016/j.childyouth.2020.104777
Chiesa, A., & Duhaime, A. C. (2009). Abusive head trauma. Pediatric Clinics, 56(2), 317–331.
https://doi.org/10.1016/j.pcl.2009.02.001
Choi, K. W., & Sikkema, K. J. (2016). Childhood maltreatment and perinatal mood and anxi-
ety disorders: A systematic review. Trauma, Violence & Abuse, 17(5), 427–453. https://doi.
org/10.1177/1524838015584369
Conrad-Hiebner, A., & Byram, E. (2020). The temporal impact of economic insecurity on child
maltreatment: A systematic review. Trauma, Violence & Abuse, 21(1), 157–178. https://doi.
org/10.1177/1524838018756122
Development Services Group. (2013). Protective factors for populations served by the
Administration on Children, Youth, and Families: A literature review and theoretical summary.
Administration on Children, Youth and Families.
Duhaime, A. C. (2008). Demographics of abusive head trauma. Journal of Neurosurgery:
Pediatrics, 1(5), 349–350. https://doi.org/10.3171/PED/2008/1/5/349
Eccles, M. P., & Mittman, B. S. (2006). Welcome to implementation science. Implementation
Science, 1. https://doi.org/10.1186/1748-­5908-­1-­1
Estabrooks, P. A., Brownson, R. C., & Pronk, N. C. (2018). Dissemination and implementation
science for public health professionals: An overview and call to action. Preventing Chronic
Disease, 15, retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6307829/pdf/
PCD-­15-­E162.pdf. https://doi.org/10.5888/pcd15.180525
Finkelhor, D., Hotaling, G., Lewis, I. A., & Smith, C. (1990). Sexual abuse in a national survey
of adult men and women: Prevalence, characteristics, and risk factors. Child Abuse & Neglect,
14(1), 19–28. https://doi.org/10.1016/0145-­2134(90)90077-­7
Finkelhor, D., Ormrod, R., Turner, H., & Holt, M. (2009). Pathways to poly-victimization. Child
Maltreatment, 14(4), 316–329. https://doi.org/10.1177/1077559509347012
Finkelhor, D., Ormrod, R. K., & Turner, H. A. (2007). Polyvictimization and trauma in a
national longitudinal cohort. Development and Psychopathology, 19(1), 149–166. https://doi.
org/10.1017/S0954579407070083
Gold, A. L., Sheridan, M. A., Peverill, M., Busso, D. S., Lambert, H. K., Alves, S., Pine, D. S., &
McLaughlin, K. A. (2016). Childhood abuse and reduced cortical thickness in brain regions
involved in emotional processing. Journal of Child Psychology and Psychiatry, 57(10),
1154–1164. https://doi.org/10.1111/jcpp.12630
Gubits, D., Shinn, M., Wood, M., Brown, S. R., Dastrup, S. R., & Bell, S. H. (2018). What inter-
ventions work best for families who experience homelessness? Impact estimates from the
­family options study. Journal of Policy Analysis and Management, 37(4), 835–866. https://doi.
org/10.1002/pam.22071
112 4 Identifying Child Maltreatment

Hein, T. C., Goetschius, L. G., McLoyd, V. C., Brooks-Gunn, J., McLanahan, S. S., Mitchell, C.,
Lopez-Duran, N. L., Hyde, L. W., & Monk, C. S. (2020). Childhood violence exposure and
social deprivation are linked to adolescent threat and reward neural function. Social Cognitive
and Affective Neuroscience. https://doi.org/10.1093/scan/nsaa144
Individual with Disabilities Education Improvement Act of 2004 (IDEIA), [Amending 20
U.S.C. §1400 et seq.].
Institute of Medicine (US), Committee on Quality of Health Care in America. (2001). Crossing
the quality chasm: A new health system for the 21st century. Retrieved from: https://www.
iom.edu/~/media/Files/Report%20Files/2001/Crossing-­t he-­Q uality-­C hasm/Quality%20
Chasm%202001%20%20report%20brief.pdf
Jedd, K., Hunt, R. H., Cicchetti, D., Hunt, E., Cowell, R., Rogosch, F., Toth, S. L., & Thomas,
K. M. (2015). Long-term consequences of childhood maltreatment: Altered amygdala func-
tional connectivity. Development and Psychopathology, 27(402), 1577. https://doi.org/10.1017/
S0954579415000954
Kennedy, R. S. (2018). Bully-victims: An analysis of subtypes and risk characteristics. Journal of
Interpersonal Violence. https://doi.org/10.1177/0886260517741213
Klika, J. B., Rosenzweig, J., & Merrick, M. (2020). Economic burden of known cases of child
maltreatment from 2018 in each state. Child and Adolescent Social Work Journal, 37, 227–234.
https://doi.org/10.1007/s10560-­020-­00665-­5
Maguire-Jack, K., & Showalter, K. (2016). The protective effect of neighborhood social cohe-
sion in child abuse and neglect. Child Abuse & Neglect, 52, 29–37. https://doi.org/10.1016/j.
chiabu.2015.12.011
Metz, A., & Bartley, L. (2012). Active implementation frameworks for program success: How to
use implementation science to improve outcomes for children. Zero to Three, 32, 11–18.
Metz, A., Louison, L., Ward, C., Burke., K. (2020). Implementation support practitioner profile:
Guiding principles and Core competencies for implementation practice. University of North
Carolina Chapel Hill, Frank Porter Graham Child Development Institute. Retrieved from:
https://nirn.fpg.unc.edu/sites/nirn.fpg.unc.edu/files/resources/IS%20Practice%20Profile-­
single%20page%20printing-­v6-­2.20.20.pdf
Meyers, D. C., Durlak, J. A., & Wandersman, A. (2012). The quality implementation framework:
A synthesis of critical steps in the implementation process. American Journal of Community
Psychology, 50, 462–480. https://doi.org/10.1007/s10464-­012-­9522-­x
Mildon, R., & Shlonsky, A. (2011). Bridge over troubled water: Using implementation science to
facilitate effective services in child welfare. Child Abuse and Neglect, 35, 753–756. https://doi.
org/10.1016/j.chiabu.2011.07.001
Milner, J., & Kelly, D. (2020). It’s time to stop confusing poverty with neglect. Children’s Bureau
Express, 20(10) Available: https://cbexpress.acf.hhs.gov/index.cfm?event=website.viewArticl
es&issueid=212&sectionid=2&articleid=547
Morris, M. C., Marco, M., Maguire-Jack, K., Kouros, C. D., Bailey, B., Ruiz, E., & Im, W. (2019).
Connecting child maltreatment risk with crime and neighborhood disadvantage across time and
place: A Bayesian spatiotemporal analysis. Child Maltreatment, 24(2), 181–192. https://doi.
org/10.1177/1077559518814364
Nilsen, P. (2015). Making sense of implementation theories, models and frameworks.
Implementation Science, 10(1), 1–13. https://doi.org/10.1186/s13012-­015-­0242-­0
Okpych, N. J., Courtney, M., & Dennis, K. (2017). Memo from CalYOUTH: Predictors of high
school completion and college entry at ages 19/20. Chapin Hall at the University of Chicago.
Padek, M., Colditz, G., Dobbins, M., Koscielniak, N., Proctor, E. K., Sales, A. E., & Brownson,
R. C. (2015). Developing educational competencies for dissemination and implementation
research training programs: An exploratory analysis using card sorts. Implementation Science,
10(1), 114. https://doi.org/10.1186/s13012-­015-­0304-­3
Pereda, N., Guilera, G., Forns, M., & Gómez-Benito, J. (2009). The prevalence of child sexual
abuse in community and student samples: A meta-analysis. Clinical Psychology Review, 29(4),
328–338.
References 113

Peterson, C., Florence, C., & Klevens, J. (2018). The economic burden of child maltreatment
in the United States, 2015. Child Abuse & Neglect, 86, 178–183. https://doi.org/10.1016/j.
cpr.2009.02.007
Powell, B. J., McMillen, C., Proctor, E. K., Carpenter, C., et al. (2012). A compilation of strategies
for implementing clinical innovations in health and mental health. Medical Care Research and
Review, 69, 123–157. https://doi.org/10.1177/1077558711430690
Ramaswamy, R., Mosnier, J., Reed, K., Powell, B. J., & Schenck, A. P. (2019). Build capacity for
public health 3.0: Introducing implementation science to MPH curriculum. Implementation
Science, 14. https://doi.org/10.1186/s13012-­019-­0866-­6
Robertson, C., & O’Brien, R. (2018). Health endowment at birth and variation in intergenerational
economic mobility: Evidence from US county birth cohorts. Demography, 55(1), 249–269.
https://doi.org/10.1007/s13524-­017-­0646-­3
Rostad, W. L., Rogers, T. M., & Chaffin, M. J. (2017). The influence of concrete support on child
welfare program engagement, progress, and recurrence. Children and Youth Services Review,
72, 26–33. https://doi.org/10.1016/j.childyouth.2016.10.014
Salazar, A. M., Keller, T. E., Gowen, L. K., & Courtney, M. E. (2013). Trauma exposure and PTSD
among older adolescents in foster care. Social Psychiatry and Psychiatric Epidemiology, 48,
545–551. https://doi.org/10.1007/s00127-­012-­0563-­0
Schenck-Fontaine, A., Gassman-Pines, A., Gibson-Davis, C. M., & Ananat, E. O. (2017). Local
job losses and child maltreatment: The importance of community context. Social Service
Review, 91(2), 233–263. https://doi.org/10.1086/692075
Scott, J. C., & Pinderhughes, E. E. (2019). Distinguishing between demographic and contextual
factors linked to early childhood physical discipline and physical maltreatment among Black
families. Child Abuse & Neglect, 94. https://doi.org/10.1016/j.chiabu.2019.05.013
Section 504 of the Rehabilitation Act of 1973, 34 C.F.R. Part 104.
Sege, R. D., Seigel, B. S., & Council on Child Abuse and Neglect, & Committee on Psychological
Aspects of Child and Family Health. (2018). Effective discipline to raise healthy children.
Pediatrics, 142(6). https://doi.org/10.1542/peds.2018-­3112
Shuey, E. A., & Leventhal, T. (2017). Pathways of risk and resilience between neighborhood socio-
economic conditions and parenting. Children and Youth Services Review, 72, 52–59. https://doi.
org/10.1016/j.childyouth.2016.09.031
Slayter, E. (2016). Youth with disabilities in the United States child welfare system. Children and
Youth Services Review, 64, 165–175. https://doi.org/10.1016/j.childyouth.2016.03.012
Smith, C., Crosnoe, R., & Cavanagh, S. E. (2017). Family instability and children’s health. Family
Relations, 66(4), 601–613. https://doi.org/10.1111/fare.12272
Stith, S. M., Liu, T., Davies, L. C., Boykin, E. L., Alder, M. C., Harris, J. M., Som, A., McPherson,
M., & Dees, J. E. M. E. G. (2009). Risk factors in child maltreatment: A meta-analytic review
of the literature. Aggression and Violent Behavior, 14(1), 13–29. https://doi.org/10.1016/j.
avb.2006.03.006
Street, J. C. (2015). Childhood maltreatment and revictimization by an intimate partner: The role
of Africultural coping for at-risk African American women. Available: https://scholarworks.
gsu.edu/psych_diss/135/
Sullivan, P., & Knutson, J. (2000). Maltreatment and disabilities: A population-based epide-
miological study. Child Abuse & Neglect, 24(10), 1257–1273. https://doi.org/10.1016/
S0145-­2134(00)00190-­3
Thornberry, T. P., Knight, K. E., & Lovegrove, P. J. (2012). Does maltreatment beget maltreat-
ment? A systematic review of the intergenerational literature. Trauma, Violence & Abuse,
13(3), 135–152. https://doi.org/10.1177/1524838012447697
U.S. Department of Health & Human Services, Administration for Children and Families,
Administration on Children, Youth and Families, Children’s Bureau. (2020). Child Maltreatment
2018. Available from: https://www.acf.hhs.gov/sites/default/files/cb/cm2018.pdf
Van Scoyoc, A., Wilen, J. S., Daderko, K., & Miyamoto, S. (2015). Multiple aspects of maltreatment:
Moving toward a holistic framework. In D. Daro, A. Cohn Donnelly, L. Huang, & B. Powell
114 4 Identifying Child Maltreatment

(Eds.), Advances in child abuse prevention knowledge. Child maltreatment (contemporary

issues in research and policy) (Vol. 5). Springer. https://doi.org/10.1007/978-­3-­319-­16327-­7_2
Warren, E. J., & Font, S. A. (2015). Housing insecurity, maternal stress, and child maltreatment:
An application of the family stress model. Social Service Review, 89(1), 9–39. https://doi.
org/10.1086/680043
World Health Organization (2015). https://www.who.int/topics/violence/Global-­Initiative-­End-­
All-­Corporal-­Punishment-­children.pdf
Xerxa, Y., Delaney, S. W., Rescorla, L. A., Hillegers, M. H., White, T., Verhulst, F. C., Muetzel
R. L & Tiemeier, H. (2020). Association of poor family functioning from pregnancy onward
with preadolescent behavior and subcortical brain development. JAMA Psychiatry. https://doi.
org/10.1001/jamapsychiatry.2020.2862.
Zajac, L., Prendergast, S., Feder, K. A., Cho, B., Kuhns, C., & Dozier, M. (2020). Trajectories of
sleep in child protective services (CPS)-referred children predict externalizing and internalizing
symptoms in early childhood. Child Abuse & Neglect, 103, 104433. https://doi.org/10.1016/j.
chiabu.2020.104433
Chapter 5
Trauma-Informed Child Welfare Practice

Introduction

There is no doubt children who experience child abuse and neglect and who experi-
ence child welfare system involvement and possibly removal from their caregivers
are impacted by these traumatic events. Traumatic events such as child abuse and
neglect can impact people in a variety of ways and can be manifested in different
ways. Trauma and traumatic experiences are extremely complex as they occur in a
context that includes individuals’ personal characteristics, life experiences, and cur-
rent circumstances. These factors influence people’s experience of trauma, how they
understand and make sense of it, how they interpret and process the experience, and
how they adjust following the traumatic experience. As child welfare professionals,
it is critical to understand this dynamic and very individualized experience and how
to use an appropriate, ethical, and holistic approach in our practice with children
and families involved with the child welfare system.

What Is a Traumatic Event?

A traumatic event is one that is dangerous and frightening and that poses a threat to
a person’s life or body. Experiencing and witnessing such an event can be traumatic
as well as incidences where one fears for their life or where one believes they might
be hurt or injured. A number of experiences can be traumatic for an adult and/or
child, such as physical, sexual, or psychological abuse and neglect; family or com-
munity violence; war and refugee experiences; serious accidents; illnesses; military
experiences; sudden loss and/or death of a loved one; substance use disorder or
exposure to someone with substance use disorder; and natural disasters. Trauma
also results from experiences related to economic stress and poverty, homelessness,
and crime. Adults and children often feel helpless, confused, and afraid during and

© Springer Nature Switzerland AG 2021 115

J. M. Geiger, L. Schelbe, The Handbook on Child Welfare Practice,
https://doi.org/10.1007/978-3-030-73912-6_5
116 5 Trauma-Informed Child Welfare Practice

after a traumatic event has occurred. They may feel unable to stop the event from
occurring or to protect themselves or others from it, resulting in their inability to
process the event(s) without support from others.

How Does Trauma Affect Individuals?

Trauma affects individuals in different ways, depending on various factors, includ-

ing the severity, exposure, chronicity, reactions of others, developmental stage, inci-
dence of multiple traumatic events, and previous experiences. A traumatic response
is also impacted by one’s experience with and ability to use various means of healthy
processing and coping strategies.
For children, any one or more traumatic events and the events that follow can
continue to affect their lives long after the event(s) have ended. Child traumatic
stress is characterized by a series of events, similar or different in nature, related or
unrelated that when experienced over time can have a significant impact on a child’s
physical, emotional, social, and cognitive development. The traumatic stress
response is often manifested by depression, anxiousness, behavior changes (e.g.,
sleeping, eating), physical complaints, issues related to school performance, social
relationships, withdrawal or isolation, and/or risky behaviors (e.g., substance use or
sexual).

Signs of Traumatic Stress

Given the diverse experiences of trauma and response, there is also a range of signs
and signals that indicate traumatic stress in children. As discussed in Chap. 3, it is
critical for child welfare professionals to understand normative development in
childhood and across the life span in order to be able to recognize the signs and
respond appropriately with services and support.

Infants and Toddlers

Infants and toddlers rely exclusively on their caregivers to provide for their most
basic needs as well as emotional and physical nurturing and care. Despite their rapid
growth – physically, cognitively, and emotionally – they are also unable to process
many of the interactions they experience, including trauma, without the support and
guidance of adults, primarily their caregivers. Even with support, children may still
experience a variety of signs of traumatic stress response. These behavioral indica-
tors include changes in sleeping and eating patterns; increased tantrums and/or
inappropriate emotional reactions to various circumstances; difficulty with self-­
soothing and/or being soothed by others; excessive crying; and/or easily startled.
Triggers and Trauma Reminders 117

Preschool and Elementary School-Age Children

Young children have improved agency with some aspects of their lives, including
improved ability to care for themselves (e.g., dressing, washing hands, feeding,
using the toilet, etc.), improved social and cognitive ability to manage relationships
and problem solving, and have more physical control over their own bodies in gen-
eral. However, most preschool and elementary school-age children rely on their
caregivers to guide them through these scenarios. When children ages 3 to 10 years
old experience prolonged trauma or traumatic stress, they may demonstrate feelings
of helplessness and uncertainty; fear and anxiety when separating from caregiver;
excessive screaming or crying; eating poorly; toileting regression or bedwetting
(that did not occur before); using baby talk; arrested development; rapid changes in
behavior; anxiety and fearfulness; excessive worrying; displaying guilt and shame;
overreaction to bumps and bruises or falls; difficulty sleeping or concentrating;
changes in school performance; easily startled; and the recreation and retelling of
the traumatic event(s). Many children this age who have experienced trauma experi-
ence nightmares regularly and have difficulty self-regulating.

Middle School- and High School-Age Children

Middle school- and high school-age children have developed more mastery in their
ability to care for themselves, navigate social relationships, and manage their bodies
and behavior. When children and youth ages 11–18 years old experience trauma,
their behavior can be manifested in internalized and externalized ways due to their
ability to cognitively process trauma differently, their physical development (hor-
mones, etc.), and reliance placed on social relationships – romantic and platonic.
Signs of traumatic stress in youth include feeling depressed and alone; developing
eating disorders and/or self-harming behaviors (e.g., cutting); use and abuse or alco-
hol and/or other drugs; becoming sexually active; feeling out of control emotion-
ally; experiencing feelings of being different; taking risks; having sleep disturbances;
avoiding places that remind them of a traumatic experience or event; having changes
in school performance; being isolated or avoidant; and discussing the traumatic
event in detail, often repeatedly.

Triggers and Trauma Reminders

Those who experience trauma have a variety of immediate and long-term reactions
in the aftermath of trauma, and as described earlier, many factors impact how one
might experience and cope with trauma. Coping styles can vary from emotional
expression to action oriented. These responses can be healthy and unhealthy for the
118 5 Trauma-Informed Child Welfare Practice

individual, but they are almost always effective for them in that they allow the indi-
vidual to manage the emotions and thoughts associated with the trauma experience.
Measuring these responses tends to be related to how they impact the individual’s
ability to go about their daily life and responsibilities. As children experience such
variation in development, this can often be shielded by shifting developmental task
navigation. Initial reactions to trauma can include sadness, anger, anxiety, agitation,
numbness, dissociation, confusion, physiological response, and exhaustion. This is
the body’s response to a traumatic event, and it is appropriate to respond in this way.
More severe responses tend to persist and include more distress without one’s abil-
ity to calm, rest, or manage those symptoms. Delayed responses to trauma can
include fatigue, sleeping and eating interruptions, nightmares, fear, flashbacks, and
depression. Trauma can also affect how someone thinks and feels about the future,
about hope, and expectations. It can negatively impact positivity, which has an
impact on relationships and one’s ability to focus.
Another unique feature of traumatic stress includes the presence of “triggers” or
“trauma reminders.” Triggers are experiences that remind a person of the trauma
experienced through their senses – touch, smell, sound, sight, and taste. These trig-
gers can bring back strong memories of the traumatic event and can feel as though
it is happening again. For example, anxiousness, nervousness, or fear when they
encounter places, people, sights, sounds, smells, and feelings that remind them of
past traumatic experiences, even years afterwards. Individuals also experience dis-
tressing mental images, thoughts, and emotional/physical reactions, as well as
responses to sudden loud noises,
destroyed buildings, the smell of fire,
ambulance or police sirens, locations Practice Highlight
where they experienced the trauma, Examples of Triggers and Trauma
funerals, anniversaries of the trauma, Reminders
and television or radio news about
the event. • Anxiousness, nervousness, or
Triggers, as a result of a traumatic scared when they encounter places,
experience or traumatic stress, people, sights, sounds, smells, and
develop when a person’s body has a feelings that remind them of past
response when they are faced with traumatic experiences, even years
danger. In response to a dangerous afterward
event (e.g., car accident, abuse, etc.), • Distressing mental images,
a person’s bodies must respond thoughts, and emotional/physical
quickly in a way to protect themselves reactions
and initiates the fight, flight, or freeze • Sudden loud noises, destroyed
response. People have a physiological buildings, the smell of fire, ambu-
response with sweating and fast heart- lance or police sirens, locations
beat, and their senses are on high where they experienced the trauma,
alert. Their brain stops some of its encountering people with disabili-
normal functions, such as short-term ties, funerals, anniversaries of the
memory, in order to face the danger. trauma, and television or radio
The brain then associates details (e.g., news about the event
Impact of Trauma 119

smells, sights, or sounds) of the experience to the memory. This is what becomes
the trigger. When these experiences occur in the future, it triggers a person’s
body’s response system or alarm system. Events that remind someone of what
happened right before or during a trauma can be a potential trigger. They are typi-
cally tied to their senses and when the person sees, feels, smells, touches, or tastes
something that reminds them of the event, it can bring on symptoms associated
with the danger response. While triggers themselves are usually harmless, they
cause the person’s body to react as if the person is in danger because the body
may not be able to distinguish the events and determine safety in that moment.

Impact of Trauma

In the past several decades, researchers have begun to document the impact of
trauma on individuals, families, and communities. Earlier in the chapter, there is
discussion about how children, in particular, manifest trauma through emotions and
behaviors. When left untreated, complex trauma or traumatic stress can have long-­
term effects on a child’s current and future relationships, academic performance,
thinking and cognition, physical health, and overall stability. See Fig. 5.1 describing
the impact of childhood trauma. Early childhood trauma such as child maltreatment
can impact a person in adolescence (e.g., Heleniak et al., 2016).
When children do not form healthy attachment relationships as a result of a trau-
matic experience in that relationship or outside of that relationship, they often strug-
gle with forming healthy relationships with peers, caregivers, teachers, and family
members. As children mature into adults, they may continue to struggle forming
and maintaining those relationships in addition to romantic relationships. When
individuals experience trauma, whether it is related to child maltreatment, many
experience disruptions in those relationships, regardless of whether they were
healthy or not prior to the experience. See Chap. 3 for more information about the
importance of the attachment relationships formed between a child and their care-
giver and the impact of having a strained and/or abusive caregiving relationship for
a child.
Children and adults can also experience a negative impact on their physical
health as a result of trauma. Earlier, this chapter presented the stress response and
the development of triggers. For children who are exposed to chronic stress, their
bodies may not be able to self-regulate or respond appropriately when there is no
danger present. Their body is always on alert and ready to respond with “fight,
flight, or freeze.” Because of the hormones associated with this response, their bod-
ies cannot physically manage the constant state of alertness. Regular states of stress
can impair the development of the brain and nervous system. Research involving
scans of the brain shows that childhood adversity impacts neurodevelopment
(Hoffman et al., 2019). Childhood stress can prevent mental stimulation required for
normal growth. Children with a history of trauma may also have difficulty self-
regulating physically and emotionally. They might be oversensitive or
120 5 Trauma-Informed Child Welfare Practice

Fig. 5.1 Impact of Childhood Trauma. (Source: Child Trends (2019); https://www.childtrends.org/
publications/how-­to-­implement-­trauma-­informed-­care-­to-­build-­resilience-­to-­childhood-­trauma)

under-respond to sensory stimuli, such as sounds, smells, touch, or light. They may
respond unusually to pain or touch, which may lead to injuries. Children with a his-
tory of complex trauma can also develop chronic or recurrent physical complaints
such as headaches and stomachaches. Adults also experience similar physical
impairments in addition to engaging in risky behaviors that may lead to other physi-
cal conditions (e.g., smoking, risky sexual behaviors, overeating).
Trauma can also have an impact on a person’s emotional identification and
expression. Children learn how to appropriately identify how they are feeling and
express emotions in a way that is congruent with how they feel, the circumstances,
and can learn to self-regulate through modeling others’ behaviors, social-emotional
growth through interactions with others, and learning about emotions with peers in
Impact of Trauma 121

a school setting. Children who experi-

Practice Highlight
ence trauma will often have difficulty
in identifying, expressing, and regulat- Trauma Impact of Investigation,
ing emotions. They may not know how Removal, and Out-of-Home
to accurately verbalize their feelings or Placement
the reasons for those feelings. As a Children may have a number of behav-
result, they may internalize their emo- ioral, emotional, and cognitive experi-
tions and show symptoms of depres- ences to child welfare investigation,
sion and anxiety, or they may removal, and out-of-home placement.
inappropriately externalize their feel- Here is some possible responses to
ings through acting out, disruptive these circumstances:
behavior, or aggression. Children with
• Surprise, shock, confusion
repeated exposure to trauma or com-
• Feelings of loss of control, power-
plex trauma experiences may experi-
lessness, helplessness
ence triggers at unpredictable times,
• Betrayal, loss of trust
may react powerfully, and/or have
• Negative view of law enforcement
trouble calming down in certain situa-
or child welfare agency
tions that remind them of the trauma.
representatives
They learn that the world is a danger-
• Fear of unknown
ous place and may lack the ability to
• Sense of guilt
trust and display hypervigilant behav-
• Abrupt and overwhelming feel-
iors. They may be guarded and may not
ings of loss
respond well to interventions and/or
• Attachment disruption from
expressions of care from others.
caregiver
Experiencing complex trauma can
• Confused and conflicted about new
also cause a child (or an adult) to be
caregiver and surroundings
more likely to have highly intense
reactions or a lack of reaction when
one would have been appropriate. When a child struggles with self-regulation, they
may lack impulse control which can lead to unpredictable and volatile behaviors.
This may also lead to engaging in risky behaviors, aggression, or becoming involved
with the juvenile justice system as a result of such behaviors.
Children with a history of trauma may have trouble thinking clearly, reasoning,
or problem solving. They may have difficulties with thinking about the future, plan-
ning, and responding appropriately. When a child is faced with chronic stress and
trauma, they are often only able to focus and consider their actions in the moment
and/or near future instead of looking forward and considering consequences.
Decision-making can also be challenging when presented with multiple options.
Children with a history of trauma may also have difficulty focusing and concentrat-
ing and may show delays in language development. Children exposed to trauma
may also struggle with establishing self-esteem and self-worth. In cases of child
maltreatment, many children will blame themselves and feel shame and guilt. When
children do not feel safe, they lack a sense of hope and purpose and positive thoughts
about the future. With that, they do not plan for the future and may feel as though
they do not have agency over their actions or circumstances around them.
122 5 Trauma-Informed Child Welfare Practice

Trauma has a significant economic

Practice Highlight
impact as well. Childhood trauma,
especially that related to interpersonal Impact of Trauma
violence, has a major impact on public The impact of trauma depends on
health (e.g., Lambert et al., 2017). It is many factors including:
estimated that the cumulative eco-
• Age and development
nomic impact is close to $100 billion,
• Perception of danger
which includes the cost of child mal-
• Experience of trauma as victim
treatment, meeting the needs of chil-
or witness
dren in various systems (mental health
• Relationship to perpetrator
care, child welfare, law enforcement,
• History of trauma
etc.) and secondary and long-term
• Post-trauma experiences and
effects with regard to education, legal
support
systems, mental and health care, and
intergenerational effects (Peterson
et al., 2018).

Adverse Childhood Experiences (ACEs)

Adverse childhood experiences are described as potentially traumatic childhood

experiences such as experiencing violence, abuse, or neglect, witnessing violence,
or growing up in a household where there was substance abuse, mental health
problems, or parental separation. The Adverse Childhood Experiences (ACE)
Study was a groundbreaking longitudinal study examining the long-term impact of
adverse childhood experiences such as parental substance abuse, divorce, and
death during childhood on an adult’s physical health. The study examined the
medical history of over 17,000 participants ages 19−90 and collected data related
to adverse childhood experiences (ACEs; Felitti et al. 1998). Results showed that
over 64% of participants had at least one exposure, and or those 69% reported two
or more incidents of childhood trauma. Further, when examining the relationship
between ACEs and later health, researchers found that the presence of ACEs were
associated with high-­risk behaviors (e.g., smoking), chronic illness (heart disease
and cancer), and early death (Dong et al., 2004). People with high ACEs scores
have been found to have a reduced likelihood of high school graduation, holding a
skilled job, juvenile arrests, and felony charges (Giovanelli et al., 2016). ACEs
also have an impact on future violence victimization and perpetration. Figure 5.2
shows the ACE Pyramid and the framework of how ACEs impact a person across
the life span.
The ACEs study is valuable in that it helps make the connection between some
of the potential negative outcomes associated with adverse childhood experiences.
There are some limitations and caution should be noted when interpreting and using
the findings from this study. For example, the study is largely descriptive and not
Adverse Childhood Experiences (ACEs) 123

Fig. 5.2 The ACE Pyramid shows the conceptual framework of how ACEs impact a person across
the life span. (Source: CDC (2020a); Available: https://www.cdc.gov/violenceprevention/aces/
about.html)

causal. Only specific traumas are included. The study does not consider factors such
as resilience and protective factors. It also does not provide information about inter-
vention. It is helpful to use the ACEs in screening, but it is equally important to
focus on how screening for ACEs will be used when intervening with people who
have experienced adversity. Although these experiences increase the risk of later
health conditions, these factors are preventable. The Centers for Disease Control
and Prevention (CDC) has outlined protective factors that have been shown to
reduce ACEs and their associated harms (CDC, 2020b).
Creating and sustaining safe, stable, and nurturing relationships and environ-
ments for all children and their families can help improve health and social out-
comes into adulthood. The CDC has developed a technical package that recommends
six strategies to preventing ACEs that individuals, families, and communities can
adopt: (1) strengthening economic supports to families through financial security
and family-friendly work policies; (2) promoting social norms that protect against
violence and adversity through public education campaigns and other legislative
approaches; (3) ensuring a strong start for children through early childhood home
visitation, high quality day care, and preschool enrichment; (4) teaching skills to
children and families regarding social-emotional learning, healthy relationship
building, and parenting skills; (5) connecting youth to caring adults and activities,
such as mentoring and after-school programs; and (6) intervening to lessen the
immediate and long-term harms through enhanced primary care, services, and
124 5 Trauma-Informed Child Welfare Practice

treatment (CDC, 2014). (See Chap. 7

Practice Highlight
for more information about the CDC’s
Essentials for Childhood for informa- Understanding ACEs Is Important,
tion about the model.) but What’s Next?
The effects of trauma are well-doc- Understanding one’s adverse child-
umented; however, there are a number hood experiences is important; how-
of ways that child welfare profession- ever, it doesn’t really present ways we
als can better understand the various can address prevention and treatment
forms of impact and respond using a of these ACES. Some benefits of inte-
trauma-informed approach to screen- grating ACEs into our practice in child
ing and make the necessary referrals welfare is that we are all “speaking the
for thorough assessment and treat- same language” across disciplines
ment. Child welfare professionals can (e.g., medicine, social work), and rais-
use their skills and resources when ing awareness across disciplines and
intervening at various stages of child areas of practice about the impact of
welfare practice, including investiga- ACEs. However, as we are early in our
tion and intake; ongoing and foster understanding of the impact of ACEs,
care; permanency; and adoption. we must also consider how we can
Having the knowledge about what are prevent these experiences and pro-
sources of trauma, how trauma mani- mote positive childhood experiences
fests, and how it can have short- and in their place. When we screen for
long-term effects on the individual, ACEs, we must have a plan for how
their family, and the community helps we will address the short- and long-
us as professionals respond in a way term impact of these experiences and
that can be helpful and supportive. learn more about successful methods
of prevention (Finkelhor, 2018).

 ssessment Tools and Strategies for Children Who Have

A
Experienced Trauma

Child welfare professionals are not required to provide treatment for children
exposed to trauma; however, it is helpful for child welfare professionals to under-
stand how to appropriately assess for trauma and traumatic stress responses and be
aware of what treatment options are available to provide information and make
referrals as necessary. There are various tools to assess for trauma (e.g., Donisch
et al., 2020). (See Chap. 8 for more information about assessment.) Child welfare
professionals review clinical documentation and assessments and should be aware
of what they are and their implications for the child and their family. In all child
welfare assessments and investigations, it is important to obtain information from
multiple sources and through various methods (observation, reports, interviews,
etc.), when possible. This is also true with trauma assessments. With children, it is
important to observe their interactions with others; however, child welfare profes-
sionals should also interview them separately as well (as appropriate) to obtain
Assessment Tools and Strategies for Children Who Have Experienced Trauma 125

differences in perspectives, accounts, and experiences. To begin, it is helpful to

obtain details about the traumatic event or exposure and what occurred before and
after. Given the varying experiences of trauma and trauma responses, this line of
questioning and investigation must be approached carefully, primarily to not re-
traumatize, create undue stress and discomfort, and assess immediate needs. It is
quite possible the child and/or the family is not prepared during the first interview
or interaction to discuss all or any of the events that have occurred; however, it is
likely that with time, they will. Many agencies use standardized questionnaires or
tools to ensure the necessary questions are being asked to determine whether abuse/
neglect has occurred; however, when assessing for trauma exposure, these questions
are used more to determine necessary services for both the child and parent/care-
giver. Through assessment of trauma response, child welfare professionals can also
provide additional although sometimes limited initial information about symptomo-
logy to foster or kin caregivers so that they may better respond to their needs and
obtain the necessary therapeutic services promptly. Moving beyond the child wel-
fare professional’s role, clinicians will often proceed with assessing post-traumatic
stress disorder (PTSD) symptomology through careful evaluation of the individual’s
meeting diagnostic criteria in the Diagnostic and Statistical Manual of Mental
Disorders, 5th Edition (DSM-5). Such a diagnosis is not required in order for thera-
peutic services to be provided to children, youth, and their families; however, it does
provide guidance in how to proceed in the clinical context. Clinicians will often
assess for other psychiatric disorders alongside referrals from caregivers and child
welfare professionals to primary care physicians to ensure appropriate overall
development.
When assessing for trauma, it is important to note the setting where the assess-
ment or screening occurs. For example, is the screening occurring in the home, the
hospital, or at school? This will impact how the child might respond. Likewise, a
child may have a different level of comfort and be impacted by who is present dur-
ing an interview and what type of relationship the screener might have with the
child. One should consider how the screening will benefit the child/parent. For
example, it can be assumed that some kind of trauma has occurred if a child welfare
professional is interviewing a child due to a report of child maltreatment; however,
what other information might suggest trauma exposure and its impact. Given what
child welfare professionals know now about trauma and its manifestation, child
welfare professionals can use this information to guide the need for a screening or
to arrange a formal assessment which includes information about trauma.
Professionals in child welfare should be aware of minimizing the need for mul-
tiple rescreening or reassessments. Protocol should include procedure for brief
screenings that could lead to an assessment as needed and should be limited to that
assessment to prevent re-traumatization and emotional and/or psychological dam-
age and fatigue related to recounting the trauma events. Appropriate documentation
of screenings and assessments as well as proper care coordination can be employed
to avoid this. The individual conducting the screening and assessments should be
adequately trained to complete the screening/or assessments and should use a client-­
focused, strengths-based, and culturally grounded approach.
126 5 Trauma-Informed Child Welfare Practice

Providers should consider when trauma screenings and assessments will be

administered, and which will be used. Most child welfare agencies have an estab-
lished protocol for how and when this will be done as well as by whom. The child
welfare professional may document symptoms, observations, and interactions with
the client that is indicative of trauma exposure; however, it is possible that they do
not formally screen or assess, but make a referral for this. Timing is also important.
Children and adults may not be prepared to discuss traumatic experiences immedi-
ately following the event, and the decision to screen at a specific time must be
approached with care and with the client in mind. Agencies may also use different
screening and assessment tools based on agency preferences, workflow systems,
and culture. Assessments may be more general to capture various types of trauma
exposures and behaviors, more clinical in nature, or may focus on a specific type of
trauma, such as child sexual abuse. Screenings and assessments may be modified
depending on the child’s age or developmental stage and on the child’s relationship
with the caregiver or other adults. Providers using a screening tool should consider
(1) factors such as the child’s age, language skills, and cognitive capabilities; (2)
whether the child is among the populations for which the tool has been validated
and normed; and (3) if there are other factors that might affect the reliability and
validity of the tool for this particular child. Tools can be completed by the provider,
the child, and/or a caregiver and can be administered in a verbal or written format.
Ongoing screening is also important to ensure children are safe in placements after
they have been removed from their family.

Engaging Families in the Screening Process

Once it is determined that it is an appropriate time to administer the screening or

assessment and how it will be administered, the provider should explain the purpose
and use of the tool, why it is necessary to obtain that information, how it will be
used, how it might benefit the individual/family, and potential challenges in the
screening/assessment. As with all interactions, it is important to note the parameters
for confidentiality. It is also good practice, as appropriate, to share the results and
explain what they might mean, if possible. Consider the impact on the child of sim-
ply completing the screening or assessment and explain to the caregiver how the
child may respond following the screening or assessment.

 educing the Trauma Associated with Child Investigation,

R
Removal, and Out-of-Home Placement

There is little doubt that children who enter the foster care system have experienced
some level of trauma. However, it is important to also consider the trauma associ-
ated with the experience of the child welfare investigation process, being removed
Reducing the Trauma Associated with Child Investigation, Removal, and Out-of-Home… 127

from their home, and placed in out-of-home care. These instances often involve
conflict, emotions, and tension among the parties involved; however, the way that
the child welfare professional and others (e.g., foster parent, law enforcement)
respond can mitigate the trauma impact of these experiences. Child welfare profes-
sionals can plan investigations, assessments, and possible removals ahead as much
as they can. They can slow down and explain to the family what is happening and
supporting them through that process while also having identified a placement prior
to removal. As much as possible, the child welfare professional should maintain a
calm approach to assessment and removal, providing comfort, empathy, and support
to the child and family. The child welfare professionals can help the parent in calm-
ing and caring for the child (e.g., help them to the car, gather some belongings, and
explain the situation). During the process of removal, the child welfare professional
can ensure the child has enough to eat and drink, has time to gather some items, and
feels comfortable in their new surroundings. Child welfare professionals can ask
parents about the child’s needs, likes and dislikes, and routines.
It is important to be on the child’s level and connect with them by attempting to
understand and acknowledge their feelings. It is critical to listen and give them age-­
appropriate information about what is happening, assuring their safety and care,
and, most importantly, that this is not their fault. Child welfare professionals should
not make any promises they can’t keep; however, they should make efforts to main-
tain relationships with family and other loved ones as much as possible. Services,
such as counseling, are often helpful during these transitions, and services for the
child should be assessed and implemented as soon as possible.

Reflection
Moving in the Middle of the Night
Consider for a moment that tonight you are woken up at 1am and told you
have to grab some clothes in a bag and move to a stranger’s house. For chil-
dren being removed from their homes, this is just a small glimpse of what it
would feel like in that moment. For some, they don’t have many possessions,
but forgetting that stuffed animal can be devastating to many. Not only are
children tired, scared, and unsure of what will happen next, but also they are
losing everything they know in that moment. Many children are not equipped
emotionally or cognitively to understand what is happening, and all of it is out
of their control. Everything about their life will change – their routine, school,
friends, family, where they sleep, the soap they use, the food they eat, where
they sit, activities they like, their neighborhood, house rules, and possibly
their cultural traditions. As child welfare professionals, it is important to
understand these elements and make every effort to recognize these changes
and try to make the transition easier. Being trauma-informed means knowing
the impact of having a child move and adjust to a new setting, even it is a
safer, more stable home.
128 5 Trauma-Informed Child Welfare Practice

Overview of Treatment of Trauma

A number of individual (child and adult) and family-based interventions have been
shown to be effective in treating traumatic stress and PTSD symptomology, includ-
ing psychosocial interventions targeting PTSD, cognitive-based therapies, eye
movement desensitization and reprocessing (EMDR), and relaxation-based psycho-
therapies. Various combinations of these approaches as well as pharmacological
treatments have also been shown to be effective in treating PTSD and trauma symp-
tomology. Exposure-based interventions have been shown to reduce symptoms of
avoidance, fear, and anxiety that are related to a specific traumatic exposure or expe-
rience by carefully exposing the individual to the stimuli associated with the trauma
in a safe, therapeutic context.

Practice Highlight
Examples of Trauma Screening and Assessment Tools
Assessment-Based Treatment for Traumatized Children: A Trauma
Assessment Pathway Model (TAP) was designed for children 0 to 18 years
of age who have experienced any type of trauma and who may or may not be
in the child welfare system. TAP is a multifaceted assessment process that
allows for screening and further assessment, if needed.
The Brief Trauma Questionnaire (BTQ) is a 10-item self-report trauma
exposure screen that can be quickly administered and is suitable for special
populations such as persons with severe mental illness as well as for general
population groups.
The Child Post-Traumatic Symptom Scale (CPSS) assesses symptom
criteria for PTSD and the corresponding impairment in functioning in chil-
dren and adolescents.
Child and Adolescent Needs and Strengths (CANS): Trauma
Comprehensive Version is a flexible, multipurpose tool that gathers informa-
tion on a range of domains relevant to the functioning of the child and caregiving
system and can organize this information to develop individualized plans of care.
Child PTSD Symptom Scale (CPSS) is a self-report measure to assess
the frequency of DSM defined PTSD symptoms.
Child Report of Post-Traumatic Symptoms (CROPS) is a self-report
measure for children and adolescents that assesses a range of post-traumatic
symptoms and can be used to measure change in symptomology over time.
Child Trauma Screening Questionnaire (CTSQ) is a 10-item self-report
screening tool that can be used to identify risk of PTSD in children. The ques-
tions assess trauma reactions following a potential traumatic event.
Life Events Checklist (LEC) is a brief 17-item self-report measure
designed to screen for potentially traumatic events in a respondent’s lifetime.
The LEC assesses exposure to 16 events known to potentially result in PTSD
or distress and includes on-item assessment any other extraordinary stressful
event not captured in the other items.
Overview of Treatment of Trauma 129

PTSD Checklist (PCL) contains 17 questions that map onto the 3 DSM-IV
PTSD symptom clusters: reexperiencing, avoidance, and arousal.
Post-traumatic Stress Disorder Semi-Structured Interview and
Observational Record is a semi-structured caregiver report measure used to
assess for PTSD symptoms for children ages 0−7 years.
Post-Traumatic Symptom Inventory for Children (PT-SIC) is a self-­
report measure of PTSD symptoms for children ages 4 to 8 years.
Trauma and Attachment Belief Scale (TABS) is the revised version of the
TSI Belief Scale to assess individuals who have experienced traumatic events.
Trauma Symptom Checklist for Young Children (TSCYC) is a 90-item
caretaker report measure to assess trauma symptomology in children ages
3 to 12.
Trauma Symptom Checklist for Children (TSCC) measures severity of
post-traumatic stress and symptomology in children ages 8 to 16 who have
experienced traumatic events.
The UCLA Reaction Index is the most commonly used measure for
PTSD symptoms in children and adolescents. There are versions of this mea-
sure for children, adolescents, and parents. It assesses the respondent’s trauma
history and frequency of the PTSD symptoms.
The Upsetting Events Survey that we designed is a modification of the
Traumatic Life Events Questionnaire (TLEQ). It assesses effectively for
trauma history.

 vidence-Informed Interventions to Address Trauma

E
in Children

There are a number of evidence-informed interventions used to treat trauma in chil-

dren and adolescents, many of which have been tailored to address trauma in chil-
dren and adolescents who have experienced maltreatment and foster care and/or
who are living in out-of-home placements. Treatments used to address symptoms
related to trauma often use variations of similar approaches and techniques.
Although child welfare professionals working in case management with children in
care will not be providing therapy or counseling for children, their parents, or care-
givers, it is important to be aware of the philosophy, dynamics, and structure of
commonly used interventions and therapeutic approaches. Interventions such as
trauma-focused cognitive behavioral therapy (TF-CBT); attachment, self-­regulation,
and competency (ARC) and integrative treatment of complex trauma for children/
adolescents (ITCT-C/A) use similar therapeutic techniques in their approach to treat
trauma with this population. Child welfare professionals often play a role in refer-
ring clients to various community programs related to parenting education, sub-
stance abuse, and trauma-focused therapy and should be aware of evidence-informed
interventions (Myers et al., 2020). A listing of evidence-based interventions can be
found on the website for the California Evidence-Based Clearinghouse for Child
Welfare (https://www.cebc4cw.org/). It is important to note when identifying
130 5 Trauma-Informed Child Welfare Practice

evidence-­based interventions that they have been evaluated with diverse groups by
age, race/ethnicity, language, etc. to ensure fit with the client.
Children’s response to maltreatment and trauma experiences differs based on
age, gender, and life history. Screening, assessment, and treatment must be flexible
enough to ensure individualization to meet the needs of the child and family. It is
important for the treatment plan to consider the child, their caregiver, and biological
family, as appropriate to develop and maintain a normal routine where a child can
feel safe and cared for.

Using a Trauma-Informed Approach

Trauma experiences are common during childhood, and children respond differently
to trauma. Many children recover on their own, some with support, and some struggle
with managing the trauma they experienced even with treatment and support. Having
the professional provider and systems in place to respond in a trauma-­informed way
is critical in facilitating recovery and growth among those who have experienced
trauma, particularly as it relates to child welfare (Kawam & Martinez, 2016). All
members of a child and family team, including the child welfare professional, their
supervisor, providers (mental health, physical health, etc.), caregiver (kin, foster par-
ent, biological parent), and other professionals (teachers, principal, staff) should use
a trauma-informed approach to care. According to the Substance Abuse and Mental
Health Services Administration (SAMHSA, 2014), this approach should “realize the
widespread impact of trauma and understanding potential paths for recovery, recog-
nize the signs and symptoms of trauma, fully integrate knowledge about trauma into
policies, procedures, and practices, and seek to actively resist re-­traumatization” (p. 9).

Practice Highlight
Common Therapeutic Approaches and Techniques to Treat Trauma
• Motivational interviewing (to engage clients)
• Risk screening (to identify high-risk clients)
• Triage to different levels and types of intervention (to match clients to the
interventions that will most likely benefit them/they need)
• Systematic assessment, case conceptualization, and treatment planning (to
tailor intervention to the needs, strengths, circumstances, and wishes of
individual clients)
• Engagement/addressing barriers to service-seeking (to ensure clients
receive an adequate dosage of treatment in order to make sufficient thera-
peutic gains)
• Psychoeducation about trauma reminders and loss reminders (to strengthen
coping skills)
• Psychoeducation about post-traumatic stress reactions and grief reactions
(to strengthen coping skills)
Trauma-Informed Child Welfare System 131

• Teaching emotional regulation skills (to strengthen coping skills)

• Maintaining adaptive routines (to promote positive adjustment at home
and at school)
• Parenting skills and behavior management (to improve parent-child rela-
tionships and to improve child behavior)
• Constructing a trauma narrative (to reduce post-traumatic stress reactions)
• Teaching safety skills (to promote safety)
• Advocating on behalf of the client (to improve client support and function-
ing at school, in the juvenile justice system, and so forth)
• Teaching relapse prevention skills (to maintain treatment gains over time)
• Monitoring client progress/response during treatment (to detect and cor-
rect insufficient therapeutic gains in timely ways)
• Evaluating treatment effectiveness (to ensure that treatment produces
changes that matter to clients and other stakeholders, such as the court system)
(Used with permission from the National Center for Child Traumatic Stress:
National Child Traumatic Stress Network. (2016). Overview of Trauma
Treatments and Practices [Web page]. Retrieved from: https://www.nctsn.org/
treatments-­and-­practices/trauma-­treatments/overview.)

CDC’s Guiding Principles to a Trauma-Informed Approach

The CDC’s Office of Public Health Preparedness and Response (OPHPR), in col-
laboration with SAMHSA’s National Center for Trauma-Informed Care (NCTIC),
developed a model that outlines six principles to adopting a trauma-informed
approach in various public health and child and family-serving organizations
(SAMHSA, 2014). The six guiding principles include safety; trustworthiness and
transparency; peer support; collaboration and mutuality; empowerment and choice;
and culture, historical, and gender issues. There is no prescription or curriculum that
shows how to be fully trauma-informed; however, it is critical to use a trauma-­
informed approach to work with clients, providers and professionals, and co-­
workers. It requires a high level of attention, caring awareness, and sensitivity on an
individual level, and also a cultural and organizational change to reflect a trauma-­
informed systems approach.

Trauma-Informed Child Welfare System

Many child welfare systems have begun to consider and implement a trauma-­
informed approach to policies and practices. Child welfare agencies and their part-
ners (e.g., court systems, community partners, etc.) should first use a systematic
process of assessing their current system, prior to planning how to implement a
system of care that is trauma-informed across the various units or departments, such
as workforce development, screening and assessment, data systems, policies,
132 5 Trauma-Informed Child Welfare Practice

funding, and interventions. It is important to focus on the workforce and take into
consideration the attitudes of frontline worker (Bosk et al., 2020).
The National Child Traumatic Stress Network (NCTSN) defines a trauma-­informed
system as, “one in which all parties involved recognize and respond to the impact of
traumatic stress on those who have contact with the system including children, caregiv-
ers, and service providers. Programs and agencies within such a system infuse and
sustain trauma awareness, knowledge, and skills into their organizational cultures,
practices, and policies. They act in collaboration with all those who are involved with
the child, using the best available science, to facilitate and support the recovery and
resiliency of the child and family.” (NCTSN, n.d.) Adopting a trauma-informed
approach means completing everyday tasks and conducting all interactions with the
knowledge of the impact of trauma experiences of others. When all members of the
system begin to incorporate these changes, it becomes a system-wide approach to prac-
tice. Using a system-wide trauma-informed approach has shown some positive changes
in child and family outcomes, including a reduction in children receiving emergency or
crisis services, use of psychotropic medication, fewer placement disruptions, and
reduced length of stay in foster care (Child Welfare Information Gateway, 2020).

Research Brief
Promoting Positive Childhood Experiences (PCEs)
With much focus placed on adverse childhood experiences (ACEs) and the
negative short- and long-term consequences to one’s physical and mental
health, it is often difficult to begin to consider how to prevent or intervene
effectively with children, youth, and adults who have experienced such
trauma. However, a new body of research has emerged that focuses on posi-
tive childhood experiences (PCEs) and how we can promote these experi-
ences in an effort to prevent ACEs. Recent research (Bethell et al., 2019)
shows adults who self-report more PCEs such as lower likelihood of depres-
sion and other mental health conditions. Positive childhood experiences
(PCEs) are not simply the absence of ACEs of going to a theme park with
your family every year. Examples of PCEs are being able to talk to family
about feelings, having family and community traditions, having caring adults
showing interest in you, and feeling safe and protected by an adult at home.
Many adults as children are exposed to adverse experiences, many of which
we cannot control. However, it is possible to do our best to balance these
experiences with other positive experiences and promoting healthy caregiver
relationships and environments for children.

Implementing a trauma-informed systems approach includes a shift in how we

view the children and families we work with and how we respond and act to protect,
support, and enhance well-being. Using a trauma-informed approach is one that is
strengths-based, resilience-based, and culturally grounded. Instead of focusing on
what someone did and what is wrong, the focus changes to what happened to that
individual and how that informs what is going on now. This has been summarized by
asking, “What happened to you?” rather than “What is wrong with you?” When
Trauma-Informed Child Welfare System 133

considering a trauma-informed approach in child welfare workforce development,

there has been a change in perspective of only focusing on protection, to safety, per-
manency, and well-being. Child welfare agencies have begun to assess and approach
families more holistically and when offering services, a using family-centered
approach. Trauma-informed also means prioritizing collaboration and the role of child
welfare professionals. Staff and their supervisors focus more on understanding trauma,
its impact, and how to move toward healing and well-being for all. There is a focus on
prevention and early intervention with children and families. There is an understand-
ing, as well, that trauma can also affect the child welfare professionals involved in
cases in the form of burnout, secondary traumatic stress, and training of this issue and
the role of trauma within families is critical (see Chap. 12 for information about burn-
out, secondary traumatic stress, self-care, and professional development.).
Training and education about trauma and its impact on children and families
should also extend to caretakers, foster parents, kinship care providers, group home
staff, biological parents, and providers. Education should continue as we learn more
about trauma and its effects and should be infused into communication, meetings,
and court hearings. Further, information and training should be available across
systems in their collaboration to promote child and family well-being. (See Chap.
12 for information about trauma-informed supervision.)

Practice Highlight
Talking with Children Who Have Been Traumatized
Although this might vary by age, developmental stage, and experience of
trauma, these are suggestions for talking with children who have been
traumatized:
• Assess the child’s readiness to talk (frequency, depth, and ability to express
themselves).
• Reassure them about safety, their supports (who they can talk to), and
what’s going to happen next. Do not ever make promises or statements
about things you don’t know for sure will happen (e.g., going back to par-
ent, visitation parameters).
• Ask what they know and how they understand the circumstances and give
factual information as appropriate. This provides a better understanding of
how they perceive past and current events. Ask them if they have questions
they need clarification on.
• Listen closely, summarize, and use appropriate body language and facial
expressions.
• Encourage and support children to show and talk about their feelings.
Acknowledge their feelings about their experiences.
• Appropriately share your feelings while empathizing with the child.
• Focus on the good and the future. Discuss positive things that may or may
not be related to the present circumstances.
• Give tools for the child to express emotions and process experiences.
• Make a referral for treatment as needed.
134 5 Trauma-Informed Child Welfare Practice

Conclusion

Child maltreatment is traumatic. Likewise, a child and family’s contact with the
child welfare system can be traumatic. Children and families experience a number
of events that are considered traumatic, with child abuse and neglect being some of
them. It is more common that they will have experienced more than one experience
of trauma. Each child experiences and responds differently to trauma, and the best
way to intervene is in trauma-informed ways that honor their experience. This chap-
ter provided information about how to approach cases in a trauma-informed manner
and how to promote screenings, assessments, and treatment that have been shown to
address trauma appropriately that will allow for healing. There are ways for child
welfare workers to respond using a trauma lens that will promote better outcomes in
the case as well as with child and family well-being. Using a trauma-informed
system-­level approach can enhance the work that professionals and their partners
are doing to improve child and family well-being.

Discussion Questions
1. What are three examples of traumatic events experienced by children?
2. Describe what trauma reminders and triggers are. What are three examples of
trauma reminders or triggers for children who have experienced child
maltreatment?
3. What are two ways that trauma is assessed? What tools are typically used?
4. How can child welfare professionals reduce the trauma experienced by children
who are removed from their home?
5. What does it mean to use a trauma-informed approach in child welfare practice?

Suggested Activities
1. Take the ACE quiz online to reflect on the impact of your own experiences with
adverse childhood experiences. https://www.npr.org/sections/health-­
shots/2015/03/02/387007941/take-­the-­ace-­quiz-­and-­learn-­what-­it-­does-­and-­
doesnt-­mean
2. Watch Through Our Eyes: Children, Violence, and Trauma: https://www.you-
tube.com/watch?v=z8vZxDa2KPM. Consider the different types of trauma
experienced by the children in the video and how it is manifested.
3. Watch How Childhood Trauma Affects Health Across a Lifetime: https://www.
youtube.com/watch?v=95ovIJ3dsNk&t=1s. Explore the different ways one’s
health is compromised as a result of trauma.
4. Read Heleniak et al. (2016). Discuss with others how the trauma of child mal-
treatment can impact adolescents’ behaviors and the implication for child wel-
fare practice.
Heleniak, C., Jenness, J. L., Vander Stoep, A., McCauley, E., & McLaughlin,
K. A. (2016). Childhood maltreatment exposure and disruptions in emotion
regulation: A transdiagnostic pathway to adolescent internalizing and exter-
nalizing psychopathology. Cognitive therapy and research, 40(3), 394–415.
(Available: https://rdcu.be/ccaW1).
References 135

Additional Resources
California Evidence-Based Clearing House for Child Welfare: https://www.
cebc4cw.org/
Casey Family Programs, Why should child protection agencies become trauma-­
informed?: https://www.casey.org/why-­become-­trauma-­informed/
Centers for Disease Control and Prevention, Adverse Childhood Experiences
(ACEs): https://www.cdc.gov/violenceprevention/aces/index.html
National Center on Substance Abuse and Child Welfare, Child Welfare and Trauma:
https://ncsacw.samhsa.gov/resources/trauma/child-­welfare-­and-­trauma.aspx
The National Child Traumatic Stress Network: https://www.nctsn.org/
Title IV-E Prevention Services Clearinghouse: https://preventionservices.
abtsites.com/

References

Bartlett, J. D., & Steber, K. (2019). How to implement trauma-informed care to build resilience
to childhood trauma. Child Trends. Retrieved from: https://www.childtrends.org/publications/
how-­to-­implement-­trauma-­informed-­care-­to-­build-­resilience-­to-­childhood-­trauma.
Bethell, C., Jones, J., Gombojav, N., Linkenbach, J., & Sege, R. (2019). Positive childhood expe-
riences and adult mental and relational health in a statewide sample: Associations across
adverse childhood experiences levels. JAMA pediatrics, 173(11), e193007–e193007. https://
doi.org/10.1001/jamapediatrics.2019.3007
Bosk, E. A., Williams-Butler, A., Ruisard, D., & MacKenzie, M. J. (2020). Frontline staff charac-
teristics and capacity for trauma-informed care: Implications for the child welfare workforce.
Child Abuse & Neglect, 104536. https://doi.org/10.1016/j.chiabu.2020.104536
Centers for Disease Control and Prevention. (2020a) About the Kaiser-CDC ACE Study. Retrieved
from: https://www.cdc.gov/violenceprevention/aces/about.html
Centers for Disease Control and Prevention. (2020b). Preventing adverse childhood experiences.
Retrieved from: https://www.cdc.gov/violenceprevention/acestudy/fastfact.html
Centers for Disease Control and Prevention. (2014). Essentials for childhood: Creating safe, sta-
ble, nurturing relationships and environments for all children. Retrieved from: https://www.
cdc.gov/violenceprevention/childabuseandneglect/essentials.html
Child Welfare Information Gateway. (2020). The Importance of a Trauma-Informed Child Welfare
System. U.S. Department of Health and Human Services, Administration for Children and
Families, Children’s Bureau.
Dong, M., Anda, R. F., Felitti, V. J., Dube, S. R., Williamson, D. F., Thompson, T. J., et al. (2004).
The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction.
Child Abuse & Neglect, 28(7), 771–784. https://doi.org/10.1016/j.chiabu.2004.01.008
Donisch, K., Zhang, Y., Bray, C., Frank, S., & Gewirtz, A. H. (2020). Development and prelimi-
nary validation of the University of Minnesota's Traumatic Stress Screen for Children and
Adolescents (TSSCA). The Journal of Behavioral Health Services & Research, 1–13. https://
doi.org/10.1007/s11414-­020-­09725-­1
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., & Marks,
J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading
causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal
of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/S0749-­3797(98)00017-­8
Finkelhor, D. (2018). Screening for adverse childhood experiences (ACEs): Cautions and sug-
gestions. Child Abuse & Neglect, 85, 174–179. https://doi.org/10.1016/j.chiabu.2017.07.016
136 5 Trauma-Informed Child Welfare Practice

Giovanelli, A., Reynolds, A. J., Mondi, C. F., & Ou, S. R. (2016). Adverse childhood experiences
and adult well-being in a low-income, urban cohort. Pediatrics, 137(4). https://doi.org/10.1542/
peds.2015-­4016
Heleniak, C., Jenness, J. L., Vander Stoep, A., McCauley, E., & McLaughlin, K. A. (2016).
Childhood maltreatment exposure and disruptions in emotion regulation: A transdiagnostic
pathway to adolescent internalizing and externalizing psychopathology. Cognitive Therapy and
Research, 40(3), 394–415. https://doi.org/10.1007/s10608-­015-­9735-­z
Hoffman, E. A., Clark, D. B., Orendain, N., Hudziak, J., Squeglia, L. M., & Dowling, G. J. (2019).
Stress exposures, neurodevelopment and health measures in the ABCD study. Neurobiology of
Stress, 10, 100157. https://doi.org/10.1016/j.ynstr.2019.100157
Kawam, E., & Martinez, M. J. (2016). What every social worker needs to know… trauma informed
care in social work. New Social Worker. Retrieved from https://www.socialworker.com/
feature-­articles/practice/trauma-­informed-­care-­in-­social-­work/.
Lambert, H. K., Meza, R., Martin, P., Fearey, E., & McLaughlin, K. A. (2017). Childhood trauma
as a public health issue. In M. A. Landolt, M. Cloitre, & U. Schnder (Eds.), Evidence-based
treatments for trauma related disorders in children and adolescents (pp. 49–66). Springer.
https://doi.org/10.1007/978-­3-­319-­46138-­0_3
Myers, C., Garcia, A., Beidas, R., & Yang, Z. (2020). Factors that predict child welfare caseworker
referrals to an evidence-based parenting program. Children and Youth Services Review, 109,
104750. https://doi.org/10.1016/j.childyouth.2020.104750
National Center for Child Traumatic Stress: National Child Traumatic Stress Network. (2016).
Overview of trauma treatments and Practices. Retrieved from: https://www.nctsn.org/
treatments-­and-­practices/trauma-­treatments/overview.
National Child Traumatic Stress Network. (n.d.). Creating trauma-informed systems. Retrieved
from: https://www.nctsn.org/trauma-­informed-­care/creating-­trauma-­informed-­systems.
Peterson, C., Florence, C., & Klevens, J. (2018). The economic burden of child maltreatment
in the United States, 2015. Child Abuse & Neglect, 86, 178–183. https://doi.org/10.1016/j.
chiabu.2018.09.018
Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of
trauma and guidance for a trauma-informed approach (HHS Publication No. (SMA) 14-4884).
Rockville, MD.
U.S. Department of Health and Human Services. (2013, July 11). [Letter to State Medicaid
Directors]. Retrieved from http://www.medicaid.gov/Federal-­Policy-­Guidance/Downloads/
SMD-­13-­07-­11.pdf
Chapter 6
Child and Family Engagement in Child
Welfare Practice

Introduction

Child and family engagement is one of the most important components in child wel-
fare practice and is key in promoting the safety, permanency, and well-being of chil-
dren and families interacting with the child welfare system. In order to effectively
engage parents and children in services, cooperation, and work toward positive case
outcomes, it is essential for child welfare professionals to actively collaborate with all
family members as well as community members, and other key partners such as men-
tal health professionals, attorneys, child welfare staff, and extended family. Respect,
patience, empathy, and collaboration are important attributes and skills to practice
when engaging with families involved in the child welfare system.

Engagement

Engagement is a manner of interacting with another individual for the purpose of

encouraging participation. In doing so, the child welfare professional understands
the client has their own set of needs, experiences, and values (both cultural and
personal) that shape their actions. Until the client believes the person they are
interacting with (e.g., caseworker) understands their needs and is willing to help
them meet those needs, there will be little progress made. Disregard for those
needs and beliefs will often lead to estrangement and disillusionment on the part
of the client.
Family engagement occurs throughout the case in child welfare. It is a family-­
centered and strengths-based approach that involves establishing and maintaining
positive and collaborative relationships with families. Family engagement priori-
tizes joint efforts toward goal setting, developing case plans, making decisions, and

© Springer Nature Switzerland AG 2021 137

J. M. Geiger, L. Schelbe, The Handbook on Child Welfare Practice,
https://doi.org/10.1007/978-3-030-73912-6_6
138 6 Child and Family Engagement in Child Welfare Practice

communicating with each other to ensure safety, permanency, and well-being of the
family and children involved. This collaborative process involves all members of
the family (including children as appropriate depending on age), service providers,
extended family, kinship caregivers, and foster/resource caregivers.
Family engagement and empowerment in child welfare practice is particularly
important given the presence of a power differential. Regardless of the circum-
stances, child welfare professionals are in a position of great power when the child
welfare system becomes involved with a family as they often have control over
whether a child is removed from the home, how long a child is placed in care,
whether services are offered, what types of services offered, and whether a child is
returned home to their family of origin. The way that power and trust are used by
child welfare professionals is an important component in parental engagement in
the change process (Yatchmenoff, 2005) and may be predictive of case outcome
(Damiani-Taraba et al., 2017; Graybeal, 2007). Gladstone et al. (2014) examined
what casework skills contributed to parents involved in child welfare being engaged
with their workers. They found three key skills: (1) workers including parents in
planning, (2) workers being caring and supportive, and (3) workers praising parents
for their efforts, ideas, or achievements. Other studies have found an association
between engagement and workers’ honesty and straightforwardness, providing
information, and being able to listen and empathize (Platt, 2008), focusing on
strengths and being flexible (Gockel et al., 2008), and using clear communication
about agency involvement, returning calls, and being responsive (De Boer & Coady,
2007). In summary, research indicates that consistent strengths-based, family-­
centered, and culturally grounded practice is essential in managing potential biases
and maximizing family engagement and motivation in child welfare practice
(Gladstone et al., 2014).
Research has shown that family engagement in child welfare can enhance the
helping relationship, promote family “buy-in,” encourage parental participation
in services, increase motivation to complete services and requirements, expand
options for permanency and placement, improve the quality and focus of family
visits, increase placement stability, improve timeliness of permanency, build fam-
ily decision-­making skills, and enhance the fit in family needs and services.
Family engagement is relevant throughout all of child welfare. Ensuring that
families believe that the services or programs are useful and relevant to them is
important. Care must be taken to assess if programs and services meet the needs
of families involved with the child welfare system. For example, the evidence-
based parenting interventions Pathways Triple P had not been evaluated thor-
oughly with families in child welfare, and a recent study interviewed parents
involved in the program to understand their satisfaction of the program and
understanding of its appropriateness (Lewis et al., 2016). The study’s main find-
ing was parents found the program helpful and relevant. The study also high-
lighted barriers parents identified which can be used to help to improve
interventions and better engage families.
Strength-Based Practice in Child Welfare 139

Reflection
Initial Impressions: The Effects of Personal Bias
• What impacts someone’s first impressions?
• How can initial impressions affect (negatively or positively) a purposeful
helping relationship?
• When might initial impressions have positive outcomes? Negative
outcomes?
• How might the client’s initial impressions of the child welfare professional
impact the relationship? How do these impressions impact our ability to
effectively work with the client?

Strength-Based Practice in Child Welfare

A strength-based approach refers to the practice and policies that identify and culti-
vate the strengths of children, families, and communities. It acknowledges the indi-
vidual and collective strengths and challenges and emphasizes a collaborative
approach in engaging all family members in planning, implementation, and evalua-
tion of service plan goals. Strength-based practice, in general and in child welfare,
involves a number of skills and attributes, including an empowerment-focused
approach in developing and maintaining a collaborative relationship between the
client(s) and family that aims to create change and positive outcomes as families
work toward self-sufficiency. Strengths-based practice as a philosophy is consistent
with the values and ideals of social work and other helping professions and is
embraced by a variety of private and public child welfare agencies used to guide
practice with clients and systems. All children and families possess strengths that
can be used to improve their lives. Recent research has found that strengths can
improve mental health outcomes for youth with an experience of child maltreatment
(e.g., Kisiel et al., 2017). By identifying children and families’ strengths, we are
identifying the tools that will be used to resolve many of the issues they present
with. When we focus on strengths, we motivate our clients to change, give them
hope, and help them view themselves in a more positive light.

Research Brief
Engaging Parents in Child Welfare System Interventions
Brittany Mihalec-Adkins, M.S.Ed.
One critical component of successful child welfare system intervention is par-
ents’ meaningful engagement with services, requirements, and helping rela-
tionships (e.g., Platt, 2012; Yatchmenoff, 2005). Briefly, parent engagement is
140 6 Child and Family Engagement in Child Welfare Practice

critical because of the following: (1) parents cannot benefit from interventions
unless they are sufficiently participatory, and (2) child welfare authorities can-
not feel confident in parents’ progress and suitability unless they observe atti-
tudes, efforts, and commitment to remedying the conditions that led to child
protection services involvement. However, cultivating and maintaining mean-
ingful levels of parental engagement in nonvoluntary state-­mandated inter-
ventions have proven challenging – particularly among parents most in need
of services (e.g., Fusco, 2015; Toros et al., 2018).
Barriers to meaningful parent engagement identified include parent- or
family-level factors, such as histories of intimate partner violence (Kohl et al.,
2005), past and present substance misuse (Kemp et al., 2014), and poor men-
tal health (e.g., Littell et al., 2001) – all of which are prevalent (and often
comorbid; Stromwall et al., 2008) among parents in child welfare interven-
tions (Darlington et al., 2004; Guo et al., 2006). Parents with unmet personal,
social, and material needs understandably struggle to meaningfully and con-
sistently engage; fortunately, preliminary research has found promise in inter-
ventions that provide parents with material or financial support, and that
provide parents with “peer mentors” to help them navigate the intervention
process (e.g., Rostad et al., 2017a, b; Summers et al., 2012).
Parent engagement can also be stifled by various factors at the caseworker-
or intervention-level, including parent-caseworker relationships characterized
by poor communication (e.g., unclear expectations), conflict, overt power dif-
ferentials, stigma, and judgment. However, there is evidence to suggest that
when services feel relevant to parents, and when parents feel “heard” and
respected by caseworkers, they are more likely to persistently and meaning-
fully engage in services and to nourish positive helping relationships
(Chapman et al., 2003; Kapp & Vela, 2004). Indeed, caseworkers’ abilities to
be appropriately supportive and nonjudgmental with CWS clients have shown
promise for promoting parental engagement in services and positive attitudes
toward CWS personnel (Kapp & Vela, 2004). Similarly, parents have been
found to be more willing to earnestly engage when they felt that caseworkers
were not exploiting their obvious power (Dumbrill, 2006; Gladstone et al.,
2012; Maiter et al., 2006).
While initial efforts to identify paths to promoting parent engagement have
been promising, more research must be done to address remaining gaps and
limitations. For instance, there are vast array of definitions and assessments of
parent engagement employed across practice settings and research studies.
Reaching consensus on both can benefit future efforts immensely. Further,
extant research on child welfare-involved parents has focused almost exclu-
sively on mothers, leaving sizable and irresponsible blind spots in research
and practice when it comes to engaging and serving fathers (Brown et al.,
2009; Campbell et al., 2015; Maxwell et al., 2012).
Family-Centered Practice in Child Welfare 141

Family-Centered Practice in Child Welfare

Family-centered practice is based upon the belief that the best way to meet a per-
son’s needs is within their families. It is also the belief that services and support can
be provided to a child and their family to ensure safety, permanency, and well-being
by engaging, involving, and strengthening families by considering the whole family
and their communities. The key components of family-centered practice include
developing a trusting, respectful, and honest relationship between family members
and service providers, working closely with family members to ensure safety and
well-being, strengthening families’ ability to function well independently, engag-
ing, empowering, and working collaboratively with families while making deci-
sions and setting goals, and providing culturally grounded, individualized services
and supports for each family. Child welfare professionals who are family-­centered
strive to preserve the family and prevent out-of-home placement while providing
the necessary services and supports to ensure safety. The family-centered model
views families as being capable of making decisions for their own families, priori-
tizes strengths, and encourages families to advocate for their own needs. When safe
to do so, children should remain in their own homes to preserve the family unit. (See
Chap. 7 for information about family preservation.) In situations where children
must be placed in out-of-home care, the least restrictive placement is used, and
families continue to be actively involved, informed, and empowered to make deci-
sions that will lead to reunification. Community agencies can also engage in family-­
centered practice by providing evidence-supported interventions that cultivate
individual and family strengths and empower families to keep children safe, well,
and in the home with their caregivers. Family-centered practice involves meeting
clients “where they are,” which helps to understand that a client and their family
have a unique needs, experiences, and values that shape their actions.
Despite the widespread support and promotion of these approaches in practice,
the implementation of strengths-based and family-centered practice is often diffi-
cult (Lietz, 2013). Child welfare practice is challenging on an individual and sys-
temic level and requires a collaborative approach at multiple levels. There are a
number of ways that child welfare agencies can enhance family engagement on a
systems level as well as an individual level. For example, agency leadership, super-
visors, and staff can implement a family-focused organizational culture in practice
through policies and standards, by ensuring manageable caseloads, ongoing profes-
sional development, and access to services and performance review and monitoring
systems (Child Welfare Information Gateway, 2016). In casework, child welfare
professionals can utilize family-centered and strengths-based skills and practices to
enhance family engagement, such as being clear, honest, and respectful when com-
municating with families, ensure adequate time with families and check in fre-
quently, implement shared decision-making and participatory planning, offer
services that match needs, and encourage parents and children through the process.
Many agencies are implementing family engagement strategies to ensure cross-­
systems collaboration, shared decision-making, and family-friendly policies to
142 6 Child and Family Engagement in Child Welfare Practice

engage all members of the family. One common practice is the use of Child and
Family Teams (CFTs) that brings together family members and professionals
involved with the case regularly to brainstorm, set, and assess goals for the children
and their families in between court hearings. These meetings typically occur
monthly and focus on the needs of the children and the parents to ensure they receive
the social-emotional, academic, and physical health services to promote their well-­
being and family reunification. Similarly, some agencies use family group decision-­
making (FGDM) early on in the case to make decisions about placement, services,
family finding, and visitation. These meetings and groups also prioritize a family’s
strengths and their voice in making decisions that are best for their family.
Child welfare agencies recognize the importance of fathers to the healthy devel-
opment of children and how fathers have often been excluded when child welfare
systems become involved. Agencies are beginning to provide resources and guid-
ance about engaging fathers and working to enhance their positive involvement with
children. Services offered vary depending on the agency; however, they often
include assessment, planning, helping fathers understand the system, and strategies
for obtaining custody or improving parenting skills. Recently, there have been
evidence-­based parent training program developed specifically for specific groups
such as fathers or military families. Programs such as SafeCare Dad to Kids (Dad2K;
Rostad et al., 2017b) and mDad (Mobile Device Assisted Dad; Lee & Walsh, 2015)
are designed specifically for fathers. There is a need for more programs to address
the needs of fathers and to target specific groups of fathers (e.g., Black fathers,
fathers of adolescents) to increase engagement and ultimately child well-being
(Cryer-Coupet et al., 2020). There are also programs addressing the needs of mili-
tary families (e.g., Ross et al., 2020).
Another strategy is foster family – Practice Highlight
birth family meetings and increased use
of shared parenting. Shared parenting Elements of Family Group
refers to the practice in which foster par- Decision-Making (FGDM)
ents cultivate positive, supportive rela- • The presence of a coordinator
tionships with birth parents. Shared who acts as the group facilitator
parenting is a gradual process in which a • Recognition and acknowledg-
relationship is nurtured to a point of trust ment that the family group
and understanding. Families work represents an important deci-
together toward shared goals for the sion-making partner in case
child’s safety and well-being. This model • Inclusion of private family time
helps with improving the relationship • Preference of the case plan
between biological parents and foster developed by the family over
parents through communication, trust, other plans
care, and helps with modeling parenting • Provision of services, resources,
skills, which often contribute positively and supports for the case plan to
to family reunification efforts. These be successful
relationships allow both sets of caregiv- • Follow-up after the FGDM until
ers to establish a parenting routine and outcomes are achieved
standards. Early in the case, biological
Building Rapport and Developing an Alliance with the Family 143

parents can share important information about the child necessary to their care-
giving (e.g., likes and dislikes), and the foster parents can talk about the child’s
home environment and routine. Depending on the circumstances of the case, case
investigators can discuss these issues with the biological parents at the time of
removal, or this information can be exchanged during early court conferences
and/or family group decision-making (FGDM) or child and family (CFT) meet-
ings. This allows for multiple individuals who know the child well can offer their
ideas to ensure the child’s needs are being met.
Engaging parents as peer mentors has also been shown to improve family engage-
ment. Peer mentoring programs enlist people who were once involved in the child
welfare system as parents to help new parents navigate the system and meet case
plan goals. In many states, parent partner programs or birth parent leadership groups
have been successful in assisting parents faced with their children being removed
from their care and child welfare system involvement. It supports parents who need
the assistance and provides an opportunity for experienced parents in building skills
and improving a sense of purpose and self-esteem (Rockhill et al., 2015).

Building Rapport and Developing an Alliance with the Family

Respectful and successful intervention

Practice Highlight
with a family involved with the child wel-
fare system depends heavily on the rela- Parent Cafes: Building Protective
tionship between the child welfare Factors and Leadership
professional and the family (Van Zyl
Parent cafes are an informal and
et al., 2014). However, developing a posi-
inviting atmosphere with space for
tive relationship with families at risk for
gathering that mimics a café. They
child maltreatment can be challenging for
typically involve a small group of
all who are involved. It is possible these
four to six individuals that engage
families have had negative experiences in
in conversations around experi-
the past working with agencies and sys-
ences of child welfare. It is com-
tems and therefore are distrustful, fearful,
mon to have a peer host who has
or hesitant to engage due to negative per-
participated in other parent cafes
ceptions of the child protection agency.
and who may have training to facili-
The quality of this relationship is depen-
tate conversations that promote sup-
dent on developing a collaborative rela-
port and advice for other parents.
tionship with the family (DePanfilis,
2000) that begins at the first meeting and
continues throughout the case. In order to develop a relationship with the client, it
must be intentional, genuine, and planned. The relationship should be based on
trust, care, connection, and commitment. The child welfare professional and the cli-
ent must be willing to be vulnerable and understanding with one another.
The three “core conditions” of a helping relationship, according to Carl Rogers
(1957), are respect, empathy, and genuineness. Other researchers highlight relation-
ship qualities such as personal warmth, acceptance, affirmation, sincerity, and
144 6 Child and Family Engagement in Child Welfare Practice

encouragement (Duncan et al., 2010). By engaging in these seemingly basic skills,

the family and the worker can engage in a relationship where there is a sense of trust
and security, where the core issues can be dealt with, children are safe, and families
can be well together.
Respect, empathy, and genuineness are not only feelings or beliefs but also
actions. These skills must also be demonstrated in daily practice with children and
families. By showing respect, empathy, and genuineness, child welfare profession-
als can more readily make appropriate and balanced assessments, make necessary
referrals, and proceed with a case as required legally and morally. Showing respect
involves a child welfare professionals’ ability to communicate care for the individ-
ual and family, value, and acceptance of each person in the family. Children and
families experiencing child maltreatment require respect and acceptance in order
for professionals to be able to understand their circumstances and provide the best
care to ensure safety and well-being. Respect is communicated through words and
actions.
Empathy is also a critical skill
to demonstrate our ability to under-
Practice Highlight
stand where a family is and has
been, their experiences, to be able Key Skills to Increase Family
to manage our own feelings and Engagement
biases, and recognize that our
• Provide culturally grounded services.
experiences and feelings are sepa-
• Balance discussions of problems with the
rate from those of the family.
identification of strengths and resources.
Empathy involves active listening,
• Listen to and address issues that con-
reflecting, and understanding body
cern the family.
language, use of words, and emo-
• Help families meet concrete needs
tions. Empathy is key in building
(e.g., housing, food, etc.).
trust with children and parents
• Set goals that are mutually agreed upon.
involved in child welfare and build-
• Focus on improving family mem-
ing rapport and relationships. The
bers’ skills.
presence of empathy means
• Provide family with choices when
acknowledging bias, but withhold-
possible.
ing judgment, understanding the
• Obtain commitment that the family
trauma each member of the family
will engage.
may have experienced, and
• Share openly about what to expect.
acknowledging the role of individ-
• Conduct frequent and substantive case-
ual and collective experiences that
worker visits with parents, children,
have led the family to child welfare
and caregivers.
system involvement.
• Use effective and approved technolo-
Being genuine with others may
gies to engage families.
be easier than it is for others and
• Recognize and praise progress.
develops and improves over time
• Invite all members of the support sys-
and experience. It simply means
tem to be a part of meetings (extended
being honest, open, non-­defensive,
family, teachers, clergy, etc.).
and flexible in interactions with
Connecting with Children 145

children and families. People

• Clarify goals, roles, responsibilities,
respond more openly when we
and expectations.
present our true selves in a genuine
• Consider families’ other obligations
way. Being genuine does not mean
(e.g., employment) when scheduling
being unprofessional or overly
meetings.
casual in our interactions; it means
Adapted from Child Welfare Information
balancing our knowledge of the
Gateway (2016)
agency’s policies and procedures
with a calm, engaging, open
response. It means using positive language that does not blame, disrespect, or show
anger or disappointment. This approach reduces the likelihood of the parent or care-
giver being alienated, bitter, resistant, or closed to questions. More often than not,
our ability, as child welfare professionals to regulate our emotions, stay calm, and
show respect helps us relate better to the individuals we are working with. Child
welfare workers should focus on shared values and goals to be able to move forward.
All of these skills show others that we are there to help and empower the family
to understand the need for our involvement, to explore solutions, and use strengths
and resources to improve safety and promote well-being for all. Child welfare pro-
fessionals should approach families with the assumption that the family has the capa-
bility of making change, and it is within their role to help them in creating change.

Connecting with Children

Engaging children is a different skill set when working with families involved in the
child welfare system. Child welfare professionals must have knowledge about child
development and what to expect
for a specific age for a child.
Practice Highlight
Additionally, in these cases, chil-
dren are the victims of maltreat- How to Show Empathy, Respect, and
ment and will have experienced Genuineness
some level of trauma from the
• Active listening
abuse and/or neglect and possibly
• Appropriate body language
from being interviewed and/or
• Understanding the other’s point of
removed from their caregiver and
view and experience
home. Skills such as empathy,
• Using humor, appropriate self-disclo-
warmth, and genuineness should
sure, and warm expressions (smiles,
be used, as they are with adults.
eye contact, etc.)
Children may be suspicious and
• Summarizing
struggle to understand events and/
• Taking the time to understand culture
or consequences related to the cir-
and family traditions
cumstances. Child welfare profes-
• Always incorporating family strengths
sionals interviewing children
• Being present, available, and honest
should be sure to get on their level
146 6 Child and Family Engagement in Child Welfare Practice

physically and speak to them in a way that is appropriate for their age. For example,
they can sit on the floor with them and speak slowly while using words they can
understand based on their age. Also, child welfare professionals can also use cre-
ative means of communicating if necessary (nonverbally, through stories, or art), be
trustworthy and honest, and ensure their safety. In engaging children, child welfare
professionals must be aware of trauma indicators and screen and refer for treatment
as necessary.

Culturally Grounded Engagement in Child Welfare

Engagement helps to meet a family “where they are” and requires that we see a fam-
ily through a culturally grounded lens. It requires that we attempt to understand the
client’s motivation and reasons for their actions and acknowledge that this can help
us develop solutions toward planning for change. While understanding that cultures
may differ in how they view discipline and corporal punishment, we must always
use proper assessment tools to determine safety and risk and not excuse cultural
practices that might lead to child abuse and neglect. Chapter 3 discussed appropriate
discipline, and Chap. 4 presents the definition and assessment of child abuse and
neglect.
Four components to consider in developing culturally “competent” or cultural
“humility” include: cultural awareness, knowledge acquisition, skill development,
and inductive learning (Fong, 2001). These factors allow us to better understand
how others view their behaviors in relation to culture. We can learn from their
beliefs and match our response in terms of services and interactions to best serve the
child and family. Racial disparity and disproportionality continue to be an issue in
child welfare systems. As discussed in previous chapters, in many jurisdictions,
children of color are overrepresented in the child welfare system due to differential
treatment by race (Fluke et al., 2010), oftentimes as a result of bias, lack of under-
standing, or fear. Racial bias occurs on multiple decision-making levels including
reporting, investigations, and ongoing/permanency. These decisions often happen
on an unconscious basis, and at the individual level, there is no intention to treat
families differently; however, the bias is present, and it is often difficult to point to
one individual or decision that causes overall trends in racial disparity and
disproportionality.

Child Welfare Professional as Change Agent

The child welfare professional assigned to a case is not only one who manages and
reports on a case – they also are a change agent, someone who takes an active role
in promoting change. The intervention requiring change begins by establishing a
relationship with the family so that they feel capable and motivated to make changes
Child Welfare Professional as Change Agent 147

in their behavior, thoughts, and emotions to healthier patterns of relating to others,

particularly their family members. The child welfare worker facilitates change by
conducting comprehensive assessments; advocating for services; providing leader-
ship and support for the client; assisting the family in recognizing and accessing
their strengths and resources; helping the family build protective factors internally
and externally; and helping to keep a strengths, solution, and family-centered focus.

Practice Tip
Strategies for Building Rapport
• Use an open mind when working with the family.
• Determine what is most important to the family.
• Use reflective strategies by taking note of the words the family uses and
use similar language.
• Listen to the family’s account of the situation without interrupting.
• Ask the family what their goals are.
• Use open-ended questions.
• Explain your expectations, process, and purpose in working with the family.
• Involve the family in planning throughout the process.
• Acknowledge feelings and encourage openness and honesty.
• Be consistent and follow through.
• Encourage participation in decision-making and problem-solving.
(Berg & Kelly, 2000)

There are a number of skills and models that child welfare professionals can
adopt to facilitate change alongside their clients, including solution-focused therapy
strategies, motivational interviewing, and using a strengths-based, cognitive behav-
ioral model for change.
In order for humans to make changes, there must be certain elements present,
and they must be motivated to change. First, there must be a level of discomfort
present related to something that the family wants but does not have (e.g., children
removed, sense of peace and calmness, safety, stability). Second, the individual
must take responsibility and see themselves not only as part of the issue but also the
solution related to the discomfort. The individual must feel emotional security and
vulnerability in those who are there to support them through the process of change.
The individual must have a preferred alternative future, and that is how they envi-
sion the future to be. Lastly, they must have the ability and belief that they can
change. These are all elements that the child welfare professional can instill, sup-
port, and promote to assist with creating change; however, there must also be buy-in
on the individual’s part.
148 6 Child and Family Engagement in Child Welfare Practice

Solution-Focused Approach in Child Welfare

Solution-focused brief therapy (SFBT) Practice Highlight

was developed by Steve de Shazer and
Insoo Kim Berg and their team at the Examples of Solution-Focused
Milwaukee Brief Family Therapy in the Questions
early 1980s. The overall philosophy of • Tell me what you like most
the therapeutic intervention is to focus on about parenting.
solutions rather than the problems clients • Tell me about how you have
are facing. Main assumptions of the been able to manage (the chil-
approach are that: (1) all clients have dren/household).
strengths and resources; (2) the relation- • How were you able to overcome
ship between the client and therapist has obstacles in the past?
significant therapeutic value; (3) change • On a scale of 1 to 10, how would
happens all the time; (4) the focus you rate your progress since the
remains on the present and future, rather last time we met?
than the past; (5) small change leads to
bigger change; (6) clear goals are essen-
tial; and (7) it is not essential to know the cause of a problem in order to find a
solution (De Jong & Berg, 2008). Using a solution-focused approach in child wel-
fare practice helps the client consider a more positive and preferred outlook and
alternate future. The approach is accepting of all individuals, no matter their pasts,
actions, or experiences. Several strategies within SFBT are helpful in developing
positive rapport and change with clients. When using a solution-focused approach,
child welfare professionals use questions about past successes, exception ques-
tions (when the issue/problem does not occur), the miracle question, scaling ques-
tions, and coping questions. The purpose of asking questions about past successes
allows us to discover instances when the family was functioning well. Exception
questions allow us to learn more about the times when the problem was not occur-
ring but could have (e.g., where, when, how, who, etc.). The miracle question asks
the family to describe how things would look if the problem no longer existed as
if a miracle had occurred overnight. Scaling questions involve clients rating the
severity of the problem (on a scale of 1−10), from their perspective, and relation-
ship questions ask how other individuals (typically other family members) would
view the problem/issue. Finally, coping questions help clients discover their own
resources and strengths by asking them how they managed to cope given the chal-
lenging circumstances.
When applying this model to child welfare, practitioners should focus on capital-
izing on family strengths and setting goals that use a family’s specific language and
support “family ownership” and track progress while celebrating successes.
Solution-focused casework has been shown to be effective in increasing families’
involvement in their case plan, follow-through on referrals to service, and less recid-
ivism in terms of reports for repeat maltreatment.
Motivational Interviewing in Child Welfare Practice 149

Motivational Interviewing in Child Welfare Practice

Motivational interviewing, developed by William Miller and Steven Rollnick

(2002), is a directive, client-centered approach of eliciting behavior change by help-
ing clients to explore and resolve ambivalence. Compared with nondirective coun-
seling, it is more focused and goal-directed. The examination and resolution of
ambivalence are its central purpose, and the interviewer is intentionally directive in
pursuing this goal. Motivational interviewing is also a common method to support
families that may be ambivalent or resistant to engage in change with the child wel-
fare agency. There are four core techniques that allow individuals in families to
explore this ambivalence and motivate them to make changes at various stages of
the case, including the first interaction. The acronym used to describe these tech-
niques is OARS (Open-ended questions, Affirmations, Reflections, Summary).

Practice Tip
Motivational Interviewing Techniques
O – Open Questions: These encourage family members to use their own
words and elaborate on a topic.
“What do you know about why I am here today?”
“What is a typical day like for your family?”
“What has been challenging in your ability to parent lately?”
A – Affirm Client: This builds productive and cooperative working relation-
ships with families by engaging their positive intents, characteristics, or traits.
“Sounds like you’ve had a lot of challenges lately, but you have really worked hard to
make things better.”
“I’ve really noticed how positive you’ve been and open to making changes. Thank you.”
“I know it’s not easy to parent a child with special needs, but I admire how organized
you are and what great care you’ve taken.”

R – Reflect: This engages others in the relationship, builds trust, and fosters
motivation to change by ensuring breakdowns in communication don’t occur.
“You were angry with Bart for soiling his pants.”
“It sounds like this was a very frustrating situation.”
“You’re worried that LeeAnn will have a temper tantrum at the store next time.”

S – Summarize: This ensures there is clear communication between the

speaker and listener.
“Here’s what I heard you say…”
“Tell me if I understand this correctly…”
150 6 Child and Family Engagement in Child Welfare Practice

Open-ended questions are important to gather information from the client’s per-
spective. By asking open-ended questions, we avoid making any assumptions and
allow the client to offer information in their own words and experience. Affirmations
are used to recognize individual and family strengths and to use those to encourage
and motivate the client toward making a change. It also shows them that they have
the tools to make changes and helps them to build confidence. Statements about
progress and positive actions can also motivate a client toward change. Clients
respond to statements that show empathy and how we relate. This also allows for
open-ended questions to elicit more information about their abilities, motives, and
strengths.
Active listening is a critical skill in the helping profession when interviewing and
engaging clients. The key part of active listening is being able to reflect back what
the individual is saying in a way that shows understanding. It involves more listen-
ing and less talking to avoid giving advice or offering solutions, which is challeng-
ing for many to do. Reflecting involves statements of the client’s words to “check”
what the client is saying. For example, reflective statements use language that shows
understanding of their thoughts, feelings, and emotions based on what they have
said. Miller and Rollnick (2002) describe various types of reflections, including
simple, complex, double-sided, and amplified reflections.
Finally, summarizing is a key technique in motivational interviewing that allows
the listener to pull together important aspects of the conversation that summarize
what was said, getting agreement on issues, and going forward, what next steps are.
It involves obtaining a commitment to actions (from all involved) and addressing
some of the ambivalence that families
may have.
A change agent is often the source of Practice Highlight
support that helps motivate the client
Types of Reflective Statements
through the process. This process can start
in the first meeting and in as little as Client statement: “I don’t think
5−30 min and best used in subsequent this is fair.”
meetings with the client. The child wel-
Simple: “This doesn’t seem fair
fare professional can adopt the following
to you.”
several principles when motivating
change. First, they should express empa- Complex: “This feels unfair to you
thy. They can highlight apparent conflicts when nobody will listen.”
between stated goals and current behav-
Double-sided: “While you don’t
iors by developing discrepancies. It is
think this is fair, you are willing to
important to avoid argumentation and roll
participate in the classes.”
with resistance. Acknowledging and
accepting resistances as normal while Amplified: “Even with all of your
supporting self-efficacy encourages even efforts, none of this seems fair
small attempts with change. to you.”
Managing Difficult Encounters with the Family 151

Other motivational interviewing strategies include asking for permission, elicit-

ing change talk, exploring importance and confidence, normalizing, decisional bal-
ancing, using a supporting self-efficacy, and gauging readiness to change.
Practitioners also use what is referred to as the “Columbo” approach, which involves
presenting the facts that appear to conflict, giving the person an opportunity to
respond, and then asking questions to clarify the issues. Eliciting change talk can be
challenging when clients view themselves as being unable to change or unwilling to
change. The more we encourage them to talk about change, the more likely they
begin to think about change and take action to change. Some strategies for eliciting
change talk include asking them to scale the importance of an issue and their confi-
dence level. This allows them to think about where they are in the change process
and establish a reference point for measuring change. Second, asking clients to
verbalize extremes, using terms such as worst, best, biggest, and lowest, also gets
clients to think about moving toward change. Assessing progress with clients by
asking them to look back (to the beginning) and looking forward toward what
change looks like can be effective. Another strategy elicits the exploration of pros
and cons of change for the individual and their family. For example, “what are the
positives of not changing?” or “what are the downsides to not changing?”

Managing Difficult Encounters with the Family

Working with individuals and families who did not seek help can be challenging and
can often present with difficult circumstances. As a child welfare professional, we
have the authority and responsibility to investigate and monitor situations where
child safety is involved. Oftentimes in those circumstances, the adult caregivers or
biological parents are the individuals who are responsible or suspected of abuse or
neglect of the child. As a result, they will be hostile, resistant, and possibly reactive.
The child welfare professional’s approach in these situations can often predict how
the encounter will go; in other situations, they may have little control in what occurs.
There are a range of challenging encounters with families, from adults who do not
want to open the door and allow entry to those who are threatening violence. Verbal
and physical threats are all too common in situations that are as volatile as the threat
of removing a child from their parent. When dealing with resistance, denial, or hos-
tility, it is possible to still navigate a productive meeting or interview with another
adult without law enforcement involvement. By staying calm, in control, and non-­
defensive, child welfare professionals can work toward small steps in engaging in
discussion with the adult(s). Child welfare professionals can normalize the circum-
stances, avoid blaming or labeling, and acknowledge the difficult situation both the
child welfare professional and the parents placed in. It is important to note any
behaviors that are escalating or if feeling unsafe. In those situations, child welfare
professionals should prioritize their safety and leave and request support from a
supervisor or law enforcement. Be aware, use active listening, stay focused, and
keep an appropriate distance. Use discretion, be strategic, and know how to remain
safe. See Chap. 12 for more information about safety in child welfare practice.
152 6 Child and Family Engagement in Child Welfare Practice

 orking with Families Experiencing Mental Health

W
Challenges, Substance Abuse, and Intimate Partner Violence

When working with families, it is important to note various underlying conditions

that play a role in how a parent is able to care for a child. There may be issues that
are preventing a parent from providing the care a child needs, such as the presence
of mental health symptoms, developmental disabilities, substance abuse, and/or
domestic violence. These experiences vary and can change over time; however, the
presence of these underlying conditions may negatively impact a parent’s ability to
meet the child’s needs and may increase the risk of abuse or neglect. This does not
mean that abuse and neglect are present if a family is experiencing one of the under-
lying conditions. Once one of the underlying conditions has been identified with the
child or the parent, it must be assessed for a regular basis. Treatment or attention to
the condition may also be a part of the case plan goals and therefore must be moni-
tored throughout the case.

Practice Highlight
Motivational Interviewing: Sample Questions and Statements
Open-Ended Questions
“Tell me about your parenting experiences.”
“What concerns do you have about your parenting?"
“How can I help you with your parenting?”
Reflective Listening (Ambivalence)
“I hear you.”
“I’m accepting, not judging you.”
“Please say more.”
Affirmative Statements (Building Trust and Confidence)
“You are very courageous to be so honest about this.”
“You’ve accomplished a lot in a short time.”
“I can understand why this has been so hard for you.”
Summary Statements
“What you said is important. I value what you say. Here are the salient points.”
“Did I hear you correctly?”
“We covered that well. Let’s talk about …”
Elicit Self-Motivational Statements
Problem recognition: “I never realized how this has been a problem." "Maybe
I have been doing something wrong.”
Expression of concern: “I am really worried about parenting and how my
kids are being affected.”
Intention to change: “I don’t know how but I want to try.”
Theme about optimism: “I think I can do it. I am going to overcome this problem.”
Working with Families Experiencing Mental Health Challenges, Substance Abuse… 153

Substance Abuse

It is estimated that more than a third of child welfare cases involve alcohol or other
drugs as a contributing factor for removal (U.S. DHHS, 2020). With cases that
involve alcohol and other drugs, it’s important to consider timeframes. Policies
regarding permanency have certain timeframes for reunification or another plan for
children. (See Chap. 10 for more details about required timeframes.) In these cases,
we must consider time for treatment and recovery and the child’s sense of time
based on their age, attachment, and relationships with biological parents and foster
or kinship providers. As a child welfare professional, it is not our responsibility to
provide substance abuse treatment; however, it is our responsibility to assess for the
need for treatment by conducting a screening and assess the impact of the substance
abuse condition that impacts the child’s need for safety and well-being, and work
alongside the parent to obtain treatment and support success through child-parent
visits, providing tangible supports, and monitoring the use of the following treat-
ment. To facilitate success for parents experiencing substance abuse issues, a child
welfare professional can provide transportation for drug screenings, treatment,
groups, therapy, and visitation. It is important to work closely with the parent to
ensure they understand what is required of them and how they can work toward
reunification. Being aware of what substance abuse treatment typically entails is
also helpful. No one treatment approach is appropriate for everyone, and treatment
may be lengthy. Recovery often includes relapse; therefore, treatment should
include planning and supports to prevent relapse and promote long-term recovery.
Parents may deny the need for treatment, particularly inpatient treatment, and
they may be resistant to change. This does not mean they do not want to parent or
do not love their child. They may be without support, or may have legal or financial
barriers to treatment, which should be addressed to promote family reunification.

Note from the Field

A Family’s Struggle with Substance Abuse
Carol Taylor, MSW, LCSW
Maya1 was an African-American woman in her late 30s when she came to the
attention of DCFS for a second time. Maya had given birth to a baby girl that
tested positive for cocaine. When DCFS was alerted of the case, they realized
that mom had two adolescent boys age 13 and 16 already in foster care. The
boys had come into care over 10 years earlier due to Maya’s substance abuse.
Maya’s two sons had spent the majority of their lives in the DCFS system and
bounced around to several homes but had been in the current home for the last
3 years. Maya was in and out of their lives over the 10 years but never actively
working toward their reunification, and at the same time, no home until now
had been willing to do permanency. The current foster parent was also vacil-
lating in her commitment to move forward with adoption.
154 6 Child and Family Engagement in Child Welfare Practice

When the private agency was notified of Maya’s new baby, investigations
unit was making a decision on whether to remove the baby from her care. The
current situation was that Maya was now in a long-term relationship with the
baby’s father, John. John had a history of substance abuse and domestic vio-
lence but had been clean for the last couple of years. Maya agreed to go to
inpatient substance abuse treatment, and John was willing to take the baby
home. DCP made the decision to allow for John to be the primary caregiver
with a safety plan for Maya to complete treatment and be monitored by the
family case worker at the private agency.
The family case worker monitored Maya as she successfully completed
drug treatment; both Maya and John completed domestic violence classes and
continued to both drop clean. Since the new baby arrived, the family case
worker started visitation between both older boys, Maya, the baby, and John.
Since Maya and John continued to do well, the child and family team decided
to staff the case and discuss the possibility of changing the goal to return
home for the older boys. The boys wanted to go home, and Maya and John
desired them to be reunified.
At the next court date, the goal was changed to Return Home within 12
months. The case moved quickly since the risks that were in place years ago
were less due to Maya’s stability but also do to the boys being older and able
to protect themselves. Within several months, the youngest of the two boys
was returned home. Maya relapsed once but immediately went back to treat-
ment for the family to remain intact.
The oldest son did not return home. He had stopped attending school and
struggled with his own substance use. The child and family team decided that
a goal of Independence was best for him and the family in order to allow him
to focus on his own needs while Maya focused on raising her youngest two
children and remaining sober.
1
All names and other personal identifiers in cases and examples throughout
this book have been changed to protect privacy and confidentiality.

Intimate Partner Violence (IPV)

Intimate partner violence (IPV) is also common among families reported for child
maltreatment. The National Coalition Against Domestic Violence (n.d.) defines
domestic violence/intimate partner violence as the “willful intimidation, physical
assault, battery, sexual assault, and/or other abuse behavior as a part of a systematic
pattern of power and control perpetrated by one intimate partner against another.”
Violence includes physical violence, sexual violence, psychological violence, and
emotional abuse directed at one’s partner. When interviewing a client who presents
with an intimate relationship, whether it is a spouse or paramour/significant other, we
should assess for any violence and how the violence may affect the child and caretaker.
Working with Families Experiencing Mental Health Challenges, Substance Abuse… 155

Child maltreatment is more likely to

Practice Tip
occur in cases where there is intimate
partner violence (e.g., Hartley, 2002; Assessing for Intimate Partner
Herrenkohl et al., 2008). It is also often Violence
linked to severe and fatal cases of child
• Tell me about your relationship.
abuse. Perpetrators of intimate partner
• How are decisions made in your
violence may use children to establish or
relationship? How are disagree-
maintain control over the victim by physi-
ments resolved?
cally, emotionally, or sexually attacking
• Do you feel free to do, think, or
the children. Further, research has begun
believe what you want?
to document the impact on children living
• Does your partner ever act jeal-
in homes where intimate partner violence
ous or possessive?
is present. Proper assessment is critical in
• Have you ever felt afraid of your
the early stages and throughout the case.
partner? In what ways?
Child welfare professionals can assist
• Have you ever been afraid for
with treatment – therapy, shelter services,
the safety of your children?
financial services, and housing to assist in
preventing intimate partner violence and
preventing out-of-home care for the child.
Collaboration between child welfare professionals and advocates providing ser-
vices and supports to families who have experienced intimate partner violence is
important in working toward family reunification, family safety, and well-being.
Advocates can work with child welfare professionals to develop safety plans,
enhance family resilience, and provide necessary services and supports to families
in need of housing, counseling, etc. Child welfare professionals can offer expertise
around issues of child maltreatment, share information about the dependency case
(as appropriate), and collaborate on accessing services for children and families
exposed to intimate partner violence.

Mental Illness

One in 5 adults experiences a mental illness any given year, and 1 in 25 lives with a
serious mental illness (NAMI, 2019). A mental illness is a condition that impacts a
person’s thinking, feeling, or mood and may affect their ability to relate to others
and function on a daily basis. A diagnosis of mental illness according to the
Diagnostic and Statistical Manual of Mental Disorders (DSM), one must experi-
ence clinically significant impairment or distress in one’s personal, social, or occu-
pational life. National data are not collected regarding mental illness being the
primary reason for child removal; however, in a study of birth records in California,
it was estimated that more than a third (34.6%) of infants born to mothers with a
mental health disorder were reported by Child Protective Services within 1 year
(Hammond et al., 2017). Research also shows that approximately two-thirds of
women with mental illness are mothers (Nicholson et al., 2002), which may increase
156 6 Child and Family Engagement in Child Welfare Practice

the risk for child maltreatment (Chaffin

Practice Highlight
et al., 1996; Kohl et al., 2011; Moore
et al., 2004) and foster care entry (Park Mental Illness and Symptomology
et al., 2006). It is also documented that
Major Depressive Disorder
parental mental health can impact chil-
dren’s well-being (e.g., Marçal, 2020). • Depressed mood
This has implications for child welfare • Diminished interest or pleasure
professionals. Although as a child welfare • Significant weight loss
professional, we do not diagnose clients; • Insomnia
it is helpful to be aware and become famil- • Chronic fatigue
iar with signs and symptoms of mental ill- • Feelings of worthlessness
ness that may warrant referral for further • Lack of concentration or
assessment or treatment. Some common decisiveness
types of mental illnesses encountered in • Recurrent thoughts of death
child welfare work include major depres-
Bipolar Disorder
sive disorder, anxiety disorders, bipolar or
mood disorders, and schizophrenia. • Significant mood swings
The most important issue to consider • Inflated self-esteem
when working with families faced with • Racing thoughts
mental health challenges is the impact of • Distractibility
the mental illness on parenting ability. If a • Decreased need for sleep
parent or caretaker has been diagnosed • Irritability
with a mental illness, it does not mean
Schizophrenia
they are incapable of parenting. However,
children whose parents have mental ill- • Delusions
ness are at increased risk for mental health • Hallucinations
problems, which have implications for the • Disorganized speech
child’s needs and possible treatment. • Grossly disorganized behavior
Maternal depression (and schizophrenia) • Magical thinking
is associated with other risk factors (e.g.,
psychosocial stress, poverty, or marital
difficulty), and mothers who experience depression, particularly new mothers or
mothers who have recently given birth, may be more negative when interacting with
their infant. It has been shown that insecure attachment is more common in children
of mentally ill parents, and conflict between parents and children is more prevalent
in families where a parent is mentally ill. Child welfare professionals should be able
to recognize when a parent’s mental illness might be a concern, determine when a
mental health assessment is needed, and be able to refer the parent to a mental
health provider. Close collaboration with the parent and the provider is important,
as well as including appropriate mental health interventions in the case plan and
monitoring mental health throughout the case.
Promoting Collaborative Practice in Child Welfare 157

Promoting Collaborative Practice in Child Welfare

There are many different professionals and individuals who serve various roles in
the child welfare system. Further, as child welfare professionals, we interact with
individuals who are a part of other systems as well, such as the judicial system,
health, mental, and behavioral health system, and educational system. To promote
positive family and child outcomes, it is necessary to collaborate with various indi-
viduals who play a role in the life of the child and family and the case process.
These individuals may be providing care for the child (e.g., foster and kinship care-
givers, group home, or residential staff), be involved with the legal aspects of the
case (e.g., law enforcement, dependency court staff, attorneys, etc.), serve as a men-
tor or advocate for the child or parent (e.g., CASA, guardian ad litem), provide
necessary services for the child or parent (e.g., therapist, medical provider, special-
ist, home visitor), or may be a part of the immediate or extended family.
Child protection requires people working together. It may not always be easy due
to differences in professional training and personalities. While we all have the over-
arching goal of child safety, sometimes there are different views of how best to
accomplish this. Sometimes there are certain protocols within an agency that may
seemingly conflict with the protocols of another agency or views of a professional.
There may be “turf” issues where different professionals do not readily share infor-
mation and work together when possible. Sometimes there are communication
issues stemming from differences in professional training. Professional skills and
practice are generally necessary in all of these relationships; however, there are
some differences in interactions, requirements, and considerations, as the child wel-
fare professional that may show to improve collaboration with these individuals
and groups.

Working with Substitute Caregivers

When children are in out-of-home placements, they are placed in a variety of set-
tings, and often multiple settings during their time in care. (See Chapter 9 for details
about out-of-home placements.) Children are most often placed in family-like set-
tings, with relatives or not relatives or in residential homes and facilities or group
homes, depending on the child’s needs. As discussed in earlier chapters, many fac-
tors play into the child’s initial and ongoing placements, including preferences,
availability, safety, and the child’s needs. Those residing or working in those place-
ments play a critical role in the care, safety, and well-being of the child and spend a
considerable amount of time with them. They are charged with ensuring the medi-
cal, educational, and social-emotional needs of the child is being met on a daily
basis. They must also stay apprised on case processes and promote or facilitate
parent or sibling visitation, court attendance (for older youth), and therapy or other
appointments the child requires. Given the nature of a child being in care and the
158 6 Child and Family Engagement in Child Welfare Practice

trauma associated with child maltreatment and removal from their parents’ care, a
child may need therapy or additional medical attention. Caregivers also need to be
available for home visits from case managers, attorneys (e.g., guardians ad litem) or
family or service providers. They are the ones who spend a considerable amount of
time with the child and are responsible for their care and well-being; therefore, it is
critical to have open and regular communication with them as a child welfare pro-
fessional, as well as fair expectations, while also allowing for decision-making
skills and autonomy in care, as appropriate.
In a recent study, researchers asked Practice Tips
foster care providers for their suggestions
Supporting Caregivers in
to improve relationships with child wel-
Promoting Mutual Attachments
fare workers and found that foster care
with Children
providers wanted caseworkers who were
responsive to their needs, provided con- Children in care have exten-
crete and emotional support, and improved sive needs.
communication and teamwork (Geiger • Support the foster family to be
et al., 2017). They also recognized that accepting of the child’s needs.
many child welfare professionals were • Help caregivers prioritize needs
often overwhelmed with system chal- and understand they do not have
lenges. Foster parents’ decisions to con- full responsibility for meeting
tinue fostering are influenced by the level all the child’s need.
of respect and recognition as integral • Encourage them to not neglect
members of the team (Geiger et al., 2013). their own needs.
Many discontinue fostering early due to Child’s emotional energy is
issues with the child welfare system or devoted to the grieving process.
navigating the system, concerns about the Give children “permission” and
child’s behavior, stressful interactions space to express their feelings.
with the biological parents, or being • Work with families in providing
named in allegations of abuse (Rhodes the child with consistent/accu-
et al., 2001). All of these reasons can be rate information about his/her
mitigated through positive support and family, placement, and visitation.
relationships with the child welfare • Secure appropriate therapeutic
agency and staff. For example, the case services as needed.
manager can provide social-emotional Child may not have a foundation
and behavioral services or therapy for the for healthy attachment.
child; promote shared parenting as appro- Encourage the caregivers’ consis-
priate and make sound decisions about tent efforts to protect, nurture, and
biological parent-foster parent interac- meet the child’s needs.
tions; reduce the impact of abuse allega- • Help them to not expect “too
tions through support; system response; much, too fast.”
and service provision. Further, studies • Assist foster families in finding
show several important interpersonal and additional support (e.g., agency
professional skills that promote positive resources, caregiver support
relationships between child welfare pro- groups).
fessionals and foster parents, including
Promoting Collaborative Practice in Child Welfare 159

having a physical presence and open communication (MacGregor et al., 2006), trust
(Chipungu & Bent-Goodley, 2004), and establishing and maintaining a positive rap-
port (Rhodes et al., 2003).
The relationships between foster care providers and child welfare professionals
are critical in recruiting and retention efforts in child welfare. Improved relation-
ships often can prevent placement disruption and enhance the over well-being of the
child, their caregiver, and family. Positive relationships can improve overall satis-
faction and feelings of inclusion and respect. Child welfare professionals will inter-
act the most with foster care providers and are the ones who are able to provide
services to the child and the family, highlighting the importance of this relationship
in promoting safety, permanency, and well-being. Retaining quality foster care pro-
viders has implications for child well-being by promoting placement stability, the
development of secure attachments, and pro-social behaviors (Ramsay-Irving,
2015). Increased stability and support from their caregivers can improve a child’s
mental and emotional health and reduced risk of re-traumatization (Rubin
et al., 2007).
Child welfare workers can also learn more about the licensing requirements for
foster parents, stay attuned to available trainings to take part in and recommend to
foster parents, and include foster parents as team members in case management,
promoting permanency, and making decisions. Foster parents should be kept
apprised about the case, its status, any changes, and should be consulted about the
child’s needs and desires.
Licensed foster care providers receive hours of pre-service and ongoing training
and have to complete a number of assessments and evaluations to become licensed.
Many have experience working with children and the child welfare system and
often know how to advocate for services and the needs of the children. However,
many kinship care providers have not interacted with the child welfare system as
caregivers or professionals or may possibly have a negative impression, or experi-
ence with the system may present with challenges in understanding and navigating
the system.

Working with Kinship Placements

There are many similarities in terms of what kinship caregivers need when caring for
children in out-of-home placement. Children placed with kin still need the stability,
services, and support as licensed foster caregivers. Caseworkers should identify the
child and family’s needs and tailor them to support kinship placements, while also
helping children in foster care maintain positive family connections. In all cases,
child welfare professionals should work with kinship caregivers and provide full
disclosure throughout the case, including prior to placement. They should provide
information about the child welfare system, what one can typically expect in the
course of a case (e.g., court hearings), their roles and responsibilities as a kinship
caregiver, and sources of support (e.g., financial support, social support, tangible
support) within the agency and in the community. Discussions should include options
about permanency and their thoughts, beliefs, and feelings about those options.
160 6 Child and Family Engagement in Child Welfare Practice

Working with Residential and Group Home Placement Staff

Child welfare collaboration with residential or group home staff is very similar to
working with other care providers; however, some differences exist in terms of the
environment, communication, and involvement. Due to the nature of a staffed facil-
ity as a placement, there will be more than one or two caregivers in the home or
placement, and these staff work in shifts and may also not be long term. Relationships
between the youth and staff vary, with some establishing strong relationships, simi-
lar to a mentoring role that is built on trust and understanding, while others are
based on meeting basic needs within the setting. Again, many of the staff and man-
agement may spend a great deal of time with the youth, getting to know them and
can offer support and guidance throughout their case. The home leader or manager
may participate in child and family teams, educational meetings (e.g., IEP, caregiver
conferences), and facilitate visitation, recreation, etc. They also are a key member
of the team to assist with implementing the case plan in the home with the youth and
providing important feedback to the child and family team and the case manager.

Note from the Field

Child Removals Are Never Easy
Carol Taylor, MSW, LCSW
Lia is a 14-year-old African-American girl who had been living with her
grandmother for most of her life in kinship care within the child welfare sys-
tem. Grandma was struggling with the normal ups and downs of adolescence.
The permanency plan for Lia was to have Grandma to adopt her. On a Friday
afternoon, I, who had been working with the family for over a year received a
call that the Grandma could no longer care for Lia and requested her removal
immediately. I attempted to deescalate the situation and offered support, but
Grandma was unwilling to give it any more time.
I arrived at the home to find the tension very high. Grandma reported that
Lia was being disrespectful toward her and that she could not have her live
there any longer. I talked with Lia who was unusually quiet and visibly sad.
Lia had the perspective that Grandma was too strict and would not allow her
to do anything.
I attempted to offer support and see if there was anything that would help
Grandma to allow her to stay, but she was tired and needed the break. I talked
with Grandma alone to see if there were any family that she was aware of that
may take Lia at this time to allow for Lia to stay with family. Grandma did not
have any suggestions.
Promoting Collaborative Practice in Child Welfare 161

Lia and I left the home with Lia’s belongings in a combination of bags and
garbage bags. The protocol was to rule out kinship care, then consider foster
care, and as a last resort contact a shelter. Since this was a Friday afternoon,
there was an additional challenge of not being able to quickly be in contact
with anyone, and additionally, the child welfare office was closing and would
not be an option.
Once Lia was out of the house, she asked about her Aunt as an option for
placement. We attempted to reach her Aunt with no avail. At the same time, I
continued to leave messages for foster parents and as a last resort start the
process of having Lia go to the shelter. The foster parents that were reached
were hesitant to take on a soon-to-be freshman in high school despite that she
received good grades and had no behavior concerns outside of the normal
desires for more independence that adolescence brings. The shelter process
required proof of contact with multiple caregivers prior to consideration for
Lia to be placed at the shelter; since I was not hearing back from several care-
givers, we were at a standstill.
During this time, Lia remained quietly distraught with her current situa-
tion. I continued to talk and encourage Lia despite the difficult situation. I
eventually was able to reach her Aunt to discover she would be willing to have
her come to the home but would not be home until 10:00 pm that evening.
After a trip to McDonald’s and hours of time together, we arrived to the Aunt’s
home around 10:00 pm. Lia visibly showed signs of relief when she was wel-
comed by her Aunt to the home.

Working with Law Enforcement

Law enforcement officers can be important allies in keeping children safe. Child
welfare professionals and systems can enhance partnerships with law enforcement
by educating them about the nature of their work and the laws governing child pro-
tection. They can also help law enforcement systems and officers about child wel-
fare’s focus on strengths-based, family-centered practice with children and families
and can help them to understand the similar and different approaches professionals
within each sector respond to and address the needs of children and families. Law
enforcement officers may be the first responder in a situation where a child welfare
professional is needed to assess and provide a safe and stable placement for the
child. Likewise, child welfare professionals may require the support of law enforce-
ment in cases where the safety of the child, caseworker, or other household member
might be at risk in the home, court, or meeting place. Law enforcement may accom-
pany the child welfare worker in situations where there is potential danger or if a
family member has a history of being violent. It is important to understand the roles,
responsibilities, and skill sets of each of the professionals, given the circumstances.
162 6 Child and Family Engagement in Child Welfare Practice

Both professionals work together by sharing information, communicating effec-

tively, and collaborating to ensure the safety of all involved. Both units should be
cross-trained on issues where child welfare professionals and law enforcement offi-
cers might interact. Both should be trained in using a trauma-informed approach
when working with families, which means minimizing trauma to all parties involved,
and understanding that trauma may play a role in the family’s circumstances.

Working with Attorneys and Court Personnel

As with practice with other professionals, child welfare workers must be aware of the
roles, responsibilities, and common practice of those they work with and, likewise,
help them to be aware of the roles, responsibilities, and common practice of child
welfare professionals. By delineating these roles, we can promote a healthier, more
productive collaboration with shared goals. As discussed in Chap. 2, attorneys and
court personnel serve different roles based on the practice jurisdiction; however, get-
ting to know these roles and what the child welfare professionals’ relationships are to
them and within the case is helpful in collaboration. The parents’ attorneys, child’s
attorney, guardian ad litem (typically an attorney), and state’s attorney (agency attor-
ney) all represent different members involved in the case. In other words, their respon-
sibility is to represent the wishes and best interest of that individual or group. In most
cases, all or many parties to the case can come to an agreement about decisions and/
or recommendations made to the court, and sometimes they may not. As child welfare
professionals, it is our responsibility to provide reports and information (as appropri-
ate and required) to each party within a reasonable amount of time. Attorneys will
often be invited to agency and family meetings and may or may not attend or send a
representative but should always be informed of meetings involving their client. With
regard to legal matters, attorneys should always talk to other attorneys (instead of the
clients of other attorneys); however, it is often common practice for the attorneys to
approach the child welfare professional about specifics of the case (e.g., progress, case
plan, visitation) when appropriate. By using effective communication, members
involved with the case can create more efficient case processes and ensure safety,
permanency, and well-being for the child and family.
Court personnel (e.g., bailiff, judicial assistant, court reporter) are also integral
parts to the team. They may not be actively involved in the case processes or be
aware of case details; however, they serve an important role in facilitating informa-
tion sharing with the judicial officer (e.g., judge, commissioner) on the case, who
also requires all court reports and information shared with all parties. This individ-
ual also serves as a liaison with the judge in terms of motions and other court docu-
ments being filed, reviewed, and approved and often manages the court calendar.
The bailiff helps maintain security and safety and may coordinate court proceedings
at times. Maintaining positive relationships with the court personnel can facilitate
efficient and productive court proceedings.
Promoting Collaborative Practice in Child Welfare 163

Practice Highlight
The Importance of Understanding the Needs of the Children Entering
Foster Care
Barbara H. Chaiyachati, MD, PhD
Entrance into the child welfare system may represent a vulnerable transi-
tion for children with regard to medical care. Medical history may be lost
amidst the many simultaneous priorities of information gathering. Caregivers
may not provide complete information, intentionally or unintentionally. For
example, caregivers may not have immediate recall of complete information
at this high stress point. Caregivers may wish to obfuscate for any number of
reasons including insight to inadequate utilization of health care. Transmission
of health information between responsible caregivers – from biological par-
ents to foster parents and hopefully back to biological parents – is typically
completed via child welfare professionals. This game of telephone can be
fraught with errors and omissions.
Removing a child from a home without having adequate information may
result in loss of access to life-saving medications or vital equipment for daily
success, such as eyeglasses. It may also impede children’s ability to continue
in established medical homes depending on location of foster care placement
as well as perceived or actual impacts on insurance. After entrance to foster
care, unstable placements may further disrupt normal access to health care.
Even if outreach is initiated by healthcare providers, the medical records may
not contain appropriate contact information for current foster care providers.
Additionally, issues of who can consent for medical care of a minor can create
real and perceived barriers to receiving appropriate medical care. There is a
need to prioritize communication and continuity to ensure children receive
the necessary medical care while in the child welfare system.

Working with Medical and Behavioral Health Providers

Pediatric professionals, emergency staff and personnel, nurses, counselors, family

medicine professionals, and others who help to promote physical and mental health
are key members of the child welfare team. Not only do they provide services and
supports for children and families already involved in the child welfare system, but
also they are responsible for identifying and reporting suspected abuse and neglect. It
is well documented that children with a history of child maltreatment and those who
enter the foster care system often have greater physical and mental health needs when
compared to their same-aged peers who have not had those experiences (e.g., Minnis
et al., 2006). As a result, it is critical that child welfare professionals work alongside
healthcare and mental health professionals by providing the information and support
164 6 Child and Family Engagement in Child Welfare Practice

needed for them to best treat the child, meet with and discuss progress and/or concerns
to facilitate a joint decision-making process, work together to facilitate improved
access and service delivery and coordination of care, and make the necessary referrals
and recommendations for needed care. Coordinating physical and mental health care
requires good communication, obtaining, maintaining, and consolidating records to
ensure proper care, enrolling, and ensuring appropriate coordination when coverage
or services change (e.g., aging out, family reunification). These professionals share
common philosophies of care with child welfare professionals in that they take
responsibility to prevent child maltreatment, uphold confidentiality and privacy of
children and families, use trauma-informed care and practice, and serve as a resource
to children, families, and those who manage cases in child welfare.

Note from the Field

Advocating for Therapy and Academic Supports
Libby Fakier, MBA
Most of the children who have been placed in our care struggle academically,
either because of the circumstances in their birth home or due to changes in
school placement as a result of moves from placement to placement. Exacerbating
the issue is that many children in care have learning disabilities, psychosocial
challenges, and generalized anxiety that inhibit their ability to learn.
When a child comes into our home, we meet with the case management
team to assess grades, individualized educational programs (IEPs), learning
disabilities, psychological evaluations, and supports that are currently in place.
Often, we find that the child has not been evaluated for services or that evalua-
tions were not followed up with approvals and implementation of therapeutic
services. We see that children go years without services and suffer academi-
cally, psychologically, and physically because by the time they are evaluated at
one placement, they are moved again before services are implemented. At the
outset of receiving a new placement in our home, I advocate for my children to
immediately receive psychological counseling with a professional that I have
worked with for years. This creates the foundation of care for my kids on which
we can build supports for all the other areas where the child needs help.
Wading through the bureaucracy is not for the faint of heart and requires a
determined and unrelenting mindset to ensure that children in care get the
services and support they need and deserve. Foster parents must be vigilant
about advocating for their children’s needs and not give up when the case
management team or public school system either denies services or drags
their feet about getting evaluations completed and services implemented.
Daily calls, weekly emails, and constant follow-up with everyone on the case
management team are essential to securing services in a timely manner.
Promoting Collaborative Practice in Child Welfare 165

There’s a very small window to address children’s psychological or thera-

peutic (physical therapy, occupational therapy, and speech therapy) needs to
get them back on track. Medication evaluation and management must be
streamlined so children have continuity of care and mental health issues are
addressed before the child decompensates. Time is of the essence. Foster par-
ents have the moral obligation and responsibility to ensure that their chil-
dren’s needs are met as quickly as possible. They must remain unconquered
in their fight to advocate for the support services their children need to grow,
heal, and succeed.

Working with Educators and the School System

Educators (especially elementary, secondary, and early childhood) play an impor-

tant role in the well-being of children in general, and in particular children involved
with the child welfare system. They spend a great deal of time with children and
their families, build strong relationships with them and the community, and can be
a great resource to them. They are also the most common professional to report
child maltreatment and are critical in the prevention of child maltreatment. Educators
can provide critical information to child welfare professionals who are investigating
an allegation of child maltreatment and can also offer knowledge about child and
family strengths, sources of supports, as well as needs. They have insight into the
community and its resources, as well. When a child is in out-of-home placement,
educators and other school professionals (e.g., school social workers) can assist
with obtaining school records, making referrals, conducting, and evaluating educa-
tional and behavioral assessments as needed. Educators and school professionals
can help with ensuring stability and normalcy by offering extracurricular activities,
remedial support, tutoring, and promote social-emotional well-being. Child welfare
professionals rely on educators and other school-level professionals to support chil-
dren and their families in learning and improving overall family functioning.
Child welfare professionals can partner with educators and school staff to ensure
children are ready to learn and are offered the resources and supports for an optimal
learning environment. Children who have been maltreated and/or who enter the
child welfare system are often behind academically. Specifically, children entering
foster care may not be at grade level for their age, may require special education, or
other supportive services (speech, occupational therapy, etc.), and may not have all
of the necessary paperwork and documentation required to enroll. Child welfare
professionals can work with schools and districts to make efforts to keep children in
their school of origin to reduce the emotional and academic impact of moving
schools and peer groups. The Fostering Connections Act provides guidance regard-
ing keeping children in their home schools by providing transportation and sup-
ports. When this is not possible, child welfare professionals and schools should
166 6 Child and Family Engagement in Child Welfare Practice

work together to ease the transition. The Uninterrupted Scholars Act of 2013 also
assists with records access and sharing with appropriate personnel and systems.
Similarly, Every Student Succeeds Act (ESSA) of 2015 promotes collaboration
among education and child welfare professionals to ensure stability and decision-­
making. Child welfare professionals can also ensure that educators and other school
professionals are aware of the child’s situation regarding child welfare system
involvement and invite them to be a part of the child and family team.

Research Brief
Engaging Fathers in Child Welfare Practice
Justin S. Harty, MSW, LCSW and Tova B. Walsh, PhD, MSW
Father involvement in children’s lives and in child and family services has
important consequences for child well-being. Father involvement in chil-
dren’s lives is associated with positive social, emotional, and cognitive out-
comes for children from infancy to adolescence and into adulthood. Father
engagement in child and family services including parent training, family
therapy, and permanency planning is associated with improved child out-
comes. A growing body of research demonstrates that fathers provide a unique
contribution to their children’s development and suggests that outreach,
engagement, and inclusion of fathers are an important strategy for improving
well-being, permanency, and safety of children and families involved with the
child welfare system.
Yet father involvement in child welfare services is generally low. It is
widely recognized that fathers face numerous obstacles and barriers to
engagement in child welfare services. Trauma, mental health issues, sub-
stance use disorders, incarceration, or other challenges may limit their capac-
ity to be fully engaged. Competing demands, time constraints, intermittent
employment, and housing instability may present additional barriers. Fathers
may have a decreased willingness to engage when they have adversarial rela-
tionships with their child’s mother; the mother holds negative views of their
parenting; or the mother acts as a gatekeeper. Child welfare practitioners who
believe fathers cannot be trusted are reluctant to participate in services, or
present risk to children and families also creates conditions in which fathers
are less likely to engage in services. It may be challenging to engage some
fathers in child welfare practice. However, there are things that child welfare
practitioners can do to more effectively engage fathers. Strategies include:
Child and Family Teams 167

• Engage with fathers as early and equally as mothers, including engaging

fathers in case planning, meetings, and court dates, and other important
case-related tasks.
• Engage fathers whenever possible, even when fathers have not engaged in
the past.
• View every decision point, case event, and exchange as an opportunity for
father engagement.
• Use a father-focused, strengths-based approach that emphasizes fathers’
self-determination and strengths.
• View fathers as an asset and not a risk. Recognize that fathers generally
want what is best for their child and address obstacles or barriers prevent-
ing them from engaging in services or from meeting the needs of their child.
• In cases where fathers have presented risk to children or mothers, continue
to assess if, when, and how fathers may be safely engaged in the future.
• Explore fathers as viable placement options and paternal family members
as resources for support and permanency planning.
Engaging fathers in child welfare practice is not limited to fathers with
children involved in the child welfare system. Child welfare practitioners
need to be prepared to engage men as foster fathers, including single and
same-sex fathers, as well as young fathers in foster care. Practitioners must
also recognize that fathers are not a homogenous group, and child welfare
practice must be tailored to meet the needs of diverse fathers and families.

Child and Family Teams

A child and family team are a group of individuals identified by the child and fam-
ily, as well as the professionals familiar with the case to brainstorm strategies around
strengths, resources, and needs of the child and the family. The goal of the child and
family team is to establish shared goals that will meet the needs of the family and
keep all team members apprised so that they may contribute resources and supports
in attaining the family’s goals. Teams can consist of children/youth, substitute care-
givers, biological parents, extended family, educators and school personnel, natural
supports (e.g., clergy, neighbor, mentor, friend), mental health providers, Court
Appointed Special Advocate (CASA), or legal/law enforcement staff (e.g., attor-
neys, probation).
168 6 Child and Family Engagement in Child Welfare Practice

Child and family teams are intentional

Practice Tip
and critical to strengthening and support-
ing a family involved with the child wel- Facilitating a Child and
fare system. They involve planning, Family Team
creating a mission statement, document-
Encourage participation and
ing strengths and needs, and developing
collaboration.
and monitoring of a plan of care. The
planning stage involves developing a team Address any conflict that occurs
through outreach and engagement, devel- through discussion.
oping a family mission, and helping to
Be aware and promote child and
orient the family to the child and family
family voice.
process. After exploring and noting all
family strengths, a family will develop a Be cognizant of agency and policy
needs statement, which addresses the requirements for meetings (e.g.,
“what” of the circumstances. For exam- frequency, duration, membership).
ple, there may be specific reasons a child
Acknowledge successes, strengths,
came to the attention of the child welfare
and effort of all team members.
system; however, there may also be some
underlying reasons that have led the fam-
ily to require additional services or resources. However, needs are not services.
Child welfare professionals may be asked to facilitate child and family teams.
Other times, this is the responsibility of a mental health team leader or another team
member. Some ideas to facilitate the process of the meeting and team are to allow
for introductions, establish ground rules, develop a family vision and/or mission,
and review any safety or crisis plans to begin. The team will identify needs in early
meetings and develop goals accordingly. The team will brainstorm ideas about ser-
vices that will address the needs identified, followed by who will complete specific
tasks related to the goals and objectives. During the facilitation of child and family
teams, it is important to establish and follow the group rules set forth by the team
and to be aware of the time and manage it well. It helps to have an agenda to follow
to ensure time management. It is important to be flexible, in control, creative, and
think beyond traditional services offered. Keep the family central to the team and
the meetings and focus on solutions rather than the problems that are creating
barriers.

Conclusion

Family engagement is the core of child welfare casework and helps us work toward
child safety, permanency, and well-being. Effective engagement with the child and
the family requires individual skills and collaboration among providers, extended
family, and must be infused into the child welfare systems. Despite the challenges
often encountered when engaging families in a difficult process, child welfare pro-
fessionals acknowledge the benefits of including all family members in a
Conclusion 169

family-­centered, strengths-based approach to making decisions, setting goals, and

working alongside to achieve those goals to strengthen the family.

Acknowledgments The authors thank Brittany Mihalec-Adkins, M.S.Ed; Carol Taylor, MSW,
LCSW; Barbara H. Chaiyachati, MD, PhD; Libby Fakier, MBA; Justin S. Harty, MSW, LCSW;
and Tova B. Walsh, PhD, MSW, for their contributions to Chap. 6.

Discussion Questions
1. Why is engagement so important in child welfare practice?
2. What are three ways child welfare professionals can increase family engagement
with child welfare services?
3. What are three ways to build rapport with children and families?
4. How are cases involving substance abuse, intimate partner violence, and mental
illness different from other cases in child welfare?
5. What are three strategies for healthy collaboration with other key partners in
child welfare (e.g., foster parents, residential staff, educators, etc.)?

Suggested Activities
1. Listen to the “Engaging Fathers” Podcast series with Child Welfare Information
Gateway. Consider ways to engage fathers throughout the life of a case. https://
www.childwelfare.gov/more-­tools-­resources/podcast/episode-­6/
2. Watch: “Building Partnerships in Child Welfare” and think about ways to work
collaboratively among multiple team members: https://www.youtube.com/
watch?v=ES8Vij2CNBA
3. Watch: “Interviewing the Child Client” to better understand how attorneys and
other professionals can interact appropriately with children in cases of child wel-
fare investigations: https://www.youtube.com/watch?v=OYLWkVH
vgOM&t=45s
4. Read Kisiel et al. (2017) and write a reflection paper on the value of using
strength-based practice in child welfare in interventions with children.
Kisiel, C., Summersett-Ringgold, F., Weil, L. E., & McClelland, G. (2017).
Understanding strengths in relation to complex trauma and mental health symp-
toms within child welfare. Journal of child and family studies, 26(2), 437-451.
(Available: https://rdcu.be/ccbwI).

Additional Resources
Child Welfare Capacity Building Collaborative: https://capacity.childwelfare.gov/
Child Welfare Information Gateway, Family Engagement: https://www.childwel-
fare.gov/pubs/f-­fam-­engagement/
Child Welfare Information Gateway, Partnering with Birth Parents to Promote
Reunification: https://www.childwelfare.gov/pubs/factsheets-­families-­partnerships/
170 6 Child and Family Engagement in Child Welfare Practice

Child Welfare Information Gateway, The Importance of Fathers in the Health

Development in Children: https://www.childwelfare.gov/pubs/usermanuals/
fatherhood/
National Responsible Fatherhood Clearinghouse: https://www.fatherhood.gov/
Youth.gov, Family Engagement: https://youth.gov/youth-­topics/family-­engagement

References

Berg, I. K., & Kelly, S. (2000). Building solutions in child protective services. W. W. Norton &
Company.
Brown, L., Callahan, M., Strega, S., Walmsley, C., & Dominelli, L. (2009). Manufacturing ghost
fathers: The paradox of father presence and absence in child welfare. Child and Family Social
Work, 14(1), 25–34. https://doi.org/10.1111/j.1365-­2206.2008.00578.x
Campbell, C. A., Howard, D., Rayford, B. S., & Fordon, D. M. (2015). Fathers matter: Involving
and engaging fathers in the child welfare system process. Children and Youth Services Review,
53, 84–91. https://doi.org/10.1016/j.childyouth.2015.03.020
Chapman, M. V., Gibbons, C. B., Barth, R. P., & McCrae, J. S. (2003). Parental views of in-home
services: What predicts satisfaction with child welfare workers? Child Welfare, 82, 571–596.
Child Welfare Information Gateway. (2016). Family engagement: Partnering with fami-
lies to improve child welfare outcomes. U.S. Department of Health and Human Services,
Children’s Bureau.
Chipungu, S. S., & Bent-Goodley, T. B. (2004). Meeting the challenges of contemporary foster
care. The Future of Children, 75–93. https://doi.org/10.2307/1602755
Chaffin, M., Kelleher, K., & Hollenberg, J. (1996). Onset of physical abuse and neglect: Psychiatric,
substance abuse, and social risk factors from prospective community data. Child Abuse &
Neglect, 20(3), 191–203. https://doi.org/10.1016/S0145-­2134(95)00144-­1
Cryer-Coupet, Q. R., Dorsey, M. S., Lemmons, B. P., & Hope, E. C. (2020). Examining multiple
dimensions of father involvement as predictors of risk-taking intentions among black ado-
lescent females. Children and Youth Services Review, 108, 104604. https://doi.org/10.1016/j.
childyouth.2019.104604
Damiani-Taraba, G., Dumbrill, G., Gladstone, J., Koster, A., Leslie, B., & Charles, M. (2017).
The evolving relationship between casework skills, engagement, and positive case outcomes
in child protection: A structural equation model. Children and Youth Services Review, 79,
456–462. https://doi.org/10.1016/j.childyouth.2017.05.033
Darlington, Y., Feeney, J. A., & Rixon, K. (2004). Complexity, conflict and uncertainty: Issues in
collaboration between child protection and mental health services. Children and Youth Services
Review, 26(12), 1175–1192. https://doi.org/10.1016/j.childyouth.2004.08.009
De Boer, C., & Coady, N. (2007). Good helping relationships in child welfare: Learning
from stories of success. Child & Family Social Work, 12(1), 32–42. https://doi.
org/10.1111/j.1365-­2206.2006.00438.x
DePanfilis, D. (2000). How do I develop a helping alliance with the family. Handbook for Child
Protection Practice, 36–40. https://doi.org/10.4135/9781452205489.n8
Dumbrill, G. C. (2006). Parental experience of child protection intervention: A qualitative study.
Child Abuse & Neglect, 30(1), 27–37. https://doi.org/10.1016/j.chiabu.2005.08.012
Duncan, B. L., Miller, S. D., Wampold, B. E., & Hubble, M. A. (2010). The heart and soul of
change: Delivering what works in therapy. American Psychological Association. https://doi.
org/10.1037/12075-­000
References 171

Fluke, J. D., Chabot, M., Fallon, B., MacLaurin, B., & Blackstock, C. (2010). Placement deci-
sions and disparities among aboriginal groups: An application of the decision making ecology
through multi-level analysis. Child Abuse & Neglect, 34(1), 57–69. https://doi.org/10.1016/j.
chiabu.2009.08.009
Fong, R. (2001). Culturally competent social work practice: Past and present (pp. 1–9). Skills,
Interventions, and Evaluations.
Fusco, R. A. (2015). Second generation mothers in the child welfare system: Factors that pre-
dict engagement. Child and Adolescent Social Work Journal, 32(6), 545–554. https://doi.
org/10.1007/s10560-­015-­0394-­4
Geiger, J. M., Hayes, M. J., & Lietz, C. A. (2013). Should I stay or should I go? A mixed meth-
ods study examining the factors influencing foster parents’ decisions to continue or discon-
tinue providing foster care. Children and Youth Services Review, 35(9), 1356–1365. https://doi.
org/10.1016/j.childyouth.2013.05.003
Geiger, J. M., Piel, M. H., & Julien-Chinn, F. J. (2017). Improving relationships in child wel-
fare practice: Perspectives of foster care providers. Child and Adolescent Social Work Journal,
34(1), 23–33. https://doi.org/10.1007/s10560-­016-­0471-­3
Gladstone, J., Dumbrill, G., Leslie, B., Koster, A., Young, M., & Ismaila, A. (2014). Understanding
worker-parent engagement in child protection casework. Children and Youth Services Review,
44, 56–64. https://doi.org/10.1016/j.childyouth.2014.06.002
Gockel, A., Russell, M., & Harris, B. (2008). Recreating family: parents identify worker-client
relationships as paramount in family preservation programs. Child Welfare, 87(6).
Graybeal, C. T. (2007). Evidence for the art of social work. Families in Society, 88(4), 513–523.
https://doi.org/10.1606/1044-­3894.3673
Guo, S., Barth, R. P., & Gibbons, C. (2006). Propensity score matching strategies for evaluating
substance abuse services for child welfare clients. Children and Youth Services Review, 28(4),
357–383. https://doi.org/10.1016/j.childyouth.2005.04.012
Hartley, C. C. (2002). The co-occurrence of child maltreatment and domestic violence: exam-
ining both neglect and child physical abuse. Child Maltreatment, 7(4), 349–358. https://doi.
org/10.1177/107755902237264
Herrenkohl, T. I., Sousa, C., Tajima, E. A., Herrenkohl, R. C., & Moylan, C. A. (2008). Intersection
of child abuse and children’s exposure to domestic violence. Trauma, Violence & Abuse, 9(2),
84–99. https://doi.org/10.1177/1524838008314797
Hammond, I., Eastman, A. L., Leventhal, J. M., & Putnam-Hornstein, E. (2017). Maternal mental
health disorders and reports to child protective services: a birth cohort study. International
Journal of Environmental Research and Public Health, 14(11), 1320. https://doi.org/10.3390/
ijerph14111320
Kapp, S. A., & Vela, R. H. (2004). The unheard client: Assessing the satisfaction of par-
ents of children in foster care. Child and Family Social Work, 9(2), 197–206. https://doi.
org/10.1111/j.1365-­2206.2004.00323.x
Kemp, S. P., Marcenko, M. O., Lyons, S. J., & Kruzich, J. M. (2014). Strength-based practice and
parental engagement in child welfare services: An empirical examination. Children and Youth
Services Review, 47, 27–35. https://doi.org/10.1016/j.childyouth.2013.11.001
Kisiel, C., Summersett-Ringgold, F., Weil, L. E., & McClelland, G. (2017). Understanding strengths
in relation to complex trauma and mental health symptoms within child welfare. Journal of
Child and Family Studies, 26(2), 437–451. https://doi.org/10.1007/s10826-­016-­0569-­4
Kohl, P. L., Edleson, J. L., English, D. J., & Barth, R. P. (2005). Domestic violence and path-
ways into child welfare services: Findings from the National Survey of Child and Adolescent
­Well-­Being. Children and Youth Services Review, 27(11), 1167–1182. https://doi.org/10.1016/j.
childyouth.2005.04.003
Kohl, P. L., Jonson-Reid, M., & Drake, B. (2011). Maternal mental illness and the safety and sta-
bility of maltreated children. Child Abuse & Neglect, 35(5), 309–318. https://doi.org/10.1016/j.
chiabu.2011.01.006
172 6 Child and Family Engagement in Child Welfare Practice

Lee, S. J., & Walsh, T. B. (2015). Using technology in social work practice: the mDad (Mobile
Device Assisted Dad) case study. Advances in Social Work, 16(1), 107–124. https://doi.
org/10.18060/18134
Lewis, E. M., Feely, M., Seay, K. D., Fedoravicis, N., & Kohl, P. L. (2016). Child welfare
involved parents and Pathways Triple P: perceptions of program acceptability and appropri-
ateness. Journal of Child and Family Studies, 25(12), 3760–3770. https://doi.org/10.1007/
s10826-­016-­0526-­2
Lietz, C. A. (2013). Strengths-based supervision: Supporting implementation of family-centered
practice through supervisory processes. Journal of Family Strengths, 13(1), 6.
Littell, J. H., Alexander, L. B., & Reynolds, W. W. (2001). Client participation: Central and
under-investigated elements of intervention. Social Service Review, 75(1), 1–28. https://doi.
org/10.1086/591880
MacGregor, T. E., Rodger, S., Cummings, A. L., & Leschied, A. W. (2006). The needs of foster
parents: A qualitative study of motivation, support, and retention. Qualitative Social Work,
5(3), 351–368. https://doi.org/10.1177/1473325006067365
Maiter, S., Palmer, S., & Manaji, S. (2006). Strengthening social worker-client relationships
in child protection services: Addressing power relationships and ruptured relationships.
Qualitative Social Work, 5(2), 161–186. https://doi.org/10.1177/1473325006064255
Marçal, K. (2020). Caregiver depression and child behaviour problems: A longitudinal mixed
effects approach. Child & Family Social Work. https://doi.org/10.1111/cfs.12786
Maxwell, N., Scourfield, J., Featherstone, B., Holland, S., & Tolman, R. (2012). Engaging fathers
in child welfare services: A narrative review of recent research evidence. Child and Family
Social Work, 17(2), 160–169. https://doi.org/10.1111/j.1365-­2206.2012.00827.x
Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change.
2002. Guilford Press.
Minnis, H., Everett, K., Pelosi, A. J., Dunn, J., & Knapp, M. (2006). Children in foster care: Mental
health, service use and costs. European Child & Adolescent Psychiatry, 15(2), 63–70. https://
doi.org/10.1007/s00787-­006-­0452-­8
Moore, P. S., Whaley, S. E., & Sigman, M. (2004). Interactions between mothers and children:
impacts of maternal and child anxiety. Journal of Abnormal Psychology, 113(3), 471. https://
doi.org/10.1037/0021-­843X.113.3.471
National Alliance on Mental Illness. (2019). Mental health by the numbers. Retrieved from: https://
www.\.org/mhstats
National Coalition Against Domestic Violence. (n.d.). Learn more. Retrieved from: https://ncadv.
org/learn-­more
Nicholson, J., Biebel, K., Katz-Leavy, J., & Williams, V. (2002). The prevalence of parenthood
in adults with mental illness: Implications for state and federal policymakers, programs, and
providers.
Park, J. M., Solomon, P., & Mandell, D. S. (2006). Involvement in the child welfare system
among mothers with serious mental illness. Psychiatric Services, 57(4), 493–497. https://doi.
org/10.1176/ps.2006.57.4.493
Platt, D. (2012). Understanding parental engagement with child welfare services:
An integrated model. Child and Family Social Work, 17(2), 138–148. https://doi.
org/10.1111/j.1365-­2206.2012.00828.x
Platt, D. (2008). Care or control? The effects of investigations and initial assessments on the
social worker-parent relationship. Journal of Social Work Practice, 22(3), 301–315. https://doi.
org/10.1080/02650530802396643
Ramsay-Irving, M. (2015). The foster care systems are failing foster children: The implications
and practical solutions for better outcomes of youth in care. Canadian Journal of Family and
Youth/Le Journal Canadien de Famille et de la Jeunesse, 7(1), 55–86. https://doi.org/10.29173/
cjfy24298
Rhodes, K. W., Orme, J. G., & Buehler, C. (2001). A comparison of family foster parents who quit,
consider quitting, and plan to continue fostering. Social Service Review, 75(1), 84–114. https://
doi.org/10.1086/591883
References 173

Rhodes, K. W., Orme, J. G., Cox, M. E., & Buehler, C. (2003). Foster family resources, psychoso-
cial functioning, and retention. Social Work Research, 27(3), 135–150. https://doi.org/10.1093/
swr/27.3.135
Rockhill, A., Furrer, C. J., & Duong, T. M. (2015). Peer mentoring in child welfare: A motivational
framework. Child Welfare, 94(5), 125.
Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change.
Journal of Consulting Psychology, 21(2), 95. https://doi.org/10.1037/h0045357
Ross, A. M., DeVoe, E. R., Steketee, G., Emmert-Aronson, B. O., Brown, T., & Muroff, J. (2020).
Outcomes of a reflective parenting program among military spouses: The moderating role
of social support. Journal of Family Psychology, 34(4), 402–413. https://doi.org/10.1037/
fam0000637
Rostad, W. L., Rogers, T. M., & Chaffin, M. J. (2017a). The influence of concrete support on child
welfare program engagement, progress, and recurrence. Children and Youth Services Review,
72, 26–33. https://doi.org/10.1016/j.childyouth.2016.10.014
Rostad, W. L., Self-Brown, S., Boyd, C., Jr., Osborne, M., & Patterson, A. (2017b). Exploration
of factors predictive of at-risk fathers’ participation in a pilot study of an augmented evidence-­
based parent training program: A mixed methods approach. Children and Youth Services
Review, 79, 485–494. https://doi.org/10.1016/j.childyouth.2017.07.001
Rubin, D. M., O’Reilly, A. L., Luan, X., & Localio, A. R. (2007). The impact of placement stability
on behavioral well-being for children in foster care. Pediatrics, 119(2), 336–344. https://doi.
org/10.1542/peds.2006-­1995
Stromwall, L. K., Larson, N. C., Nieri, T., Holley, L. C., Topping, D., Castillo, J., & Ashford,
J. B. (2008). Parents with co-occurring mental health and substance abuse conditions involved
in child protection services: Clinical profile and treatment needs. Child Welfare, 87(3), 95–113.
Summers, A., Wood, S. M., Russell, J. R., & Macgill, S. O. (2012). An evaluation of the effective-
ness of a parent-to-parent program in changing attitudes and increasing parental engagement
in the juvenile dependency system. Children and Youth Services Review, 34(10), 2036–2041.
https://doi.org/10.1016/j.childyouth.2012.06.016
Toros, K., DiNitto, D., & Tiko, A. (2018). Family engagement in the child welfare system: A
scoping review. Children and Youth Services Review, 88, 598–607. https://doi.org/10.1016/j.
childyouth.2018.03.011
US Department of Health and Human Services. (2020). Administration for Children and Families,
Administration on Children, Youth, and Families, Children’s Bureau. The AFCARS report.
Preliminary FY 2017 estimates as of August 10, 2018. 2018.
van Zyl, M. A., Barbee, A. P., Cunningham, M. R., Antle, B. F., Christensen, D. N., & Boamah,
D. (2014). Components of the solution-based casework child welfare practice model that pre-
dict positive child outcomes. Journal of Public Child Welfare, 8(4), 433–465. https://doi.org/1
0.1080/15548732.2014.939252
Yatchmenoff, D. K. (2005). Measuring client engagement from the client’s perspective in non-­
voluntary child protective services. Research on Social Work Practice, 15(2), 84–96. https://
doi.org/10.1177/1049731504271605
Chapter 7
Child Maltreatment Prevention
and Family Preservation

Introduction

Child maltreatment prevention efforts have improved in the last several decades as
we learn more about the etiology of child maltreatment and better understand ways
to support families before child maltreatment occurs. One major challenge in child
abuse prevention is that it is so varied in its manifestation, etiology, and how it can
be managed. Instead of managing a biological public health threat, we are instead
having to account for human behavior, which is more complicated, less predictable,
and difficult to manage. It is also challenging to reach all those who are in need of
support and services.

Child Maltreatment Prevention

Child maltreatment prevention can be conceptualized within three levels in terms

of its approach: primary, secondary, and tertiary. This conceptualization delin-
eates different types of activities used to address public health threats, such as
child maltreatment at different time points (Caplan, 1964). The types of preven-
tion as a framework in child welfare are outlined in Fig. 7.1. Primary prevention
activities target the general population in an effort to prevent maltreatment before
it occurs. Primary prevention is a universal approach where everyone in the com-
munity has access to services. Primary prevention approaches also focus on
addressing systemic factors that may place children and families at risk of
maltreatment.

© Springer Nature Switzerland AG 2021 175

J. M. Geiger, L. Schelbe, The Handbook on Child Welfare Practice,
https://doi.org/10.1007/978-3-030-73912-6_7
176 7 Child Maltreatment Prevention and Family Preservation

Practice Highlight
Examples of Primary Prevention of Child Maltreatment Activities
• Public service announcements regarding positive parenting
• Parent education programs and groups with information and support
related to child development and parenting
• Family support and family strengthening programs designed to improve
access to services, resources, and support
• Public awareness campaigns with information on reporting suspected child
maltreatment

Secondary prevention activities focus on populations that are at a greater risk for
child maltreatment and are exposed to one or more risk factors associated with child
maltreatment (e.g., poverty, parental substance abuse, parental mental health con-
cerns, and young parental age). Programs and approaches may include parent edu-
cation programs focused on specific groups such as teen parents and parents with
substance abuse issues; parent support groups that help parents manage stress and
parenting challenges; home visitation programs with expecting and new mothers;
and respite care services for parents with
children who have special needs.
Tertiary prevention activities target Practice Highlight
children and families who have experi- Examples of Child Maltreatment
enced maltreatment and are focused on Prevention Programs
treatment and reducing the risk of recur-
rence of maltreatment. Tertiary prevention Primary Prevention
aims to reduce the impact of child mal- • Nurse-Family Partnership
treatment. Some activities include inten- • Safe Environment for Every
sive family preservation services, parent Kid (SEEK)
mentoring and support groups for parents • Body Safety Training Workbook
whose children are in care, and mental • Period of Purple Crying
health services for children and families
who have experienced child maltreatment. Secondary Prevention
Many child welfare agencies as well as • Incredible Years
the federal government use a comprehen- • Coordination, Advocacy,
sive approach to child maltreatment pre- Resources, Education, and
vention that includes all levels of Support (C.A.R.E.S.)
prevention, where individuals, systems, • CICC Effective Black
and communities are involved in efforts. Parenting Program
Each child welfare agency is required to • Nurturing Parenting Program
develop plans that outline primary, sec-
ondary, and tertiary prevention activities
in order to receive funds from the state and federal government. More recently a
greater emphasis has been placed on primary prevention efforts to curb the signifi-
cant social and economic impact of child maltreatment.
History of Child Maltreatment Prevention 177

Fig. 7.1 Levels of prevention services. (Source: Child Welfare Information Gateway. (n.d.).
Framework for prevention of child maltreatment.
https://www.childwelfare.gov/topics/preventing/overview/framework/)

The Children’s Bureau highlights the importance of proactively preventing child

maltreatment and investing in the capacity of parents to keep their children safe
early on through collaboration with the legal, judicial, educational, and child wel-
fare systems through an increased focus on primary prevention and by strengthen-
ing the capacity of communities to support the children and families who live there
and provide the critical services they need before (and after) child welfare system
involvement (Child Welfare Information Gateway, 2018). Part of child maltreatment
prevention is increasing awareness, which can be delivered through public aware-
ness campaigns (e.g., Drazen et al., 2009).

History of Child Maltreatment Prevention

Child maltreatment has been a growing concern in the United States with the recog-
nition of the impact of child neglect and physical abuse. Henry Kempe et al.’s (1962)
work in the 1960s led to the implementation of federal and state policy directed at
forming a reporting system, laws against child abuse and neglect, followed by the
Child Abuse Prevention and Treatment Act (CAPTA) of 1974, which mandated
reporting of child abuse and neglect cases. A greater awareness of the issue led to an
increase in education directed at the general public about identifying child abuse
and neglect and its consequences.
178 7 Child Maltreatment Prevention and Family Preservation

The shift towards prevention began with funding to projects that examined the
causes of child maltreatment and corresponding strategies for preventing child mal-
treatment. Some of the earliest projects funded were home visitation programs that
promoted education on pregnancy and child development, healthy mother-child
bonding, and a positive home environment. In the 1990s, funding through the
Family Preservation and Support Services Program Act of 1993 provided services
for families in need of counseling, in-home services, parent support, and childcare.
The importance of early relationships with caregivers and connection to the com-
munity was emphasized with new research from the Neurons to Neighborhoods
Study (Phillips, & Shonkoff, 2000). It further discussed the impact of experiences
of child abuse and neglect on the growing child within the context of their environ-
ment. Research began to focus on protective factors, those elements that helped
families overcome risks and promoted improved outcomes. Protective factors func-
tion as buffers and mitigate the risks associated with maltreatment while also pro-
moting resilience (Walsh et al., 2015). These protective factors became the basis for
programs and policies that invested in family strengths, early education, and com-
munity building and supports. The Center for the Study of Social Policy (CSSP)
described five overarching protective factors that when promoted could help parents
overcome stress that might lead to child maltreatment: parental resilience, social
connections, concrete support in times of need, knowledge of parenting and child
development, and development of social and emotional competence in children.
CAPTA has been amended numerous times over the last several decades and
continues to fund programs that focus on preventing child maltreatment through
programs that infuse protective factors targeting children and families and those
that address issues related to child maltreatment risk. The Administration Children
and Families (ACF) identified 10 protective factors from the research that help
guide programming and policy that promote child and family well-being: self-reg-
ulation, relational skills, problem-solving skills, involvement in positive activities,
parenting competencies, caring adults, positive peers, positive community, positive
school environments, and economic opportunities (Child Welfare Information
Gateway, 2014).

Reflection
Moving Upstream
There is a commonly used story that people often use to describe the concept
of “going upstream” address certain problems. It tells the story about a group
of campers on a riverbank who are gathering when one of them sees a baby in
the water. Of course, he immediately jumps in and rescues the infant. But as
he climbs out of the water, one of the other campers spots another baby in the
river headed their way, followed by another. And another. Overwhelmed by
the number of babies, the campers grab anybody around them so that they can
help them get babies from the water.
Prevention Strategies 179

Before they know it, the river is filled with babies, and more and more
rescuers are needed to help the campers. But not all the babies can be saved.
Also, some of the brave rescuers occasionally drown. But they somehow con-
tinue to work together to create a complex system that involves multiple sup-
ports to be able to keep pulling babies from the river.
At one point, one of the rescuers starts walking upstream. The others ask
them, “Where are you going? We need your help to pull the babies out.” The
rescuer replies: “You carry on here … I’m going upstream to find the bugger
who keeps chucking all these babies in the river.”

Prevention Strategies

Given what is known about the individual, family, and community risk and protec-
tive factors associated with child maltreatment, several national organizations have
established approaches to prevent child maltreatment and provide guidance to child
welfare agencies and practitioners, as well as policy-makers, to further implement
priorities in practice as it fits with their population and needs. Many of these
approaches have adopted a public health perspective. Experts have argued that to
address child maltreatment it is necessary to have a universal system that seeks to
help all children and families (Daro, 2016). Various communities are attempting to
address child maltreatment systematically, as is the case in South Carolina and
Colorado (Daro et al., n.d.). South Carolina has embraced public health policies and
the Positive Parenting Program (Triple P), a population parenting program working
with experts in communities across the state to ensure its implementation (Strompolis
et al., 2020). To assist communities, the Centers for Disease Control and Prevention
(CDC) Essentials for Childhood Framework and the Center for the Study of Social
Policy Strengthening Families Framework provide direction on how to address and
prevent child maltreatment.

 enter for the Study of Social Policy (CSSP)

C
Strengthening Families

The CSSP Strengthening Families is a research-informed approach to “increase

family strengths, enhance child development, and reduce the likelihood of child
abuse and neglect.” (CSSP, n.d.). It is family-centered, rooted in communities, and
focused on building five key protective factors. The Strengthening Families frame-
work is based on the idea that all families possess strengths and that it is possible to
cultivate existing and new characteristics to promote child and family well-being.
They draw on the above protective factors at multiple levels to guide programs,
180 7 Child Maltreatment Prevention and Family Preservation

practice, and policies. The framework’s logic model outlines core functions of state
and system alongside program and community leaders to build parent partnerships;
deepen knowledge and understanding; shift practice, policy, and systems; and
ensure accountability. It further outlines worker and program practice serving
­children and families that support families to build and cultivate the five protective
factors to strengthen families, achieve optimal child development, and reduce
child maltreatment (CSSP, n.d.) See Table 7.1 for details about the
Strengthening Families approach.
Across multiple frameworks and strategies to prevent child maltreatment, there is
general consensus that in order to achieve positive child and family outcomes, pro-
viders should work alongside parents as partners, providing the necessary support
and resources in order for them to be successful. Most would agree that changing the
circumstances so that parents can enhance relationships with their children and pro-
vide nurturing environments for their families can mitigate some of the risks associ-
ated with child maltreatment. Overall, we should focus on promoting family strengths
and protective factors on an individual level and changing systems that create cir-
cumstances that lead to child maltreatment. Child maltreatment prevention must be
a multisystemic, collaborative effort in order for it to be effective. Children and fami-
lies interact with a number of systems that can collectively provide the support, guid-
ance, and resources needed for well-being. Strategies to prevent child maltreatment
must incorporate data-driven methods and rely on evidence-informed programs
when available. Funding is also essential to establish a strong research base and to
pilot prevention programs targeting the families who need them.

Table 7.1 Components and description of the Strengthening Families approach

Parental resilience • Honor family’s, language, culture, history, and approach to
parenting
• Support parents as decision-makers
• Help parents to intervene and support their children during
challenging times
Social connections • Help families to value, build, and sustain social networks
• Create an inclusive environment
• Promote community engagement and participation
Knowledge of parenting and • Provide information and resources on parenting and child
child development development
• Provide opportunities to practice new parenting skills
• Model and teach developmentally appropriate interactions
with children
Concrete support in times of • Provide connections to services in the community
need • Respond immediately to families in crisis
• Support families in developing skills and strengths to
identify needs and access supports
Social and emotional • Help parents to foster child’s social-emotional development
competence of children • Help children develop a positive cultural identity and
interact in a diverse society
• Model nurturing support to children
Source: Used with permission from the Center for the Study of Social Policy. (n.d.). Strengthening
Families
Prevention Strategies 181

CDC Essentials for Childhood

The CDC’s Division of Violence Prevention (2014) developed a technical pack-

age that outlines four overarching areas of focus that lead to safe, stable, and
nurturing relationships (SSNRs) and promote primary prevention of child mal-
treatment. Strategies related to these areas involve targeting child maltreatment at
multiple levels, including individual, familial, societal, and community levels. In
order to prevent child maltreatment and reduce risk for child maltreatment, they
recommend policies, programs, and supports (Fortson et al., 2016): (1) Strengthen
economic supports for families, (2) change social norms to support parents and
positive parenting practices, (3) provide quality care and education in infancy and
early childhood, (4) enhance parenting skills to promote healthy child develop-
ment, and (5) intervene when necessary to lessen the potential for harm and pre-
vent future risk.
Research shows that policies that
Practice Highlight
improve an individual and family’s finan-
cial stability can have an impact on health Contributors to Safe, Stable, and
outcomes (Frieden, 2010) and reduce Nurturing Relationships (SSNRs)
child abuse and neglect (Stith et al., 2009);
• Greater awareness of child mal-
however, little is known about the effec-
treatment and a commitment to
tiveness and economic efficiency of poli-
prevent it
cies and practices that provide economic
• Use of data to inform actions
supports to families to prevent child abuse
• Programs to create the context
and neglect. By supporting family finan-
for healthy children and families
cial security, parents are able to better
• Policy that develops such
meet their children’s basic needs, such as
a context
shelter, food, and health care. Improved
health can have positive effects on child
development and educational and social outcomes. In order to strengthen household
financial security, policies can address family needs related to tax credits; nutrition
assistance programs; child support payments and financial assistance; safe, stable,
and affordable housing; and childcare. In addition, the Fortson et al. (2016) high-
lights the need for livable wages, paid leave for family members, and flexible and
consistent schedules as a means of improving financial security for families. It is
also critical to identify community conditions that increase or reduce the incidence
of child maltreatment to promote the development of SSNRs. Finally, research is
needed to evaluate the economic effectiveness of programs that reduce multiple
forms of child maltreatment and their relationship with other forms of violence,
such as youth violence, intimate partner violence (IPV), and suicide.
182 7 Child Maltreatment Prevention and Family Preservation

Note from the Field

Home Visitation as a Game Changer
I worked with Jada,1 a 19-year-old new mom of a beautiful baby girl. Jada has
been in foster care since she was 11 and lived in a series of group homes and
shelters, until 3 months ago, when she received notice that she had was able
to use Section 8 housing. She moved into a one-bedroom apartment with her
baby. She didn’t have much work experience and hoped she could get a job
soon. While she was in the hospital, a social worker referred her to the Healthy
Families program offered in the county she lived. The social worker told her
that she would have someone come visit her, teach her about parenting, help
her to access benefits and training, and offer support in her parenting journey.
Jada wasn’t sure she needed the help, but after being in foster care, she didn’t
have much of a role model for good parenting and didn’t want her daughter to
be taken from her. She was worried they would judge her parenting and report
her to the child welfare authorities. She took a chance, and Tracy was assigned
her case. Tracy came to her home almost every day to begin. She first focused
on helping her access things for the baby: diapers, a breast pump, and identi-
fying a pediatrician for the baby. She sat down and showed her how to hold
her, soothe her when she was upset or fussy, and helped her set up a safe
sleeping environment for her. When the baby was sleeping during their visits,
she talked to her about her boyfriend who doesn’t come around anymore, her
fragmented relationship with her mom, and her friends who don’t call as
much because the baby cries a lot. Tracy helped her to map out some plans
and goals for her future with school and work and encouraged her to apply for
government assistance to help her spend more time with her baby before
going back to work. Jada called Tracy when she was struggling with her baby
refusing to nap or crying when she was teething. When Jada was ready to start
going to school part-time, Tracy helped her organize her applications and
scholarships. She helped her find childcare so she could complete her prereq-
uisite courses to apply to business school to study accounting. Jada didn’t
have many positive adults in her life when she had her baby and relied on
Tracy to help her to learn how to do the things most new parents learn from
their parents. She helped her establish a social support network and how to
navigate the various systems. Without home visitation, Jada would have strug-
gled to keep her baby in her care.
1
All names and other personal identifiers in cases and examples throughout
this book have been changed to protect privacy and confidentiality.
Child Maltreatment Prevention Models 183

Evidence suggests that providing quality care and education early in life can
improve a child’s development and help to establish SSNRs to create a positive
pathway throughout the lifespan. Policies and practices must address the need for
quality childcare options, preschool enrichment and family engagement, and
improved licensing and accreditation of childcare and preschool programs. These
opportunities can enhance a child’s ability to succeed academically and socially. A
key approach to preventing child abuse and neglect is equipping parents with the
necessary skills and tools to promote healthy child development.
Several evidence-based early childhood home visitation programs (e.g., Healthy
Families, Nurse-Family Partnership) have been shown to be effective in reducing
child abuse and neglect by providing information and resources, support, training
about child development, health, and discipline in the caregiver’s home. Parents/
caregivers and families at greater risk of child maltreatment should have access to
parenting skill development and positive relationship development programs in the
community. Not only do these home visiting programs address issues related to
child abuse and neglect but also can also protect children from other forms of vio-
lence (Knox et al., 2011; Portwood et al., 2011).

Child Maltreatment Prevention Models

Home Visiting Programs

Various models of child maltreatment prevention have been developed over the
years, with the most common and most studied being home visitation. Home
visiting programs have existed for decades, and in 2010 the Congress established
the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV)
to provide federal funds to states and tribal entities to support voluntary, evi-
dence-based home visiting services to at-risk families. These programs, although
varied, typically involve a professional (nurse or social worker) who meets regu-
larly with an expectant parent or a parent of an infant in their home to provide
information and support with parenting skill development, child development,
and accessing resources and supports in the community. Home visitation pro-
grams differ in terms of the populations they serve (e.g., expectant mothers,
parents, new mothers), who conducts the home visit (e.g., nurse, volunteer, peer,
other professional), when the program is offered (prenatally, postnatally), and
for how long (e.g., 3 months, 18 months); however, evidence has shown that this
type of intervention improves child and maternal well-being and can prevent
child maltreatment.
184 7 Child Maltreatment Prevention and Family Preservation

There are multiple evidence-based pro-

Practice Highlight
grams delivered across the United States,
including the Nurse-Family Partnership Examples of Child Maltreatment
and Healthy Families. These programs Prevention Programs
individually share similar core compo-
Triple P – Positive Parenting
nents and offer flexible and specific pro-
Program: a primary prevention
gramming based on the population they
strategy that provides parenting
serve. Studies have examined specific
support for those with children
program areas (e.g., timing, topics of vis-
ages 0–16 to prevent and manage
its, use of assessments and screening
behavioral and emotional issues
tools, training for visitors) to determine
through parenting skill develop-
what key quality components show posi-
ment and empowerment.
tive outcomes. The Administration for
Children and Families (ACF) along with Period of Purple Crying: aims to
its partners conducted a systematic review assist new parents and caregivers in
of early childhood home visiting research understanding infant crying while
most recently in December of 2019 offering support and tips for man-
(HomVEE), which outlines the effective- aging prolonged infant crying.
ness of the most common home visiting
Parents as Teachers: is a home
programs available (Sama-Miller et al.,
visiting program for parents begin-
2019). They examined program outcomes
ning during pregnancy up until the
in eight domains: (1) maternal health, (2)
age of 5. It helps parents to under-
child health, (3) positive parenting prac-
stand child development and posi-
tices, (4) child development and school
tive parenting practices, while
readiness, (5) reductions in child maltreat-
preventing child maltreatment and
ment, (6) family economic self-suffi-
promoting school readiness.
ciency, (7) linkages and referrals to
community resources, and (8) reduction Incredible Years: targets parents,
in juvenile delinquency, family violence, teachers, and children (ages 4 to 8)
and crime. Of the 50 models reviewed, 21 through curricula that promote
met the criteria set forth by the United social and emotional competence
States Department of Health and Human and address behavioral or emo-
Services for an evidence-based home vis- tional concerns.
iting program, including Healthy Families
Safe Care: is an in-home program
America, Nurse-Family Partnerships,
that supports parents how to posi-
SafeCare, and Parents as Teachers. Within
tively interact with their children,
these models, research continues to
deal with difficult behaviors, and
improve services and increase engage-
respond when a child is in need.
ment (e.g., Beasley et al., 2018). There are
promising practices being developed that
address specific groups, such as engaging fathers (e.g., Guterman et al., 2018).
Child Maltreatment Prevention Models 185

Parent Education Programs

Parent education provides caregivers the resources, knowledge, and support to be

the best parent they can while enhancing the parent-child relationship and promot-
ing well-being. Parenting practices can promote child well-being and child develop-
ment (e.g., Longo et al., 2017). Parent education programs focus on enhancing
parenting practices and behaviors, including increasing knowledge about child
development and positive discipline, promoting positive play and interaction
between parents and children, and assisting with identifying and accessing com-
munity resources and supports.
Several elements of parent education programs have been shown to promote
positive parenting and child well-being. These programs highlight mutual support
among parents, promote father engagement, and recognize that parents have indi-
vidual needs that need to be addressed in a culturally relevant way. Parent education
programs may be just one component of a larger child maltreatment prevention
approach (e.g., home visiting, Triple P); however many adopt strategies that pro-
mote protective factors, are tailored to the parents’ cultural and community needs
(e.g., Effective Black Parenting Program, Positive Indian Parenting), and utilize
qualified and trained professionals as teachers and facilitators. Further, Wilder
Research (2016) describes several program elements to reinforce protective factors,
such as early and active parent engagement, availability of frequent and ongoing
classes, and the promotion of family routines and activities.
When examining the evidence for parent education programs, several stand out
as preventing maltreatment and promoting healthy children and families, for exam-
ple, the Incredible Years, Nurturing Fathers Program, Parent-Child Interaction
Therapy, SafeCare, Triple P (Positive Parenting Program), and the Nurturing
Parenting Program (Child Welfare Information Gateway, 2019). Ongoing evalua-
tions of parenting programs specifically for parents who are involved with the child
welfare system are necessary, especially to determine if changing parents’ behav-
iors persists and if child maltreatment is reduced (Akin et al., 2017) and if the par-
ents find the interventions acceptable and appropriate (Lewis et al., 2016).

Community-Level Interventions

There are benefits of using a community-level approach to preventing child maltreat-

ment to reach families who may not be connected to services and resources already
and extend beyond the individual level. Many community-level programming
focuses on under-resourced neighborhoods and communities that experience multi-
ple challenges such as violence, lack of healthy food options and transportation, and
environmental barriers. Community-level prevention strategies target those risk fac-
tors associated with child maltreatment risk, such as a lack of affordable childcare
and health care and economic, housing, and employment stability. Community-
based prevention requires collaboration among multiple system levels, including the
community members, local service providers, and government agencies.
186 7 Child Maltreatment Prevention and Family Preservation

Research Brief
Community Prevention
What do efforts to promote child well-being in a community look like? One
project identified that children from low socioeconomic status often have
lower language development than their peers in higher socioeconomic sta-
tuses. To address this, an intervention that would occur in supermarkets was
developed; signs were placed in supermarkets that encouraged adult-child
dialog (Ridge et al., 2015). Evaluation of the project found that when the signs
were present quality and amount of talking between adults and children in in
the supermarkets serving low socioeconomic communities. This simple, cost-­
effective strategy may improve children’s language development.

Specific strategies using a community-

Practice Highlight
level approach include promoting social
norms through public awareness cam- Child Abuse Prevention Month
paigns and education and addressing the
April is National Child Abuse
unique needs of the community through
Prevention Month. This month
services, resources, and support.
and throughout the year, the child
Community-level approaches to preven-
welfare agency and other busi-
tion are typically primary prevention
nesses and organizations encour-
strategies; however, they also include
age all individuals and organizations
some secondary strategies in the form of
to play a role in making their com-
services and supports for at-risk families.
munities a better place for children
Common community-based efforts
and families. Information about
include public service announcements
child maltreatment is shared along
related to issues such as shaken baby syn-
with ways to promote healthy child
drome/abusive head trauma, guidance for
and family well-being.
safe sleeping practices for baby, child
sexual abuse, and corporal punishment. Pinwheels for Prevention® In
Such media campaigns involve radio 2008, Prevent Child Abuse America
announcements, television ads, bulletin (PCA) introduced the Pinwheels for
boards, widespread distribution of pam- Prevention® campaign. Pinwheels
phlets and literature, and newsletters. represent childlike whimsy and
Child maltreatment prevention efforts lightheartedness. PCA’s vision is
at multiple targets (individual, family, and for a world where all children grow
community) are continuing to improve up happy, healthy, and prepared to
and expand, benefitting many families succeed in supportive families and
who are in need. However, there continues communities.
to be challenges to the current approaches
in theory and in practice. For example, prevention programs are not a one-size-fits-
all, and families differ in their makeup, needs, and culture. Many communities lack
the financial means or support to implement prevention programs. Further, there are
many programs to choose from, and it may be difficult to find one that fits the family
or community, or it is not available to the family or community. Research continues
Policies Supporting Child Maltreatment Prevention 187

to show that a multipronged approach is needed to benefit the most families.

Research should continue to study the impact of current programs and explore new
ways to prevent child maltreatment.

Research Brief
Promoting Social Norms in the Community to Prevent Child Maltreatment
In order to increase safe, stable, and nurturing relationships and environments,
we must also focus on obtaining broad engagement across multiple groups,
including parents, teachers, day care providers, and coaches. There needs to
be a change in social norms at the community level as well if child maltreat-
ment is to be prevented (Fleckman et al., 2019). Norms refer to values, beliefs,
attitudes, and behaviors that are shared among most people in a group. In
order to promote social norms, it is important for these group members to
have an investment in the outcome, for example, child well-being. Research
shows that perceptions about norms can be strong predictors of behaviors.
Therefore, if a parent believes that it is common practice for a child should
enroll in school at age 5, they will more than likely comply with this norm.
They must see the benefits and have a general consensus to behaving accord-
ingly while seeing others also behaving accordingly. Changing someone’s
core values and beliefs however can be challenging, and it takes time. For
example, in the past several decades, public health specialists have changed
the norm around cigarette smoking and wearing seatbelts. With regard to
child maltreatment, scholars and practitioners have begun to change the norm
around corporal punishment. A recent study found that people in the United
States believe that child maltreatment is a serious problem and the prevention
of child abuse and neglect is possible (Klika et al., 2019). This same study
found that people may not be comfortable in taking action to prevent child
abuse and neglect due in part to a lack of knowledge. Thus, while norms may
be changing, considerable work remains to be done.

Policies Supporting Child Maltreatment Prevention

In addition to federal policies mentioned earlier in the chapter (e.g., CAPTA,

FPSSPA, MIECHV), more recent legislation has also authorized funding and guid-
ance related to child maltreatment prevention, most notably the Family First
Prevention Services Act of 2018 (Family First). This legislation changes the way
Title IV-E funds can be spent by states. With the Family First Act, states, territories,
and tribes with an approved Title IV-E plan have the option to use funds for preven-
tion services to allow children to remain in home or with relatives while funding
programs and services to facilitate this (e.g., substance abuse or mental health treat-
ment). Family First also has provisions about reducing the use of congregate care
and extends support for youth aging out of care.
188 7 Child Maltreatment Prevention and Family Preservation

Family Preservation

Many child welfare agencies Practice Highlight

engage in primary prevention strat-
egies as part of their role in the Promoting Safe Sleep Practices
community by initiating public Every year, approximately 3500 babies
service announcements, providing die in the United States due to Sudden
services and supports to all fami- Infant Death Syndrome (SIDS), accidental
lies in the community, and partner- suffocation, and undetermined reasons.
ing with local organizations The American Academy of Pediatrics
focused on maltreatment preven- (AAP) recommends placing babies on their
tion (e.g., Healthy Families, back at all sleep times (naps and night),
Prevent Child Abuse America). using a firm sleep surface for the baby (e.g.,
However, as child welfare profes- mattress and crib), keeping soft objects and
sionals, we use a prevention lens loose bedding out of the baby’s sleep area,
when working with families pri- and sharing a room with a baby but not the
marily at the secondary and ter- same bed (Task Force on Sudden Infant
tiary levels. Child welfare Death Syndrome, 2016). A recent study led
professionals may be working to by AAP using the Pregnancy Risk
provide intact family services or Assessment Monitoring System (PRAMS)
family preservation services for showed that 22% of parents reported plac-
families who present a low or ing their baby on their side or stomach,
medium risk of maltreatment or 61% shared a bed with their infant, and
maltreatment reoccurrence or with 39% used soft bedding. They also found
families whose children are in care that these practices were more common
who receive services from the among young, less educated parents who
child welfare agency or another identified as a racial/ethnic minority.
child and family-serving agency in State public health and child welfare agen-
the community. The child welfare cies have partnered with family-­ serving
professional may also not neces- organizations to promote safe sleep prac-
sarily be the provider of such ser- tices for new parents. However, some of
vices, but may refer for services these topics can often be controversial.
such as parenting classes, mental There are many reasons cited by parents
health support and services, and for choosing to sleep with their children,
substance abuse treatment related including facilitating feeding (breastfeed-
to child maltreatment prevention. ing or formula), comforting a fussy or sick
After the passage of CAPTA, infant, improving sleep for mother and
historically when a child was abused child, bonding, cultural traditions, and
or neglected, they were removed improving feelings of safety. Some advo-
from the home to protect them. The cacy groups encourage bed sharing to pro-
philosophy of family preservation mote longer duration and exclusivity of
services is that the best place for the breastfeeding and state that bed sharing is
child is to remain in the home – safe among infants who are breastfed and
unless their safety is compromised infants whose parents do not smoke, drink
or that the risk of harm is so great alcohol, or use illicit substances.
that it is not possible. Family preser-
vation services are designed for children to remain in their own home while strength-
ening the ability of the parents to meet their responsibilities in caring for the child.
Policies Supporting Child Maltreatment Prevention 189

Further, children need permanency in their family relationships in order to develop

into healthy, productive individuals; families should be the primary caretakers of their
own children, and the government and social service programs should make every
effort to support families in this function. Typically, the state or child welfare agency
does not have legal custody of the child and does not take over any of the role functions
of the parent.
Certain federal policies, such as the Adoption Assistance and Child Welfare Act
(AACWA) of 1980 and the Adoption and Safe Families Act (ASFA) of 1997, priori-
tize family preservation in cases where child welfare systems become involved with
families. AACWA was the first law passed that shifted towards prevention of
removal, in place of a reactive response during investigation. It specified that child
welfare agencies must develop and implement services to ensure reasonable efforts
are made to prevent or eliminate the need for removal of a child from their home. As
will be discussed later, this meant assessing a family’s needs and responding by
providing resources and support. Similarly, ASFA required that states must continue
to make reasonable efforts to preserve and reunify families.
The goals of family preservation are rooted in a family-centered and strengths-­
perspective approach to serving families. The goals are to help parents build on
existing strengths in order to reduce the risk of abuse and neglect, prevent the out-­
of-­home placement of children, and enable the family to function without the need
for further child welfare system involvement. Statistics show that almost half (49%)
of children in care will be reunified with their parent; therefore there is a strong
argument for reducing the trauma of removal when possible through the provision
of services and supports.
The process and services offered as part of family preservation may look different
based on the jurisdiction. Typically, it involves a family assessment, service plan,
service provision, a safety plan, ongoing monitoring of progress, and conclusion/
case closure within a certain time frame. Levels of intervention can range from no
services, where one visit is required to complete an investigation indicating no risk
to the child, to regular contact with the child and family, and wraparound services
are provided for 90–120 days or more. Community service referrals can be made to
reduce the risk of child maltreatment (e.g., food, financial support, assistance with
community supports, etc.), as well as short-term services where services and sup-
ports can be put in place that will mitigate the risk factors of child maltreatment and
that still require a level of supervision and monitoring by the child welfare agency.
Some examples that may fit these criteria are environmental neglect, short-­term hos-
pitalization, or inadequate supervision. Child welfare professionals meet regularly
with their supervisors (weekly) to review the case with regard to safety, assessments,
and service provision, make regular in-person visits (weekly at first) with all family
members, complete necessary forms and assessments, assess home safety, complete
a service plan, and often schedule and hold a child and family team meeting.
In summary, family preservation services are typically short-term, family-­
focused services designed to assist families in crisis by improving parenting and
family functioning while keeping children safe. These in-home services grew out of
the recognition that remaining with family is a priority and that separating children
from their families is traumatic for them, often leaving lasting negative effects.
Family preservation services operate under the premise that many children can be
190 7 Child Maltreatment Prevention and Family Preservation

Note from the Field

Keeping Children in the Home
Jamie, a veteran child welfare professional, was called out to conduct an inves-
tigation into a “dirty home,” where allegations were made that two children
were living with their mother who “drank too much” and the kids sometimes
didn’t go to school. It was late in the day, but Jamie knew this couldn’t wait. She
went to the home to talk to the parent and children and planned to talk to other
family members, school officials, and neighbors if possible and as appropriate.
When she arrived at the door, she noticed two dogs in a fenced in area outside
the house. One young child with a diaper hanging on was out front and another
preteen was sitting on the door step. The preteen, Muriel, said her mom wasn’t
home, but would be soon as she had just called to tell her. Muriel had dirty
clothes on and looked slim, but not emaciated. Jamie showed her identification
and told her who she was and why she was there. Muriel was apathetic and
showed her inside the house after retrieving the toddler. She asked when the
child’s diaper was last changed. Muriel said they had just run out of diapers last
night and her mom didn’t have enough money to buy more until she got paid.
They sat in the kitchen and Jamie noticed they didn’t have food in the fridge
and there were empty boxes of cereal on the counter. Jamie pulled out an apple,
banana, and an orange from her purse and some crackers and asked the kids if
they’d like some. Both nodded. Brenda, the kids’ mom, arrived home and
seemed frazzled and worried. She apologized for the state of the house and
started crying. She said her mom died last year in an accident and she was usu-
ally the one to help out with the kids and help with rent and other expenses
when she didn’t have enough from her check. She said she worked full-time at
the check-cashing store about 3 miles away. She said she often feels depressed
and so tired that she can’t clean or tidy the house, finds it hard to make ends
meet, and there’s nobody to help her. Jamie talked to the kids separately in
another room and asked a few more questions. She was convinced that it was
not an ideal setting the way it was when she arrived, but thought that with some
help, Brenda could provide a safe home for the kids. She asked about family
strengths, supports in the neighborhood or her family, and about benefits she
might be receiving for food, housing, or cash assistance. Jamie called an agency
they worked with and said she would arrange to get some diapers and an emer-
gency food box for the family. She also said she would bring some clothes by
the house later along with some applications for financial and housing assis-
tance. She asked that Brenda call her trusted neighbor, Ms. Perkins, to take the
kids tonight so she could have some time alone and would refer a cleaning
service to help get things started and back on track. Jamie also made referrals
for counseling to help her with grief, loss, and depression she has been experi-
encing. Jamie knows that in some cases, it is the best option to remove kids
from their homes to keep them safe. She also knows that the best place for kids
is with their family and it’s much harder to get them back home once they have
been removed. In this case, there were several things she could do to support
this family to ensure the children’s safety and keep them at home.
Conclusion 191

safely protected and treated within their own homes when parents are provided with
services and support that they need to make the necessary changes.

Conclusion

Child abuse and neglect continue to be a major public health concern; however,
communities have made great strides and have shown that preventing child abuse
and neglect is possible. Various models and programs have been shown to be effec-
tive in addressing child maltreatment at different time points – before it has hap-
pened, when it might happen, and after it has happened. Strategies include reducing
or removing the risk factors for child maltreatment and promoting protective factors
and positive parenting techniques, providing resources and supports, and including
community members and systems in supporting child and family well-being. Further
family preservation services underscore the importance of keeping families together
safely while providing the necessary tools and services to strengthen families.
Discussion Questions
1. How can child welfare professionals engage in child maltreatment prevention?
2. What are three programs that focus on strengthening families to prevent child
maltreatment?
3. How can the child welfare system prevent child maltreatment and support
families?
4. What are the five strategies the CDC recommends that lead to safe, stable, and
nurturing relationships?
5. What services can a child welfare worker recommend when referring for family
preservation programs?

Suggested Activities
1. Review materials released as part of child abuse prevention month (April), and
practice writing an editorial about raising awareness about child maltreatment.
2. Read essays on why prevention matters: https://preventchildabuse.org/resource/
why-­prevention-­matters/. Write a reflection paper on why you think prevention
is important in child welfare work.
3. Preventing child maltreatment includes supporting families and communities to
create positive experiences. Watch the video “Building Partnerships in Child
Welfare,” and write down a list of ideas for activities and resources for families:
https://www.youtube.com/watch?v=ES8Vij2CNBA
4. Learn more about the activities that promote child abuse prevention month
(April) in the state you live in. Obtain promotional materials, find ways to
increase awareness about child abuse prevention, and share information and risk
and protective factors.
5. Read the story, “The Fence or the Ambulance” by John N. Hurty, MD, and con-
sider the parallels to child abuse and neglect prevention: https://www.ncbi.nlm.
nih.gov/pmc/articles/PMC1558450/pdf/amjphnation00932-­0024.pdf
192 7 Child Maltreatment Prevention and Family Preservation

6. Read Lewis et al. (2016). As you read the mothers’ insights about their percep-
tions of acceptability and appropriateness about the Triple P program fit as well
as the barriers to participation, consider how this information can be useful to
child welfare professionals. Discuss with others the importance of engagement
with child welfare-involved families.
Lewis, E. M., Feely, M., Seay, K. D., Fedoravicis, N., & Kohl, P. L. (2016).
Child welfare involved parents and Pathways Triple P: perceptions of pro-
gram acceptability and appropriateness. Journal of child and family stud-
ies, 25(12), 3760-3770. (Available: https://rdcu.be/cbVtZ).

Additional Resources
Child Maltreatment Prevention: A Planning Framework for Action: https://cantasd.
i n f o / w p -­c o n t e n t / u p l o a d s / F r a m e w o r k _ f o r _ P r e v e n t i o n _ P l a n n i n g -­
FINAL-­10-­5-­17.pdf
California Evidence-based Clearinghouse for Child Welfare: https://www.cebc4cw.org/
Centers for Disease Control and Prevention, Child Abuse and Neglect Prevention:
https://www.cdc.gov/violenceprevention/childabuseandneglect/index.html
Centers for Disease Control and Prevention, Preventing Child Abuse and Neglect:
https://www.cdc.gov/violenceprevention/pdf/CAN-­Prevention-­Technical-­Package.pdf
Centers for Disease Control and Prevention, Essentials for Childhood: https://www.
cdc.gov/violenceprevention/childabuseandneglect/essentials.html
Child Welfare Information Gateway, National Child Abuse Prevention Month:
https://www.childwelfare.gov/topics/preventing/preventionmonth/
Prevent Child Abuse America: https://preventchildabuse.org/
CO4Kids, Primary Prevention Measurement Guide: https://www.co4kids.org/tools-­
and-­education/toolkit/prevention-­measurement-­guide

References

Akin, B. A., Yan, Y., McDonald, T., & Moon, J. (2017). Changes in parenting practices during
Parent Management Training Oregon model with parents of children in foster care. Children
and Youth Services Review, 76, 181–191. https://doi.org/10.1016/j.childyouth.2017.03.010
Beasley, L. O., Ridings, L. E., Smith, T. J., Shields, J. D., Silovsky, J. F., Beasley, W., & Bard,
D. (2018). A qualitative evaluation of engagement and attrition in a nurse home visiting pro-
gram: From the participant and provider perspective. Prevention Science, 19(4), 528–537.
https://doi.org/10.1007/s11121-­017-­0846-­5
Caplan, G. (1964). Principles of preventive psychiatry. Basic Books.
Centers for Disease Control and Prevention. (2014). Essentials for childhood: Creating safe, sta-
ble, nurturing relationships and environments for all children. Retrieved from: https://www.
cdc.gov/violenceprevention/childabuseandneglect/essentials.html
References 193

Center for the Study of Social Policy. (n.d.) Strengthening Families. Retrieved from: https://
cssp.org/our-­w ork/project/strengthening-­f amilies/#:~:text=The%20Strengthening%20
Families%20framework%20is,building%20the%20five%20protective%20factors
Child Welfare Information Gateway. (n.d.). Framework for prevention of child maltreatment.
Retrieved from https://www.childwelfare.gov/topics/preventing/overview/framework/
Child Welfare Information Gateway. (2014). Protective factors approaches in child welfare.
Washington, DC: U.S. Department of Health and Human Services.
Child Welfare Information Gateway. (2019). Parent education to strengthen families and reduce
the risk of maltreatment. U.S. Department of Health and Human Services, Children's Bureau.
Child Welfare Information Gateway. (2018). Preventing child abuse and neglect. U.S. Department
of Health and Human Services, Children's Bureau.
Daro, D. (2016). A public health approach to prevention: What will it take? Trauma, Violence, &
Abuse, 17(4), 420–421. https://doi.org/10.1177/1524838016658880
Daro, D., Jarpe-Ratner, E., Karter, C., Crane, K., Bellamy, J. & Seay, K. (n.d.). Child maltreatment
prevention: A planning framework for action. Chapin Hall. Available: https://cantasd.info/wp-­
content/uploads/Framework_for_Prevention_Planning-­FINAL-­10-­5-­17.pdf
Drazen, Y., Guenther, L., & Hansen, J. (2009). Public awareness campaigns. In K. S. Slack,
K. M. Jack, & L. M. Gjertson (Eds.), Child maltreatment prevention: Toward an evidence-­
based approach (pp. 17–18).
Fleckman, J. M., Taylor, C. A., Theall, K. P., & Andrinopoulos, K. (2019). Perceived social norms
in the neighborhood context: The role of perceived collective efficacy in moderating the rela-
tion between perceived injunctive norms and use of corporal punishment. Child and Adolescent
Social Work Journal, 36(1), 29–41. https://doi.org/10.1007/s10560-­018-­0581-­1
Fortson, B. L., Klevens, J., Merrick, M. T., Gilbert, L. K., & Alexander, S. P. (2016). Preventing
child abuse and neglect: A technical package for policy, norm, and programmatic activities.
https://doi.org/10.15620/cdc.38864
Frieden, T. R. (2010). A framework for public health action: the health impact pyramid. American
Journal of Public Health, 100(4), 590–595. https://doi.org/10.2105/AJPH.2009.185652
Guterman, N. B., Bellamy, J. L., & Banman, A. (2018). Promoting father involvement in early
home visiting services for vulnerable families: Findings from a pilot study of "Dads matter".
Child Abuse & Neglect, 76, 261–272. https://doi.org/10.1016/j.chiabu.2017.10.017
Kempe, C. H., Silverman, F. N., Steele, B. F., Droegemueller, W., & Silver, H. K. (1962). The battered-­
child syndrome. JAMA, 181(1), 17–24. https://doi.org/10.1001/jama.1962.03050270019004
Klika, J. B., Haboush-Deloye, A., & Linkenbach, J. (2019). Hidden protections: Identifying social
norms associated with child abuse, sexual abuse, and neglect. Child and Adolescent Social
Work Journal, 36(1), 5–14. https://doi.org/10.1007/s10560-­018-­0595-­8
Knox, M. S., Burkhart, K., & Hunter, K. E. (2011). ACT against violence parents raising safe kids
program: Effects on maltreatment-related parenting behaviors and beliefs. Journal of Family
Issues, 32(1), 55–74. https://doi.org/10.1177/0192513X10370112
Lewis, E. M., Feely, M., Seay, K. D., Fedoravicis, N., & Kohl, P. L. (2016). Child welfare
involved parents and Pathways Triple P: perceptions of program acceptability and appropri-
ateness. Journal of Child and Family Studies, 25(12), 3760–3770. https://doi.org/10.1007/
s10826-­016-­0526-­2
Longo, F., McPherran Lombardi, C., & Dearing, E. (2017). Family investments in low-income
children's achievement and socioemotional functioning. Developmental Psychology, 53(12),
2273. https://doi.org/10.1037/dev0000366
Phillips, D. A., & Shonkoff, J. P. (Eds.). (2000). From neurons to neighborhoods: The science of
early childhood development. National Academies Press.
Portwood, S. G., Lambert, R. G., Abrams, L. P., & Nelson, E. B. (2011). An evaluation of the adults
and children together (ACT) against violence parents raising safe kids program. The Journal of
Primary Prevention, 32(3-4), 147. https://doi.org/10.1007/s10935-­011-­0249-­5
Ridge, K. E., Weisberg, D. S., Ilgaz, H., Hirsh-Pasek, K. A., & Golinkoff, R. M. (2015).
Supermarket speak: Increasing talk among low-socioeconomic status families. Mind, Brain,
and Education, 9(3), 127–135. https://doi.org/10.1111/mbe.12081
194 7 Child Maltreatment Prevention and Family Preservation

Sama-Miller, E., Akers, L., Mraz-Esposito, A., Coughlin, R., & Zukiewicz, M. (2019). Home visit-
ing evidence of effectiveness review: Executive summary. Mathematica Policy Research.
Stith, S. M., Liu, T., Davies, L. C., Boykin, E. L., Alder, M. C., Harris, J. M., et al. (2009). Risk
factors in child maltreatment: A meta-analytic review of the literature. Aggression and Violent
Behavior, 14(1), 13–29. https://doi.org/10.1016/j.avb.2006.03.006
Strompolis, M., Cain, J. M., Wilson, A., Aldridge, W. A., Armstrong, J. M., & Srivastav, A. (2020).
Community capacity coach: Embedded support to implement evidenced-based prevention.
Journal of Community Psychology. https://doi.org/10.1002/jcop.22375
Task Force on Sudden Infant Death Syndrome. (2016). SIDS and other sleep-related infant deaths:
updated 2016 recommendations for a safe infant sleeping environment. Pediatrics, 138(5).
https://doi.org/10.1542/peds.2016-­2938
Walsh, T. B., McCourt, S. N., Rostad, W. L., Byers, K., & Ocasio, K. (2015). Promoting protective
factors and strengthening resilience. In D. Daro, A. Cohn Donnelly, L. Huang, & B. Powell
(Eds.), Advances in child abuse prevention knowledge. Child maltreatment (Contemporary
issues in research and policy) (Vol. 5). Springer. https://doi.org/10.1007/978-­3-­319-­16327-­7_9
Wilder Research. (2016). The benefits of parenting education: A review of the literature for the
Wilder Parent Education Center. Retrieved from https://www.wilder.org/wilder-­research/
research-­library/benefits-­parenting-­education-­review-­literature-­wilder-­parent
Chapter 8
Assessment in Child Welfare Practice

Introduction

Throughout child welfare practice, assessment is important. Assessment broadly

can be thought of as a professional collecting information for the purposes of mak-
ing decisions. There are multiple assessments that occur within child welfare. The
assessment of parenting ability, the home environment, risk factors, safety, and pro-
tective factors are all assessments that child welfare professionals conduct. Likewise,
there are assessments for children for trauma, education, and behavioral issues.
Associated professionals also assess for health, mental health, substance misuse,
and developmental issues.

Assessing Safety and Risk

To ensure children are safe in the future, child welfare professionals need to assess
safety and risk. Safety is when the child is in a home and family where there is no
threat of danger that could harm a child, or if there is a threat of danger, the family has
the ability to protect the child and manage the threat. Risk is the likelihood of child
maltreatment occurring in the future. Sometimes the term “imminent risk” used to
indicate that the risk of maltreatment is likely. It indicates that the child is not safe.
Risk factors are things that increase the changes of maltreatment occurring and include
things like intimate partner violence, parental substance misuse, and parental mental
health. Child risk factors include those who are young or who have disabilities.
Through the identification of protective factors and risks, child welfare profes-
sionals determine to what extent a child is safe in an environment. However, assess-
ments extend beyond looking at risk because protective factors and the context are
considered. For example, a risk factor could be a parent drinks heavily, frequently
passing out and not supervising or providing basic needs for the child. If the child is

© Springer Nature Switzerland AG 2021 195

J. M. Geiger, L. Schelbe, The Handbook on Child Welfare Practice,
https://doi.org/10.1007/978-3-030-73912-6_8
196 8 Assessment in Child Welfare Practice

Table 8.1 Comparing safety and risk

Comparing safety and risk
Safety Risk
Time Now or very near future Long-term
Degree of harm Moderate to severe Low to severe
Purpose of intervention To control or stop harm To reduce or resolve

Fig. 8.1 Risk and safety

circles. Safety is a subset
of risk where all factors of
safety apply to risk. Not all
risk factors apply to safety
Risk

Safety

a teenager and grandparents live in the home and provide care for the child, the risk
is lessened. However, if the parent lives alone with a young child, there
is a greater risk for maltreatment.
A child is considered to be safe when an assessment of available information
supports the belief that a child is not in immediate (near future) danger of moderate-­
to-­severe harm. The focus in safety determination is to establish the potential for
moderate-to-severe harm that could happen immediately or in the near future (see
Table 8.1). If it is determined that a child is not safe, it is necessary to intervene to
control and stop any potential harm.
Risk, however, involves the likelihood of any degree of longer-term future harm
or maltreatment. To assess risk, child welfare professionals must consider factors in
the family including their strengths and limitations as well as the resources available
to them. Child welfare professionals make decisions about the potential that chil-
dren may be abused or neglected in the future. It is important to note that risk does
not predict when the future harm might occur, but rather the likelihood that it will
happen at all. Further, concerns of risk do not specify a degree of harm or when
harm might occur. Safety is a subset of risk. All factors related to safety also apply
to risk, but not all risk factors may apply to safety (see Fig. 8.1).
There are differences and similarities between safety and risk. Both are con-
cerned with potential of future harm, both related to conditions of home environ-
ment and caregiver or family member behavior, both can change quickly, and both
can be controlled. The differences between the two are time (safety is now and near
future; risk is longer term), degree of harm, and the purpose of intervention (safety
needs to be controlled or managed now; risk can be resolved or reduced to protect a
child from potential longer-term harm).
Assessing Safety and Risk 197

As a child welfare professional, this

Practice Highlight
means that safety must be assessed
quickly, often in one visit. Risk is assessed Minimum Parenting Standards
over a longer period of time, allowing
Often a controversial and difficult
time to gather, assess, and evaluate infor-
concept to grasp for many individ-
mation. Like safety, risk is reassessed
uals is the idea of a minimum par-
whenever there is a recurrence of mal-
enting standard. When we think
treatment or a change in circumstances
about parenting, we think about
(e.g., child returning home). Safety and
ideal standards and practices that
risks can often be controlled by drawing
go beyond the basics of ensuring
on family strengths or mitigating
the child’s safety. Many states and
circumstances.
jurisdictions have a law about what
There are a number of potential safety
consists of “minimum parenting
threats, defined as specific family condi-
standards.” Although the definition
tions that are present and uncontrolled that
may vary, common elements of this
may likely to result in moderate-to-­severe
standard are that a parent (or other
harm to the child. They may be related to
person responsible for the child’s
child vulnerability (e.g., age, disability,
welfare) ensures that the child is:
psychological or emotional problems, lack
of verbal skills), severity of the abuse or • Adequately fed
neglect, and history of abuse and/or • Clothed appropriately for the
neglect and/or child welfare system weather conditions
involvement. The child welfare profes- • Provided with adequate shelter
sional must consider the effect any adult or • Protected from physical, men-
other member of the household could have tal, and emotional harm
on a child’s safety (e.g., parent’s signifi- • Provided with necessary medi-
cant other, extended family member). As cal care and education
part of a safety threat assessment, all chil- required by law
dren residing in the home are to be seen
and, if possible, interviewed out of the
presence of the caregiver and alleged perpetrator. Interviews should be conducted in
a developmentally appropriate manner.
If it is determined that the home is unsafe and the parents cannot provide a safe
environment for the child, a safety plan needs to be developed. This plan needs to
include a time frame for implementation, plan for continued monitoring, a contin-
gency plan if the plan is no longer effective, and requirements for terminating the
plan. A safety plan requires signatures of all involved in the plan. Child welfare
professionals must then follow up to ensure that the plan is being followed.

Safety Assessment Goals

The goal of safety assessment in child welfare practice is to determine if there is (or
not) a threat to the child’s safety, to determine if the child is safe or unsafe, and to
use our critical thinking skills to analyze and apply the information we collect from
our assessment process to planning and intervening to ensure child safety. This
198 8 Assessment in Child Welfare Practice

means that we go beyond simply identifying whether abuse or neglect occurred or

may occur and consider the potential for future abuse and neglect and think about
child safety throughout the life of the case. Many child welfare agencies will outline
specific and required timeframes to document safety assessments (e.g., every
90 days, within 24 hours prior to the child returning home, etc.). It is also important
to note that safety concerns are not always related to parental or caregiver behavior
and often include environmental conditions that impact child safety.

Reflection: Safety or Risk Concern or No Concern?

Consider the following case studies, and ask yourself if you think there is a
safety concern, risk concern, or no concern by consulting Table 8.1:
1. Emerson,1 age 10, and her siblings, Elijah (7) and Ezra (6), are children to
Mark and Rochelle. Rochelle is in dental assistant school, and Mark is at
home with the kids after being laid off. A hotline call was received from a
neighbor who overheard yelling and crying from next door. Rochelle was
yelling for Mark to stop hitting Emerson. When the police arrived, the
younger children ran from the apartment towards them. Mark sat down and
started crying, apologizing for hitting Emerson. Rochelle was tending to
Emerson and consoling her. She had several cuts on her face and was bleed-
ing. Rochelle also had a bruise on her face. She said it was from Mark when
she was trying to stop him from hitting Emerson. Police have responded to
numerous calls at their home in the past. When Emerson was younger, they
received services from the child welfare agency due to physical abuse.
2. Allison, age 4, was reported by domestic violence shelter staff. She had
bruises on both of her arms which she said her mother’s boyfriend caused
when he grabbed her the previous day when she wouldn’t pick up her toys.
When Allison told her mother, they had an argument, and the boyfriend
was violent with her. Allison’s mother left and brought the kids to the shel-
ter where she plans to stay until she can find housing for her and the kids.
3. An investigator finds the Adams’ family home in complete disarray. There is
animal feces on the floor in several rooms and rotting food in the kitchen and
kids’ bedroom. There are roaches in the kitchen. April (age 2) and Addison
(age 3) are sitting on the living room floor eating yogurt while their mother
watches television in the kitchen. Ms. Adams was reported to the child wel-
fare agency twice in the past for leaving her children alone in the home.
• Is there a concern for safety now or the near future (time)?
• Is the degree of harm moderate to severe (degree of harm)?
• Is the purpose of intervention to control or stop harm or to reduce or resolve
(purpose of intervention)?
If yes is the answer for any of these questions, there is likely a concern for
the child’s safety.
1
All names and other personal identifiers in cases and examples throughout this book have
been changed to protect privacy and confidentiality.
Assessment Tools 199

Assessment Tools

There are multiple assessment tools used within child welfare. States have adopted
different models. Child welfare professionals must become experts on the tools
used in their jurisdiction. It is central that whatever tools are used is relevant for the
population on which they are used. It must be emphasized that assessment tools all
have limitations. Something to take into consideration is that risk and safety assess-
ment tools typically identify discrete factors, yet there are always interactions
among factors that likely contribute to outcomes child welfare professionals seek to
prevent (i.e., child fatalities, reoccurring violence; Pecora et al., 2013). Remember,
there is not a full understanding of the etiology of child maltreatment, and there is
no perfect predictor of maltreatment or other outcomes.

Practice Highlight
Examples of Screening and Assessment Tools
The US Department of Health & Human Services Administration for Children
and Families (2012a, b) created a list of screening and assessment instruments
to measure well-being and trauma. Within the chart, they provide details
about the domains the tool assesses (i.e., behavioral/emotional, social, other/
cognitive/physical), targeted ages, the type of assessment (e.g., parent/care-
giver report, direct child assessment, child/youth report), and any training,
administration, and costs required to use the instrument. Additionally, infor-
mation is provided about which measurements are used in various national
data collection and which are recommended by experts who were consulted in
the development of the list of screening and assessment instruments. Below
are some of the instruments that are described in the report:
Early childhood
• Ages and Stages: Social-Emotional (ASQ:SE; Squires et al., 2002)
• Bayley Infant Neurodevelopmental Screener (BINS; Aylward, 1995)
• Child and Adolescent Needs and Strengths (CANS & CANS-0–3; Lyons
et al., 2004)
• Devereux Early Childhood Assessment for Infants and Toddlers (DECA-­-
I/T; Powell et al., 2007)
• Family Map of the Parenting Environment of Infants and Toddlers and
Family Map of the Parenting Environment in Early Childhood 4 (IT-­Family
Map; EC-Family Map; Whiteside-Mansell et al., 2013)
• Infant Toddler Social Emotional and Brief Infant Toddler Social Emotional
Assessment (ITSEA; BITSEA; Carter & Briggs-Gowan, 2006)
• MacArthur-Bates Communicative Development Inventories – Second
Edition (CDIs; Fenson et al., 2007)
• Peabody Picture Vocabulary Test. Fourth Edition (PPVT-4, Dunn &
Dunn, 2007)
• Trauma Symptom Checklist for Young Children (TSCYC; Briere, 2005)
200 8 Assessment in Child Welfare Practice

Middle childhood and adolescent

• Child and Adolescent Needs and Strengths; Child and Adolescent Needs
and Strengths – Mental Health (Lyons et al., 1999; CANS-MH).
• Child Behavior Checklist, Teacher Report Form, and Youth Self Report
Form (CBCL, TRF, YSR; Achenbach, 1999).
• Child PTSD Symptom Scale (CPSS; Foa et al., 2001).
• Children’s Depression Inventory (CDI 2; Kovacs, 2003).
• Loneliness and Social Dissatisfaction Scale (Cassidy & Asher, 1992).
• Mood and Feelings Questionnaire (Angold & Costello, 1987).
• Pediatric Symptom Checklist-17 (PSC-17; Jellinek et al., 1999; Jellinek
et al., 1988).
• Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997).
• Trauma Symptom Checklist (TSCC; Briere, 1996).
All age groups
• Behavioral and Emotional Rating Scale (2nd Edition) (BERS-2;
Epstein, 2004).
• Eyberg Child Behavior Inventory (ECBI; Eyberg & Pincus, 1999).
• Vineland Screener (VSC; Sparrow et al., 1993).
• Social Skills Rating System (SSRS; Gresham & Elliott, 1990).

Actuarial and Clinical-Based Approaches

Two broad categories of approaches within assessment tools are actuarial and clini-
cal approaches. Clinical approaches are likely what first comes to mind with assess-
ment. In these approaches, child welfare professionals through their use of training
and assessment tools arrive at decisions based on their professional training and
expertise. After weighing all of the evidence they have available, the professional
and in many cases their supervisor and team make a decision. While tools are used,
the basis of the decision is on clinical knowledge.
With actuarial approaches, clinical knowledge is still relevant; however, the deci-
sions are made using algorithms built to identify likelihood of specific outcomes.
Child welfare workers collect all the relevant information and enter into a computer
system which generates a recommendation for action. These systems rely on mod-
els that are built using extensive knowledge about child maltreatment and a review
of what outcomes have previously happened with cases.
Actuarial and Clinical-Based Approaches 201

One of the strengths of the actuarial

Practice Highlight
approaches of assessment is that through
using them bias can be reduced. Bias Factors That May Influence
exists in clinical decision-making because Safety and Risk
people hold views that are based on ste-
• Domestic violence (DV) and
reotypes and prejudices. It is concerning
intimate partner violence (IPV)
that decisions made by child welfare pro-
• History of reports to the child
fessionals are based on information other
welfare agency, child welfare
than facts and could be discriminatory.
system involvement, and docu-
However, one concern is that the model-
mented abuse or neglect
ing may not take everything into consider-
• Substance use and abuse
ation and there may be relevant
• Child’s age and vulnerability
information that cannot be captured in the
• Excessive violence or out of con-
model. There are limits with all models.
trol behavior
Most child welfare agencies will use a
• Child’s fearfulness
structured approach to decision-making
• Caregiver’s attitude towards the
designed to guide, support, and document
child is predominantly negative
professional judgment in situations in
• Dangerous expectations of
which children are potentially in danger
the child
immediately or in the very near future. In
• Caregiver hides or refuses access
protecting children, the major concern is
to the child
the potential for harm that is immediate and
moderate to severe. There are four stages of
assessment: gathering information (identify factors that pose concerns about immedi-
ate safety), analyzing information (assess whether the current circumstances mitigate
the identified safety factors), drawing conclusions (determine whether the child is safe
or unsafe), and making decisions (developing and implementing interventions to con-
trol for safety, if deemed unsafe).

Practice Tip
Items to Assess for Home Safety
Fire and Burn Prevention
• Working smoke detectors near family’s sleeping areas
• A fire escape plan in case of fire or emergency
• Access to lighters or matches restricted
• Stove burners are not used to heat the home
• Hot water from faucets is not at scalding temperature
• Electrical appliances are kept out of the reach of young children (e.g.,
curling irons, hair dryers)
• Electrical outlets are not overloaded
• Extension cords are not under rugs or furniture
202 8 Assessment in Child Welfare Practice

Sleeping
• Infant sleeps in crib or bassinette
• Infant sleeps with no toys, stuffed animals, or pillows
• Infant is placed on back to sleep
Choking, drowning, and falls
• Small items are kept out of reach of small children (e.g., plastic bags,
pins, buttons, coins)
• Younger children only play with toys that are too large to swallow,
unbreakable, and without points or sharp edges
• Infants and toddlers are never left alone near bath, pool, bucket, or toilet
• Children are always supervised near water
• Infants and toddlers are never left alone on changing tables, counter-
tops, etc.
• Baby walkers are not used
Poison
• Cleaning products, medicine, pesticides, and alcohol are kept out of
reach of children
• Paint is not chipping or peeling off the walls
• Rodent traps and poison are kept out of reach of younger children
• Toddlers and younger children do not have access to rotten food or trash
Violence
• Parent knows how to calm a crying infant and knows never to
shake a baby
• Firearms and ammunition are stored separately in locked locations
Supervision
• Parent provides appropriate level of supervision considering child’s
development
• Children are left with an appropriate caregiver when the parent is
not home
Illness, medical care, and immunizations
• Parent can recognize signs of illness
• Children have regular physical exams
• Children are up to date on their immunizations
New Ways to Identify Families in Need of Services 203

New Ways to Identify Families in Need of Services

Increasingly child welfare systems seek opportunities to address children and fami-
lies’ needs prior to reports to child protective services. Primary prevention and uni-
versal services that promote well-being for all families attempt to eliminate the need
for child welfare services and to intervene prior to maltreatment occurring. (See
Chap. 7 for more information about child maltreatment prevention.)
Predictive analytics is the use of statistical procedures that analyze current and
historic data to determine the likelihood of future events. This approach has been
used to identify cases that are at risk for child fatalities or reentry into the child
welfare system. While not without criticism (Eubanks, 2018), there is momentum
that predictive analytics can help identify patterns that are not readily observable
and assist with decision-making (Russell, 2015). The use of this strategy to identify
families in need of services and at risk for negative outcomes is still developing.
There are many practical and ethical considerations that need to be considered
(Lanier et al., 2020). Some child welfare systems have embraced the use of predic-
tive analytics.

By Abuse Type Practice Highlight

Family Strengths that Mitigate
During assessments, specific elements are
Safety and Risk Concerns
considered for different abuse types.
When a child appears to have experienced • Extended family networks
physical abuse, the child should be evalu- • Shared parenting practices
ated for injury by a professional health- • Range of individuals as potential
care provider. During the evaluation, the resources and supports
healthcare provider will assess the injury • Tangible resources (e.g., trans-
and take into consideration multiple fac- portation, income, utilities,
tors including consistency of explanation housing)
with the injury, feasibility of the injury • Willingness to accept help
happening due to an accident, location of • Religion, values, and spirituality
the injury, developmental ability of child, • Demonstrates love and care for
and history of injuries. family members
With child sexual abuse, child welfare
professionals with special training are
responsible for interviewing and evaluating the child. With child sexual abuse, it is
best practice to minimize the number of times a child is interviewed (e.g., Duron &
Cheung, 2016), and the number of people conducting interviews should be as small
as possible. The interviews are conducted in a way to minimize the traumatization
and ensure that information is collected that would be relevant for any court pro-
ceedings. In some cases, it may be necessary to have a healthcare provider conduct
a physical exam of a child where there are allegations of child sexual abuse.
204 8 Assessment in Child Welfare Practice

Emotional abuse is evaluated by trained mental health professionals. Within

emotional abuse, as discussed in descriptions of maltreatment types in Chap. 3, it is
important that it is documented that the caregivers’ emotional abuse directly
impacted the child. When assessing emotional abuse, it is important to observe the
child and parent interactions to understand the child-parent relationship. The rela-
tionship should also be assessed through the interview with both the parent and the
child. Other people who interact with the parent and child (e.g., teachers, neighbors,
friends) may also provide information helpful in determining the presence of emo-
tional abuse.
Neglect is assessed through examining the extent to which a child’s basic needs
are met. This includes physical needs such as food, clothing, and shelter. Evidence
that the children’s needs are not being met would be if the parents are not providing
adequate nutrition to the child, if the child does not have appropriate clothing for the
weather, or if the child does not have stable housing (i.e., moves frequently).
Assessment should determine if the house has hazardous conditions (e.g., exposed
wires, holes in floor, missing balcony railing, broken windows, no fence around a
pool, medication or cleaning supplies accessible to young children) or unsanitary
conditions (e.g., animal feces in home, trash throughout home). Assessing neglect
also extends to children’s emotional, health, and educational needs. Evidence of
neglect could include a parent not getting the child required medical care or not hav-
ing the child attend school. Within the assessment of neglect, child welfare profes-
sionals must also determine if there is appropriate level of supervision based on the
child’s developmental stage and abilities.

Practice Highlight
The Safety Plan
In cases where the child is considered unsafe, the safety plan may be for the
child to enter care with protective custody. However, there are other options to
ensure safety even when safety threats have been identified. Identifying fam-
ily strengths or circumstances that can mitigate the concerns and remove the
threat(s) to the child through a safety plan that outlines an agreement with the
caregiver and to monitor the situation. Safety is paramount; however, we also
want to develop a plan that is least intrusive and disruptive to the child.
The safety plan is typically a written description of what will be done or
what actions will be taken to ensure the child’s safety, who will be responsible
for implementing the plan and its components, and how it will be monitored.
Safety plans must be developed alongside the family and explained in detail.
The safety plan should also include a time frame for implementation, a con-
tingency plan, and requirements for terminating the plan. A copy of the safety
plan should be reviewed and signed by the caregiver and any other party
involved, and a copy should be provided to them.
Skills for Assessment in Child Welfare 205

Assessment in Different Contexts

Assessments take place throughout the course of a child and family being involved
with the child welfare system. The assessment process conceptually begins when a
call is reported to child protective services. If screened in, the initial investigation is
the first assessment. However, assessments occur throughout the course of the involve-
ment with child welfare. Once a child enters care, the case manager conducts ongoing
assessments. Some are about the child’s placement and well-being. Others are about
progress that is being made by the parents in the case plan. Some of these assessments
are formal and documented with specific assessment tools. Other times, the assess-
ments are somewhat informal as is the case when a case manager conducts routine
monthly visits with children in out-of-home care. Assessments are not only performed
by child welfare professionals; other professionals involved in the assessment process
include healthcare providers, mental health providers, and substance abuse providers.

Skills for Assessment in Child Welfare

Child welfare professionals must have multiple skills to conduct assessments and
intakes successfully. The skills for assessment include interviewing, observation,
documentation, and critical thinking. Although it must be stressed that the skills
alone are insufficient, content knowledge is central to assessment. Child welfare
professionals must understand the different types of maltreatment and the various
indicators. To conduct assessments, child welfare professionals must also under-
stand a child’s capacities, which is based on a deep understanding of development.
They should also have knowledge about family systems, trauma, and working with
people from various racial and ethnic backgrounds.
In addition to the content-relevant knowledge, the foundation of any assessment
is the child welfare professionals’ ability to interview and observe. In the interview-
ing process, child welfare professionals must ensure they are asking appropriate
questions and listening. It is important to suspend judgment during an interview so
that there can be an understanding of the circumstances. It is dangerous to assume
that answers to questions are known. Seeking clarification is important. Within the
interviews and observation, child welfare professionals must pay attention to detail.
Protocol directs much of assessment, and each child welfare system has specific
tools that are used. Some tools are interview guides or checklists used during obser-
vations for the child welfare professional to use to document information. Others
are short questionnaires for parents, teachers, or others to complete. Many of the
tools that are used in assessments are for specific developmental periods. For exam-
ple, there are specific assessments for young children as well as specific assess-
ments for adolescents. To administer some tools, sometimes there is an extensive
training process for the child welfare professional. With all assessment tools and
protocols, documentation, which is discussed later in the chapter, is paramount.
Regardless of how structured an assessment may be, child welfare professionals
must always engage in critical thinking. Critical thinking allows the child welfare
professionals to interpret what they are seeing and to not accept what they see without
applying reason and knowledge. With various assessment tools having actuarial
206 8 Assessment in Child Welfare Practice

components and the rise of predictive analytics within child protection, it is important
that professionals can interpret what the models and assessments produce. As no mod-
els are perfect and mistakes can be made, professionals must be able to identify when
something may be wrong. When an assessment that determines there is no immediate
threat while the child welfare professional is confident that the child’s immediate
safety is at risk, a professional must be able to think critically and determine if a mis-
take was made rather than blindly following the assessment.

Family Engagement in Interviewing

Interviewing occurs every time a child welfare professional meets with a client, and
their family and purposeful conversations should occur at each interaction. There
should always be a plan and a reason for contact with the family. It is also important
to note that interviewing is not interrogating – it is an interactional exchange for
sharing information and developing solutions collaboratively. The context by which
child welfare professionals keep the client engaged is through the relationship or the
rapport that has been cultivated over time. It is important to establish trust through
honesty and full disclosure. Dishonesty and failure to disclose information can lead
to a breakdown in trust and disillusionment on the client’s part.
There are several stages in an interview: social, needs identification, focus, and clo-
sure. The social stages mainly involve establishing rapport, promoting engagement, and
making the individual(s) being interviewed feel comfortable, safe, and open to talking.
Individuals who feel safe and able to talk about issues that they have in common or
something nonthreatening (e.g., weather, news, etc.) are more likely to be open to other
topics in discussion. Examples include small talk about current events and something in
the home (e.g., artwork, furniture, etc.) while also engaging family members in conver-
sation about everyday matters (e.g., school, routine). This stage is often brief, but all
members should be invited to participate, if possible. It allows the interviewer to appear
more approachable, relatable, and genuine. The second stage, needs identification,
involves questions about the purpose for the interview or visit and obtaining information
about strengths and needs from the perspective of individuals in the family. Once this
information is obtained, action-­oriented questions related to how these needs will be
met should follow, for example, “what needs to happen in order for your family to get
there?” when referring to needs and desires. The purpose of this stage is to allow fami-
lies to express their perspective and to get their input about the issue(s) and possible
solutions. A strengths perspective and family-centered approach should always be used
to merge individual and family strengths that will address the family’s needs. The pur-
pose of the focus stage is to encourage family members to talk to each other about the
changes they want for their family. It is important to use language around safety and
well-being that is action-oriented. For example, a worker could ask the family members,
“what do each of you think needs to happen in order for the children to be safe?” During
this phase, the child welfare professional serves as the facilitator of the conversation and
should be prepared to ensure all topics are covered and addressed and that all members
of the family have had an opportunity to contribute to the conversation. The closure
stage is intended for reviewing the information gathered and summarizing the plan
developed. It is important to also identify any agreements, commitments, and next steps.
Conducting Family and Home Assessments 207

Conducting Family and Home Assessments

Child welfare professionals conduct family and home assessments. At their founda-
tion, these assessments are to identify risk and to determine if the caregivers can
ensure a child’s safety in the home environment. Family assessments examine the
child’s family and determine their ability to care for the child and meet the child’s
needs. Comprehensive family assessments are considered best practices in child
welfare as they provide both a broad and in-depth examination of the child’s and
family’s situation (Smithgall et al., 2015). These assessments are multifaceted and
look at all family member’s strengths, functioning, and needs as well as the context
of the problems.
When assessing the household functioning, it is important to critically examine
a broad range of aspects starting with who is in the home. Beyond the people pres-
ent, child welfare professionals need to understand the roles of the people including
who cares for the children; who provides income; and who is responsible for the
upkeep and cleaning of the house. When examining who cares for the child, it is
important to identify those who have significant caregiver responsibilities. Who is
providing the daily care for the child and responsible for the safety and well-being
of the child? This may not be only those who are legally responsible (i.e., birth par-
ent, adoptive parent, legal guardian); it also may include paramours or other adults
living in the home. Understanding the household dynamics and family culture is
important as is having a complete picture of the support system outside of the home.
The assessment should generate an understanding of household operates.

Practice Tip
Observations of the Home Environment and Parent-Child Interactions
Your observations as a child welfare professional are extremely important
while assessing the family and the current circumstances. Some questions to
consider when making observations include the following verbal and nonver-
bal behaviors:
• Are they calm, relaxed, gentle, and confident about their parenting role?
• Do they seem to be anxious, easily frustrated, inattentive, indifferent, or
detached?
• How do they look at, touch, and attend to the child?
• What is their tone of voice and responsiveness to the child’s needs?
• Do they provide the child with appropriate stimuli?
• Do they enhance the child’s sense of security and meet their basic needs?
• Do they rely on the child to meet their needs? (Role reversal)
• Are their expectations developmentally appropriate for the child?
• Is the home safe and equipped to meet the child’s basic needs?
• What are the safety and risk factors present in the caregiver and home?
• How does the child respond to the parent or caregiver?
208 8 Assessment in Child Welfare Practice

Understanding Families

To properly conduct assessments, child welfare professionals should understand

families. There is a wide range of family structures, and none are inherently bad.
Families can be nuclear or extended. Within nuclear, it is the parents and children.
Extended families include additional generations and go outside the nuclear parents
and children structure. Grandparents, aunts, uncles, and cousins are part of a child’s
extended family. While nuclear and extended families are two structures, there are
additional patterns to take into consideration. Some families are interdependent and
prioritize the good of the family over individual family member’s needs and desires.
Other families are more independent, meaning family members’ individual identi-
ties are seen and people are not expected to only prioritize the needs of the family.
Different cultures often prioritize and value different family structures. It is the job
of the child welfare professional to understand the family’s structure and functioning.
Families are all unique with different dynamics and patterns. Some of these are
overt and easily observed by outsiders, while others are covert and not readily
apparent to someone outside the family. Family patterns are based on the values and
norms in the family. They are the ways that family members engage with one
another and behave. Within families, people have roles. (See Chap. 3 on information
about family roles.) Understanding the roles of the family can provide valuable
insights about a family’s strengths as well as risks for maltreatment.
All families have strengths. (See Chap. 6 on information on strengths-based
practice.) Assessments are needed to identify the strengths and needs of families.
The assessments take into consideration the uniqueness of each family. There are
various instruments that are used to assess families, some of which are used by child
welfare professionals. Some assessments require advanced training, and child wel-
fare professionals must collaborate with professionals with the specialized expertise
in assessing children and adults for health, mental health, substance misuse, and
developmental issues. For these assessments, child welfare professionals often part-
ner with community agencies. This is typically done with referrals to agencies. In
some communities there are limited resources, and it may be challenging to have
assessments done in a timeline manner. This can create challenges for child welfare
professionals who need the information as well as the caregivers who are trying to
meet their case plan goals. It is important to recognize these stressors for families
and to collaborate with other professionals to ensure the assessments are conducted.

Child Assessments

In assessing children, child welfare professionals have a range of tools to use.

Different agencies have different assessments that are used, but what most have in
common is that they are multidimensional and take a child’s development into con-
sideration. One such tool that widely is used is the Child and Adolescent Needs and
Strengths (CANS) which not only assists with assessment but also can assist with
Forensic Interviewing 209

monitoring outcomes. CANS, as the name indicates, examines both the needs and
strengths of the children. It does so on scales that indicate the strength or need is not
identified or evident, the strength is a centerpiece strength, and the need requires
immediate/intensive action. Through using CANS or other assessments, child wel-
fare workers can determine how to best serve children.

Practice Tip
Interviewing Children and Youth
The child welfare professional’s approach to interviewing is key in obtaining
important information and assessing for safety. When interviewing a child, be
gentle, reassuring, and supporting when asking questions. Avoid blaming or
judging the parents in the child’s presence. Child welfare professionals need
to emphasize that they are there to help the family and information they pro-
vide will help to accomplish this. It’s also important to know when it is time
to cease questioning, take a break from questioning, and resuming if appropri-
ate. When the interview is completed, it is good practice to thank them for
taking the time to talk and provide reassurance without making any promises
that cannot be kept.
There are often questions where the child may be hesitant to share infor-
mation with the child welfare professional. Consider the following when con-
ducting interviews:
Culture: It’s possible that parents may have to give their permission for the
child to speak with you.
Dependency: Children may have an allegiance to their parents and may be
distrustful of the child welfare professional, the child welfare professional’s
role, or the child welfare system.
Coaching: Parents or caregivers may have coached the child regarding what
they should or shouldn’t say to the child welfare professional.
Consequences: Children may fear punishment if they reveal problems in
their home or family.
Personality and temperament: The child may be naturally quiet, timid, or
unable to communicate effectively, and these elements should be taken into
consideration.

Forensic Interviewing

Child welfare professionals are often the first to interview a child and their family
when a report of child maltreatment is investigated. Guidance regarding this first
interview to assess safety, risk, and needs for the family is further discussed in
Chap. 6. This section provides an overview of forensic interviewing with children
210 8 Assessment in Child Welfare Practice

and research-based strategies used during a forensic interview, usually conducted

by a professional when further investigation is required when a criminal legal matter
is being pursued. These interviewing considerations and tools are helpful for child
welfare professionals when interviewing a child as well, when child maltreatment is
suspected. It is important to be aware of and make plans regarding the setting, inter-
view structure, language, introducing the topic of abuse, rapport development, and
strategies for discussing details. Research shows that a child’s memory of an event
is quite accurate, with some omissions (e.g., Paz-Alonso et al., 2009). The accuracy
of these verbal accounts in interviews is dependent on the child’s age, the event, and
the setting of the interview/retrieval of information (Bottoms et al., 2009). Further,
children are more accurate in their recall of events that involve familiar individuals
than unfamiliar individuals (e.g., Cordón et al., 2016).
Several evidence-based protocols have been developed to standardize the foren-
sic interviewing process and to ensure its accuracy of reports (e.g., cognitive inter-
view, narrative elaboration interview, NICHD protocol, and Lyon’s 10-step
interview). As with other interviews, forensic interviews involve multiple steps,
which include an initial preparatory phase (introductions, instructions, rapport
development), information gathering, and closure. Guidelines typically recommend
a private space, age-appropriate, and quiet setting for an interview. The setting
should minimize distractions and additional unnecessary individuals and be child-­
friendly. Research shows that interviewers that approach questioning in a more sup-
portive way can elicit an improved flow to the conversation and improve accuracy
of responses (Bottoms et al., 2007). Interviewers who provide positive feedback,
smile, and are friendly can reduce a child’s resistance during an interview. Questions
should be phrased in a way and with language that the child can understand.
Interviewers should gauge understanding by asking for clarification on certain
words or phrases and avoid introducing difficult concepts, especially legal terms or
ones that are too abstract. Questions should be open-ended and not leading, and
children should be permitted to say they don’t know the answer to the question.
There are a number of organizations that provide in-depth training to conduct
forensic interviewing, and with experience, interviewers improve their practice.
These types of interviews are extremely important when dealing with cases where
the criminal justice system becomes involved. It is also important to consider avoid-
ing re-traumatizing a child who has experienced maltreatment and has had to answer
questions with multiple individuals regarding the incident. Some interviewers pre-
fer or are required to follow an interview protocol, while some can be somewhat
flexible depending on the case and circumstances.

Documentation

A good rule for child welfare professionals to live by is “if it is not documented,
then it did not happen.” Child welfare professionals must keep documentation cur-
rent. Completing documentation in a timely manner increases the likelihood that
information is not lost. Child welfare workers may believe that they will remember
important salient details, yet relying on memory of what someone said is not ideal.
Writing Effective Case Notes 211

Human memory is notoriously unreliable. As the details of a case may be needed

long after a child welfare professional learned of them, it is always best to have the
information clearly documented to ensure the information is preserved. No child
welfare professional wants to have to testify in court on their memory alone.
Every agency has specific guidelines for documentation and forms that are
required. There are timelines about when documentation must be completed in a
case. Increasingly, states have transitioned to electronic case notes which has the
potential to increase efficiency, decrease redundancy, increase communication
across workers, increase standardization, and improve opportunities for communi-
cation across agencies. Some agencies provide laptops or tablets for workers to use
during home visits or when meetings outside the office. This may facilitate timely
documentation, although in order to build rapport and engage families, it is often
not possible for workers to complete documentation when they are with a child or a
family. Additionally, in some geographic areas, there may not be cell phone service
or Wi-Fi needed to access cloud-based forms and databases where case notes are
completed. Workers must dedicate time to paperwork.

Writing Effective Case Notes

While there is variation in the format and process of writing effective case notes,
there are best practices. Child welfare professionals must use facts including details
of who was involved, what happened, where did something happen, and how did it
happen. Within documentation, child welfare professionals should describe behavior
rather than label behavior. For example, labeling behavior is “SJ was upset by the
update.” To write this in describing the behavior, “When at SJ’s home, I told her the
shelter hearing was scheduled for Tuesday; she covered her face with her hands,
stood up, and left the room crying.” Effective documentation quantifies information
as much as possible, meaning giving concrete numbers within descriptions. For
example, “There was a hole in the kitchen wall that was approximately two feet in
diameter that exposed electrical wiring” is stronger than writing “There was a big
hole in the kitchen wall.” It is the responsibility of the child welfare professionals to
capture details through documentation as ultimately this is the information used to
determine how cases proceed.
Case notes are the chronological record Practice Tip Writing Good
of interactions, observations, and actions
involving a specific person and/or family. Case Notes
They provide a record of all the things that • Be concise
have happened during a family’s involve- • Be accurate (facts vs. opinions)
ment with the child welfare agency, • Nonjudgmental/without your
including phone calls, face-to-face con- appraisal
tacts, contacts with service providers, • Avoid slang/inappropriate
team meetings, court hearings, and visits. language
Case notes are also important for case • Check spelling, grammar, sen-
continuity, for legal discovery purposes, tence structure, etc.
and for historical record. Information • Avoid jargon
212 8 Assessment in Child Welfare Practice

recorded in case notes about a person or family should be impartial, accurate, and
complete. Documentation should be objective, descriptive, clear, concise, accurate,
and relevant. The language used in documentation should be nonjudgmental. The
information included in the documentation should be relevant and detail the context
in which the information was collected. Information that is not directly relevant to
the case should not be included in the documentation.
Good case notes include several important elements, including the reason for
involvement, reason for contact, the gathering of information and conversation, who
was present and seen, observations, interactions and underlying factors, and ser-
vices, intervention, and safety plan. Table 8.2 describes each of these elements and
provides concrete examples.

Table 8.2 Case note examples

Part of case
note Description Example
Reason for • Related to referral/report/ Caseworker is currently involved with the
involvement allegation of abuse or neglect Brown family because of a recent
• Provides context mandated report to DCFS that Johnny has
been absent from school for more than 2
months. Caseworker is required to follow
up in assessing Johnny’s reason for
failing to attend school and monitor his
attendance
Reason for • Related to the reason for Caseworker made a home visit with Ms.
contact involvement, but more specific Brown today to address Johnny’s failure
to the interaction to attend school for the past 2 months.
• Stating the reason keeps you
focused on the service goals to
be accomplished
Gathering of • Information from the child, Caseworker met with Ms. Brown and all
information/ family, and collateral sources is the children (Mary, age 16; Johnny, age
conversations a key task as a caseworker 15; and Jonathan, age 2) at Ms. Brown’s
• Assessment of the family must home on 10/2/19. Caseworker asked Ms.
be family-focused and highlight Brown and Johnny about the reason he
the strengths, specific needs, and has missed 2 months of school. Ms.
functioning of each family Brown said she was not aware of the
member absences until DCFS called because he
• At the first meeting, it is helpful leaves the house every day and comes
to get a full family history home at the same time every day. Johnny
• Other notes related to gathering claims he has been attending school, but
of info: he has not been going to his homeroom
 School records, interview class because a boy in that class has been
with principal (or staff that picking on him. According to Ms. Brown,
handles attendance) Johnny does not have a history of
 Medical report truancy; this is the first occurrence.
 Reports of other kids’ Johnny also said that he has not been
attendance records truant before
 Schedule a meeting with
homeroom teacher to
investigate story of child in
class
(continued)
Writing Effective Case Notes 213

Table 8.2 (continued)

Who was seen? • Since you are assessing for Present at the home today was Ms.
safety and risk factors related to Brown, her three children (Mary, Johnny,
child abuse or neglect, it’s and Johnathan), and her live-in partner,
important to document who you Mr. turner. We all met in the living room
saw and the location of the visit of the home, and I toured the home to see
the children’s bedrooms, bathrooms, and
kitchen
Observations • It’s important to use your Ms. Brown looked tired and yawned
knowledge about what you frequently. She stated that she was tired
know about child development, because she worked late the night before.
family dynamics, social The children’s hair looked dirty and
behavior, mental health, and unkempt. They were dressed in cotton
culture to record your shorts and t-shirts that were stained and
observations soiled, but appropriate for the weather.
• Record physical, social-­ The children looked healthy and well-fed.
emotional, and cognitive No bruises or scars were observed.
development and health, According to Ms. Brown, they were seen
financial well-being, and by a medical provider for well check
environmental issues. appointments the summer prior
• Pay attention to affect,
appearance, dress, behavior,
interactions, mannerisms, and
home conditions
Interactions • Note how the family members Ms. Brown met caseworker at the door
interact with each other and and did not invite the CW in the house.
with you She smiled and responded briefly to
• Qualify with examples questions. She seemed distracted and not
very engaged in the conversation. The
older children only spoke when they were
asked a question. The children appeared
tense and anxious in the presence of Mr.
Turner
Underlying • Assess for mental health Ms. Brown stated that she rarely leaves
factors concerns, domestic violence/ the house. She experiences anxiety and is
intimate partner violence, fearful about going out. She said the
developmental disorders, problem started a year ago and recently
substance abuse, and trauma got worse
histories
• Assess for strengths, values, and
beliefs
Services/ • Identify goals and service needs Caseworker explained to Ms. Brown that
intervention/ related to the presenting or her teenage children are old enough to
safety plan emerging issues. help with household chores and showed
• The services and interventions her how to set up a chore schedule
should address underlying
conditions and contributing
factors that may place children
at risk of abuse/neglect.
• Include short- and long-term
goals to help stabilize and
support the family
214 8 Assessment in Child Welfare Practice

Conclusion

Assessment is a central skill in child welfare practice. Child welfare professionals

are responsible for continuously assessing safety and risk through assessment.
Additionally, they must determine the strengths and needs of children and families.
While there are a range of tools that child welfare professionals use and the proto-
cols vary among agencies, assessments are consistently used in child welfare. The
assessments and interactions that child welfare professionals have with children and
families must be documented. Child welfare professionals must master writing
effective case notes that are concise, accurate, and judgment-free.
Discussion Questions
1. What are three things to assess while conducting a home safety assessment?
2. How are risk of child maltreatment and safety concerns different and similar?
3. What is an example of a tool to assess for strengths and needs? What are some
advantages to using this tool?
4. What are two tips to keep in mind when writing effective case notes?
5. What information should be included in case notes?
Suggested Activities
1. Explore what assessment tools used at the child welfare agency where you live.
Are they actuarial tools and assessments? How much do the assessments rely on
professional knowledge and expertise? Who is the process for assessment?
2. Use one of the case studies offered in this chapter and practice writing case notes
for different points in time (e.g., investigation, monthly home visit, case closures).
3. Download and review the Child and Adolescent Needs and Strengths (CANS)
manual (https://www.nctsn.org/measures/child-­adolescents-­needs-­strengths).
Write down some of the strengths and limitations of using this type of assess-
ment with children and families.
4. Read Lanier et al. (2020) and discuss with others your thoughts about using pre-
dictive analytics in child welfare. What are the strengths? What concerns do you
have about child welfare agencies using predictive analytics to make decisions?
Lanier, P., Rodriguez, M., Verbiest, S., Bryant, K., Guan, T., & Zolotor, A. (2020).
Preventing infant maltreatment with predictive analytics: applying ethical prin-
ciples to evidence-based child welfare policy. Journal of family violence, 35(1),
1–13. (Available: https://rdcu.be/cbVsb).

Additional Resources
American Professional Society on the Abuse of Children: Forensic Interviewing
training clinics and institutes: https://www.apsac.org/forensicinterviewing
CDC Home Safety Checklist: https://www.cdc.gov/steadi/pdf/check_for_safety_
brochure-­a.pdf
References 215

Child Welfare Information Gateway, Assessing Risk and Safety: https://www.

childwelfare.gov/topics/responding/iia/investigation/safety-­risk/
Child Welfare Information Gateway, Child Neglect: A Guide for Prevention,
Assessment, and Intervention: https://www.childwelfare.gov/pubPDFs/neglect.pdf
NC Division of Social Services, Documentation in Child Welfare: Effective
Practices for County DSS Agencies: https://fcrp.unc.edu/files/2017/09/documenta-
tion_webinar.pdf
Florida’s Center for Child Welfare, Developing Safety Plans: http://centerforchildwel-
fare.org/Preservice/ActionBoosterTrainings/SafetyPlanning/Developing%20Safety%20
Plans%20Training%20Fall%202014%20PG%2010-­21.pdf
Kids Health, Household Safety Checklist: https://kidshealth.org/en/parents/
household-­checklist.html

References

Achenbach, T. M. (1999). The child behavior checklist and related instruments. In M. E. Maruish
(Ed.), The use of psychological testing for treatment planning and outcomes assessment
(pp. 429–466). Lawrence Erlbaum Associates Publishers.
Angold, A., & Costello, E. J. (1987). Mood and feelings questionnaire (MFQ). Developmental
Epidemiology Program, Duke University. https://doi.org/10.1037/t15197-­000
Aylward, G. P. (1995). Bayley infant neurodevelopmental screener. San Antonio. https://doi.
org/10.1037/t14989-­000
Bottoms, B. L., Najdowski, C. J., & Goodman, G. S. (Eds.). (2009). Children as victims, witnesses,
and offenders: Psychological science and the law. Guilford Press.
Bottoms, B. L., Quas, J. A., & Davis, S. L. (2007). The influence of interviewer-provided
social support on children’s suggestibility, memory, and disclosures. In Child sexual abuse
(pp. 145–168). Psychology Press.
Briere, J. (1996). Trauma symptom checklist for children (pp. 00253–00258). Psychological
Assessment Resources. https://doi.org/10.1037/t06631-­000
Briere, J. (2005). Trauma symptom checklist for young children (TSCYC). Psychological
Assessment Resources.
Carter, A. S., & Briggs-Gowan, M. J. (2006). Manual for the Infant-Toddler Social & Emotional
Assessment (ITSEA)-Version 2. Psychological Corporation. https://doi.org/10.1037/t14990-­000
Cassidy, J., & Asher, S. R. (1992). Loneliness and peer relations in young children. Child
Development, 63(2), 350–365. https://doi.org/10.2307/1131484
Cordón, I. M., Silberkleit, G., & Goodman, G. S. (2016). Getting to know you: Familiarity, ste-
reotypes, and children’s eyewitness memory. Behavioral Sciences & the Law, 34(1), 74–94.
https://doi.org/10.1002/bsl.2233
Dunn, L. M., & Dunn, L. M. (2007). Peabody picture vocabulary test-revised. Pearson. https://doi.
org/10.1037/t15144-­000
Duron, J. F., & Cheung, M. (2016). Impact of repeated questioning on interviewers: Learning from
a forensic interview training project. Journal of Child Sexual Abuse, 25(4), 347–362. https://
doi.org/10.1080/10538712.2016.1161687
Epstein, M. H. (2004). BERS-2 Behavioral and emotional rating scale (2nd ed.). PAR, Inc., London.
Eubanks, B. (2018). Artificial intelligence for HR: Use AI to support and develop a successful
workforce. Kogan Page Publishers, New York, NY.
216 8 Assessment in Child Welfare Practice

Eyberg, S., & Pincus, D. (1999). Eyberg child behavior inventory & Sutter-Eyberg student behav-
ior inventory-revised: Professional manual. Psychological Assessment Resources.
Fenson, L., Marchman, V. A., Thal, D. J., Dale, P. S., Reznick, J. S., & Bates, E. (2007). MacArthur-­
Bates communicative development inventories. Paul H. Brookes Publishing Company. https://
doi.org/10.1037/t11538-­000
Foa, E. B., Johnson, K. M., Feeny, N. C., & Treadwell, K. R. (2001). The child PTSD symptom
scale: A preliminary examination of its psychometric properties. Journal of Clinical Child
Psychology, 30(3), 376–384. https://doi.org/10.1207/S15374424JCCP3003_9
Goodman, R. (1997). The strengths and difficulties questionnaire: A research note. Journal of
Child Psychology and Psychiatry, 38(5), 581–586. https://doi.org/10.1111/j.1469-­7610.1997.
tb01545.x
Gresham, F. M., & Elliott, S. N. (1990). The Social Skills Rating System. Circle Pines, MN:
American Guidance Service.
Jellinek, M. S., Murphy, J. M., Little, M., Pagano, M. E., Comer, D. M., & Kelleher, K. J. (1999).
Use of the pediatric symptom checklist to screen for psychosocial problems in pediatric pri-
mary care: A national feasibility study. Archives of Pediatrics & Adolescent Medicine, 153(3),
254–260. https://doi.org/10.1001/archpedi.153.3.254
Jellinek, M. S., Murphy, J. M., Robinson, J., Feins, A., Lamb, S., & Fenton, T. (1988). Pediatric
symptom checklist: Screening school-age children for psychosocial dysfunction. The Journal
of Pediatrics, 112(2), 201–209. https://doi.org/10.1016/S0022-­3476(88)80056-­8
Kovacs, M. (2003). Children’s depression inventory (CDI). Multi-Health System.
Lanier, P., Rodriguez, M., Verbiest, S., Bryant, K., Guan, T., & Zolotor, A. (2020). Preventing
infant maltreatment with predictive analytics: Applying ethical principles to evidence-­
based child welfare policy. Journal of Family Violence, 35(1), 1–13. https://doi.org/10.1007/
s10896-­019-­00074-­y
Lyons, J., Griffin, E., Fazio, M., & Lyons, M. B. (1999). The child and adolescent needs and
strengths: An information integration tool for children with mental health challenges and their
families. Northwestern University Institute for Health Services Research and Policy Studies.
https://doi.org/10.1037/t02500-­000
Lyons, J. S., Weiner, D. A., & Lyons, M. B. (2004). Measurement as communication in outcomes
management: The child and adolescent needs and strengths (CANS). (p. 461–476) in (Ed. Mark
E. Maruish). The use of psychological testing for treatment planning and outcomes assess-
ment. Volume 2: Instruments for children and adolescents. Third Edition. Laurence Erlbaum
Associates, Publishers. doi:https://doi.org/10.4324/9781410610621-­17.
Paz-Alonso, K., Ogle, C. M., & Goodman, G. S. (2009). Children’s memory and testimony in “sci-
entific case studies” of sexual abuse. Issues in investigative interviewing, eyewitness memory,
and credibility assessment, 143–172. doi:https://doi.org/10.1007/978-­1-­4614-­5547-­9_6.
Pecora, P. J., Chahine, Z., & Graham, J. C. (2013). Safety and risk assessment frameworks:
Overview and implications for child maltreatment fatalities. Child Welfare, 92(2), 143–160.
Powell, G., Mackrain, M., LeBuffe, P., & Lewisville, N. C. (2007). Devereux early childhood
assessment for infants and toddlers technical manual. Kaplan Early Learning Corporation.
Russell, J. (2015). Predictive analytics and child protection: Constraints and opportunities. Child
Abuse & Neglect, 46, 182–189. https://doi.org/10.1016/j.chiabu.2015.05.022
Smithgall, C., Jarpe-Ratner, E., Gnedko-Berry, N., & Mason, S. (2015). Developing and testing
a framework for evaluating the quality of comprehensive family assessment in child welfare.
Child Abuse & Neglect, 44, 194–206. https://doi.org/10.1016/j.chiabu.2014.12.001
Sparrow, S. S., Carter, A. S., & Cicchetti, D. V. (1993). Vineland screener: Overview, reliability,
validity, administration, and scoring. Yale University Child Study Center.
Squires, J., Bricker, D., & Twombly, E. (2002). Ages and stages questionnaires: Social-emotional.
Brookes. https://doi.org/10.1037/t11524-­000
U.S. Department of Health & Human Services, Administration for Children and Families,
Administration on Children, Youth and Families, Children’s Bureau. (2012a). Well-­
References 217

being instruments for early childhood. https://www.acf.hhs.gov/cb/grant-­funding/

well-­being-­instruments-­early-­childhood
U.S. Department of Health & Human Services, Administration for Children and Families,
Administration on Children, Youth and Families, Children’s Bureau. (2012b). Well-being
instruments for middle childhood and adolescence. https://www.acf.hhs.gov/cb/grant-­funding/
well-­being-­instruments-­middle-­childhood-­and-­adolescence
Whiteside-Mansell, L., Johnson, D., Bokony, P., McKelvey, L., Conners-Burrow, N., & Swindle,
T. (2013). Supporting family engagement with parents of infants and toddlers. NHSA
Dialog, 16(1).
Chapter 9
Foster Care Placement

Introduction

In 2018, approximately 250,000 children were removed from their homes and
placed into out-of-home placements (US DHHS, 2020a). Over 400,000 children
were in foster care on September 30, 2019, and over 670,000 children are in foster
care annually (US DHHS, 2020b). There are various types of placement to meet
children’s unique needs and circumstances. What all out-of-home placements have
in common is that there are people who are caring for a child to meet the child’s
daily needs during a time when it has been determined that the child cannot safely
remain in the home. Not all children who are involved in the child welfare system
are in out-of-home placements, but foster care play a central role in child welfare.

Child Removal and Placement Process

The decision to remove a child from their caregivers is made only after it is deter-
mined that a child cannot safely remain within the home. Removing a child from the
home is not the preferred option, but will be done when it is necessary to keep the
child safe. Child welfare professionals do not make the decision to remove a child
from their home in isolation; they must get a court order to remove children from
their caregivers. Each jurisdiction has slightly different procedures; however, the
overarching process is the same.
When child welfare professionals determine a child is not safe and is at imminent
risk during an investigation, they may petition the court to temporarily remove a
child from the home. The child will be placed in an appropriate out-of-home setting.
There will be a shelter hearing where the child welfare professionals, who are joined
by the agency attorneys, present information about the maltreatment and safety. The
caregivers, who have the right to have their own attorney, can challenge the petition

© Springer Nature Switzerland AG 2021 219

J. M. Geiger, L. Schelbe, The Handbook on Child Welfare Practice,
https://doi.org/10.1007/978-3-030-73912-6_9
220 9 Foster Care Placement

for the child’s removal. A judge determines if the child is to remain in out-of-home
care or returned to the caregiver. (See Chap. 2 for more details about the process.)
The courts oversee the out-of-home placement, and the judges approve the case
plan and oversee the case including placements and visitation. Review hearings are
regularly scheduled to monitor the process on the case plan. Children are not reuni-
fied with their caregivers unless the case plan has been completed successfully.
After a year in out-of-home placement, a permanency hearing determines the per-
manency for the child. At this point, the courts may seek to terminate parental rights
as per the Adoption and Safe Families Act of 1997 (ASFA).

Trauma of Removal

Being removed from their home and placed in out-of-home care can be traumatic
for children. The disruption of relationships and daily routine can negatively impact
a child. The process is foreign to children who may not understand why they must
leave their family and may desperately wish to remain with their caregivers despite
the maltreatment. Children may be given little information about the process, being
removed with little warning and without the opportunity to say goodbye or pack
personal belongings to take with them (Mitchell, 2018). Being removed from their
home may be alarming, and the presence of law enforcement could make them feel
that they have done something wrong. Children often experience loss and grief after
being removed from their caregivers and placed in foster care. This may be ampli-
fied when the process does not take children’s needs into consideration, for exam-
ple, information is poorly communicated to the child, the process described to the
child is not followed, or siblings are separated (Mitchell, 2018). (See Chap. 5 for
information about trauma-informed child welfare practice.)

Note from the Field

Always Ready
In foster parent training, they always said to be ready at any time – even in the
middle of the night – for a call from the child welfare agency to have a child
placed with us. We didn’t have any kids of our own and were hoping to have a
child placed with us long term. We thought we were ready for anything. One
cold December night, we received a call that they needed to place a 3-year-old
child. He was left alone in a car while his mother went to work at a nightclub.
He had been put to sleep with a bunch of blankets in the backseat. This was in
southern California, so it wasn’t freezing temperatures, but it got cold at night.
A passerby noticed him in the car alone and didn’t see anyone come back to
the car for 15 minutes, so they called the police. Police tried to locate mom, but
the child, being so young, could not verbalize who or where his mother was.
Placement Ideals 221

The child was placed in protective custody and they were on their way to our
house. I quickly tidied the house up and got the bed ready for the child. His
name was Andrew, and he looked so tired and afraid. The investigator tried to
hand him to me; he flinched and started wailing. I felt terrible. Once he was
able to calm down a bit, I offered him a snack and showed him where he would
be sleeping. His clothes were soiled and didn’t smell great, so I also offered
him a bath. He seemed excited about that, so I let him pick out some bubbles
and gave him eat a granola bar, which he gobbled up. He still seemed very
apprehensive and would have short crying spells asking for his mom. I did my
best to stay calm and reassure him. I wrapped him up in a towel and got some
warm pajamas. We read a book together, and I held him in the rocker. He was
not yet verbal, but he would keep looking up at me and then back down. I went
to put him in the bed and he cried again and said “home” over and over. It
broke my heart. It must have been so confusing for him. I told him he would
stay here tonight to stay warm and safe. We rocked in the chair for 2½ hours
until he fell asleep well enough to be put down in the bed. He awoke several
times crying. I rubbed his back and he fell back asleep. In these situations, we
try to understand how the child must feel. He missed his mom and didn’t know
where he was or why. He didn’t know me, but I hope that he could feel that I
cared and that I was gentle and kind.

Placement Ideals

Removing children from their caregivers should be considered a last resort. Careful
considerations must be made to ensure that children are in the best placement avail-
able to meet their needs. Children should be in the least restrictive environment. In
most cases, it is ideal for children to be placed with family or kin, and sibling groups
should be kept together. Placements should be culturally appropriate and have close
proximity to the child’s family to facilitate visitation and maintain relationships
with peers and continuity of education. There should be frequent assessments of the
suitability of the placement for children who remain in care.

Least Restrictive Environments

The principle of least restrictive environments states that children should be put in a
placement that is most family-like and able to meet the child’s needs. The least
restrictive environment continuum can be envisioned as remaining with birth family
to kinship placement to foster care to congregate care. Within some of these broad
categories, subcategories exist. Foster care includes therapeutic foster homes, which
is considered more restrictive than another foster home setting due to the additional
structure and requirements. Within congregate care, the least restrictiveness in
222 9 Foster Care Placement

descending order are group homes, institutional settings, and lockdown facilities.
While some children may need more restrictive settings to meet their needs and
ensure their safety, the goal is to ensure that the environment is only as restrictive as
it must be and that ultimately children will “step down” to a less restrictive environ-
ment. Although it happens, children should not be placed in a restrictive environ-
ment because there are no other placement options.

Normalcy

Within the foster care placements, especially those which are more restrictive, chil-
dren and youth are often prohibited from engaging in activities that their “typical”
peers who are not involved in care participate in. In placements, youth may feel the
rules are restrictive and not developmentally appropriate (e.g., Rauktis et al., 2011).
“Normalcy” refers to allowing children and youth who are in care to be involved in
developmentally appropriate activities that are considered “routine.” This could be
playing sports, taking music lessons, attending dances or school functions, volun-
teering, going to friends’ homes, attending camp, or attending community events.
With teenagers, normalcy can include getting a job and learning how to drive.
The idea behind normalcy is that children and youth in foster care need to have the
experiences that promote growth and connection. While typical activities may carry
some risks (i.e., a child could get hurt playing sports; a friend’s home is not a con-
trolled environment), children and youth need to have the experiences that help them
gain responsibilities, develop skills, and build relationships. Traditionally, the child
welfare system has not always supported normalcy because of the risks and liability
inherent in some of the activities. Some jurisdictions required extensive background
checks including fingerprinting for a child in care to be involved in routine activities;
and although normalcy is considered an ideal for children and youth in care, some
agencies still require cumbersome documentation and background checks. Increasingly
there is a shift towards promoting normalcy, especially for adolescents in care.

Family/Kin

Increasingly there is a push to place children who need to be removed from the
home with relatives. The logic behind this practice is that there have be continuity
in relationships with family members with whom have long-term relationships with
children. Relative care can preserve family relationships and may be less traumatic
as a child is not removed from their caregiver and placed with strangers. There is
typically more permanency with the use of relative placements as children do not
move among placements as much. One of the concerns about the use of relative care
is that payments to caregivers providing relative care may be inadequate; some
agencies pay smaller stipends to caregivers of relative placements as compared to
nonrelative placements. Thus, the child may not be adequately provided for. Critics
of relative care have also raised concerns that relatives of the children may not be
Placement Ideals 223

screened and trained as rigorously as nonrelative foster parents because of the

assumption that the familial relationships have prepared them to care for the chil-
dren placed in their care. However, this may not be the case. In some cases, family
members’ relationships with the caregivers could lead to issues such as the child
may not be adequately protected from the caregiver if the relative does not ade-
quately supervise visitation.

Note from the Field

Kinship Placements
Ashley Wilfong, MSW
As a child protective investigator, I felt like my biggest successes and failures
were around kinship placements. In one case, I removed a 6-month-old baby
from a home where her mother and father were manufacturing methamphet-
amines. The child was placed with her maternal grandparents. The grandpar-
ents had seen a huge shift with their daughter’s behavior and parenting over
the year before the child was placed with them. They knew there were drugs
involved and tried to intervene on their own. They cared so much for the child
and the mother. They encouraged the mother to come to their home as much
as possible for supervised visits. They picked her up and took her to the child’s
doctor’s appointments. The mother even helped them pick out a daycare when
they placed their grandchild in daycare. The mother remained involved in her
child’s life while having the space to work on herself and create a safe home
for the child to come back to. Addiction to methamphetamines is not an easy
thing to overcome, but she did it with time and support from her family.
It took the mother a little over two years to reunify with her child. If her
child was placed in foster care, I do not think that would have happened.
Because of the kinship placement, lasting and meaningful change was able to
happen for the mother which, in the end, meant that the child got to go home
safely and long term.
In another case I worked, I removed two children from their mother for
physical abuse and domestic violence. The mother had a huge family who were
all willing to take the children in. In the beginning of the case, I was excited
about this because I know kinship placements are more successful. That
changed as I started interviewing family members. Everyone in the family
seemed to know exactly what was happening to the two children. Most of them
not only were present when abuse took place but also did not seem to see a
problem with what was happening. It was normal for them. Many of the adults
in the family either had violent criminal histories or records for child abuse. It
became clear that they did not understand why the children were in danger and
would not monitor the children’s contact with the mother appropriately.
I made the decision to deny multiple home studies for various family mem-
bers. I put the two children in foster care. They were placed in a great foster
home and thrived there. The oldest child bloomed in that house. The children
224 9 Foster Care Placement

became incredibly social and tried new things; their favorite being going to
the gym with the foster parent. They liked to go so they could hype people up
to do their best at the gym. The children made friends and did well academi-
cally. Finally, they were in a house where there was no volatility. They had
structure and support. The foster parent was very communicative with the
mother and family, so visitations were frequent. The mother was informed
about school and doctors’ appointments. While she was encouraged to be a
part of those things by the foster parent, she was resistant.
I got a lot of pushback from case management and the mother’s attorney.
As an investigator, my time with any case was limited to 60 days. Once I was
off the case, the case manager approved one of the home studies I had denied.
The children were moved out of the county. They had to switch schools and
lost the friends they had made. Visitations were difficult because the mother
and family member lacked transportation. The children had a hard time mak-
ing appointments because of this as well. The foster parent attempted to stay
in contact and help as much as possible, but the family would not allow it.
Kinship placements are more likely to be the right call for children when
they are removed for their parents but not always. Sometimes there is just no
one available, and sometimes those that are available are just as entrenched as
the children’s parents in the maltreatment. My advice is to try as hard as pos-
sible to find a kinship placement, but not to put the children in another danger-
ous situation.

Siblings

It is considered a best practice to keep siblings together in placement. In doing so,

siblings are able to maintain some of their central relationships. Research has also
found that siblings not only can provide support and stability but also contribute to
development. Siblings who are placed together have higher levels of placement sta-
bility. Placing siblings together is often a challenge, especially with larger sibling
groups or when siblings have complex or a diverse range of needs. When different
siblings have specific needs, it can be challenging to find a single placement that can
adequately address diverse needs. This may often be the case when there is a large
range of age. Another barrier to placing siblings together is the siblings may not
enter out-of-home care at the same time.
Sometimes workers have concerns that in a sibling group an older sibling has
assumed the role of the parent, and this could be difficult to handle in a foster home.
Another concern is when there are tension-filled relationships among siblings.
Despite these concerns – which some experts say are myths and unfounded – sibling
placement remains best practice. Foster homes that can accommodate sibling sets
are in high demand. When siblings cannot be kept together in placements, it is
important for siblings to visit and communicate regularly with one another. Some
states have established sibling visitation as a right for children in out-of-home care.
Placement Ideals 225

Note From the Field

Sibling Bonds
Early in my career, I would volunteer for a nonprofit organization that pro-
vided grants to families who cared for children in foster care. Every year, they
would put on a sibling reunion day event for brothers and sisters to get together
and play games, talk, and spend quality time together. As a new social worker,
it seemed so strange to me that there were siblings who were not able to be
placed together. I reflected on my own relationships with my siblings and how
important they were in my story and my childhood. To think that some sib-
lings don’t grow up together and see each other every day seemed unfathom-
able. Volunteers worked to reach caseworkers across the city to find out who
would benefit from this event and then coordinated the activities and logistics.
One year we had over 500 kids. Many of whom hadn’t seen their brother or
sister in months. Most of the kids just wanted to sit under a tree, share a meal,
and talk with each other. Others played games and ran around. Others didn’t
know what to say or do. At the end of the day, there were a lot of tears. It was
hard to say goodbye.
Siblings are an important part of the fabric of “us.” They know us and our
history better than anyone. They share our DNA and our memories – good and
bad. I know that sometimes kids cannot be placed together; however we must
do everything we can do to make sure they are placed together and/or see each
other regularly. They deserve that. They need that.

Culturally Appropriate Settings

With the sordid history of child protection for children who are racial and ethnic
minorities, there must be an acknowledgement of the need for culturally appropriate
settings for children in out-of-home care. (See Chap. 1 for details about the history.)
Federal policies have several mandates for serving children who are racial and eth-
nic minorities. In addition to following these policies, it is important to make sure
the placement addresses the cultural needs of a child in foster care. For example,
children should be able to attend the religious ceremonies and celebrate the holidays
of their choice. They should never be forced to convert to another religion. Foster
parents and congregate care staff should receive training and support to be culturally
competent. While they may not be of the same background as the child, they can
assist children in the development of positive self-regard and respect for their cul-
ture while allowing the child to maintain a connection to their culture while in out-­
of-­home placement. Child welfare professionals need to prioritize placements that
226 9 Foster Care Placement

are culturally appropriate for children and select the best placement for the child
with regard to language, religion, national origin, and race/ethnicity. Some states
have very specific policies regarding the process of selecting and placing a child in
out-of-home care regarding their culturally needs. Some of the ways child welfare
professionals can understand and support children in maintaining cultural ties are to
ask questions about cultural and religious traditions and practices they engage in
and/or are interested in participating in and seek out events, individuals, and infor-
mation to better meet these needs.

Proximity

A placement in or near the neighborhood where the child previously lived can
reduce the disturbances in a child’s life. Such placements can avoid the disruption
of relationships with friends, classmates, and neighbors. Staying in the same com-
munity means that there may be a familiar environment, even if the home and the
people providing for the children are different. An out-of-home placement that is
geographically close to the caregivers may facilitate more frequent visitation.
Likewise, it may make it possible for a child to remain in the same school, ulti-
mately providing more stability and permanence. This can reduce the stress and
trauma of being in an out-of-home placement for a child.

Types of Placement

When parents and caregivers cannot ensure the safety of their children, children
may be removed from their homes and placed in a foster care placement. The
U.S. federal government defines foster care as “24-hour substitute care for children
placed away from their parents or guardians and for whom the Title IV-E agency has
placement and care responsibility” (45 C.F.R. § 1355.20, 2012). The Title IV-E
agency is the child welfare authority within a given jurisdiction. The goal of foster
care is to keep children safe by providing temporary out-of-home care when neces-
sary until the child can be safely returned home, permanently placed with a relative
or adoptive family, placed in a legal guardianship, or another permanency arrange-
ment is determined. While a child is in a placement, the person (e.g., foster parent,
relative) or congregate care facility who is responsible for the daily care of the child
typically receives a stipend from a child welfare agency. The options for placement
largely fall into the categories of relative/kinship, nonrelative family/family foster
care, and congregate care. Within these categories there are other distinctions.
Additionally, some children are in pre-adoptive homes or in supervised living set-
tings. In an effort to not remove a child from their home, some receive family pres-
ervation services in their homes and are not removed from their caregivers.
Types of Placement 227

Relative/Kinship

Kinship care is “A licensed or unlicensed home of the child’s relatives regarded by

the Title IV-E agency as a foster care living arrangement for the child” (45 C.F.R. §
1355, Appendix A, 2012). Adults who are related to the child through blood, mar-
riage, or adoption and tribal or clan members or others who are determined to have
a kinship bond with the child may provide kinship care. Prior to placing a child in
out-of-home placement, efforts are to be made to determine if a child’s kin are an
appropriate placement. Kinship care increasingly is the preferred substitute place-
ment option as it is considered the least restrictive and facilitates children maintain-
ing their cultural and familial connections. Additionally, kinship care is understood
as a more normative living arrangement and carries less stigma than other forms of
placement.
In the past decade, the percentage of children in kinship care increased from 25%
in 2007 to 32% in 2019 (U.S. DHHS, 2020a). Grandparents of low socioeconomic
status with lower levels of educational attainment provide the majority of kinship
care (e.g., Ehrle & Geen, 2002). There are concerns about kinship providers having
the resources needed to care for children who often have substantial needs.
Historically, child welfare agencies have offered kinship providers fewer supports
and less training than caregivers in nonrelative placements (e.g., Sakai, Lin, &
Flores, 2011). To address the challenges kinship caregivers face, agencies increas-
ingly have offered support programs and services targeting kinship caregivers.
There is a need to better understand the nuances and complexity of kinship place-
ments, and child welfare agencies must consider the variability among the kinship
arrangements (Berrick & Hernandez, 2016). Despite some disadvantages, a review
of 62 studies found that compared to children in other types of placement, children
in kinship placements experienced greater placement stability and fewer behavioral
and mental health problems (Winokur, Holton, & Valentine, 2014).
There are a number of advantages of having children and youth placed with rela-
tives or kin, as well as some disadvantages, all depending on the circumstances of
the case. Children and youth often feel more comfortable living with family mem-
bers they are familiar with and can continue to practice family traditions and share
common values and interests. They may also be able to continue to reside in the
same neighborhood and continue to see other extended family members. However,
placement with family can also be challenging for some children and their relative
caregivers. For example, biological parents may often resent their family members
for becoming involved with the case and having to enforce limits on contact and
visitation, which is difficult for many. Many kinship caregivers may lack the finan-
cial ability to take the children into the home or struggle with how to access services
and navigate the child welfare and/or behavioral health systems. Some caregivers
may not be physically able to care for the children and feel extreme guilt about not
being able to care full-time for their relative in need. Kinship care and placement is
often complex, despite the services and supports available. In most circumstances,
youth do well when living with kin providers who are ready and able to temporarily
or permanently care for them in their home.
228 9 Foster Care Placement

Nonrelative Family Placement

The federal government defines nonrelative family foster care as “A licensed family
foster home regarded by the Title IV-E agency as a foster care living arrangement”
(45 C.F.R. § 1355, Appendix A, 2012). With nonrelative family placements, or fam-
ily foster care, children are placed in a home of nonrelative adults to care for them.
Next to kinship care, family foster care is the preferred placement option as it allows
children to live in a family-like environment. In 2019, 46% of children in out-of-­
home lived in a nonrelative family foster home; it was the most common type of
placement (U.S. DHHS, 2020b).
Family foster care may be a preferred placement for younger children when kin-
ship care is not an option and for foster youth with less severe behavioral and mental
health problems. Studies have found that children in family foster care are adopted
and reunified with their families at higher rates than children in kinship care (e.g.,
Bell & Romano, 2015). The Family First Prevention Services Act clearly prioritizes
the family setting, as it has placed limitations on the reimbursement to states for
children placed in group homes.
Therapeutic Foster Placements Therapeutic foster care, sometimes called treat-
ment foster care, is a family foster care setting where the foster parents have received
specialized training to meet the needs of children who have significant medical
needs or emotional or behavioral issues. These complex needs may be due to past
trauma, ongoing health concerns, or a combination of reasons. In many regards
therapeutic foster homes are like other nonrelative placements. The reimbursement
rate for the foster parents may be higher, and additional support to the foster family
may be provided. There are also additional restrictions such as limitations such as a
lower number of children allowed in the home to ensure there is adequate time to
provide the needed care for the children with special needs.

Congregate Care

Group homes and institutions are nonfamily settings out-of-home placements that
are referred to as congregate care. A group home is “a licensed or approved home
providing 24-hour care for children in a small group setting that generally has from
seven to twelve children.” An institution is defined as “a child care facility operated
by a public or private agency and providing 24-hour care and/or treatment for chil-
dren who require separation from their own homes and group living experiences”
(45 C.F.R. § 1355, Appendix A, 2012). In 2019, 10% of children in out-of-home
care were placed in some form of group care or institution (U.S. DHHS, 2020b). In
the last decade, group care and institutional placements have declined by over a
third (37%; Children’s Bureau, 2015).
Due to the high costs, restrictiveness, possible iatrogenic effects, and weak evi-
dence supporting their benefits for children, congregate care has been criticized. Yet
group care is the appropriate placement option for the children in care who need
more intensive or structured care than less restrictive settings can offer (Barth, 2005;
Types of Placement 229

Children’s Bureau 2015). There is interest in strengthening the evidence base of

congregate care and improving outcomes of children who are in congregate care
(Boel-Studt & Tobia, 2016). Compared to children in other out-of-home settings,
children in congregate care are older on average, more likely to be male, and exhibit
more severe behavioral and mental health problems (Children’s Bureau, 2015).
Studies on effectiveness of residential group care have mixed findings (Bettman &
Jasperson, 2009); however, there is evidence group homes contribute to positive
behavioral and emotional outcomes for some youth (e.g., Hooper et al., 2000; Lyons
et al., 2001), as well as prosocial skills and family functioning (e.g., Hooper
et al., 2000).

Pre-adoptive Homes

A pre-adoptive placement is defined as “a home in which the family intends to adopt

the child. The family may or may not be receiving a foster care payment or adoption
subsidy on behalf of the child” (45 C.F.R. § 1355, Appendix A, 2012). Pre-adoptive
homes may overlap with foster home placements, as foster families may adopt a
child in foster care after reunification is no longer a goal and parental rights have
been terminated. In 2019, on a single day, fewer than one in 20 (4%) of children in
foster care were in pre-adoptive placements (U.S. DHHS, 2020b). Almost a quarter
(26%) of children in foster care are adopted; however, rates vary greatly by age. Of
children who are adopted from foster care, almost a quarter (22%) are by relatives;
the majority of children adopted are by nonrelative families (Malm, Vandivere, &
McKindon, 2011).

Supervised Independent Living

Supervised independent living (SIL) is “an alternative living arrangement where the
child is under the supervision of the agency but without 24-hour adult supervision,
is receiving financial support from the child welfare agency, and is in a setting which
provides the opportunity for increased responsibility for self-care” (45 C.F.R. §
1355, Appendix A, 2012). SIL is designed to serve youth preparing to age out with
APPLA as a goal of their permanency plan. SIL supports youth who are transition-
ing into adulthood by providing holistic psychosocial, educational, employment,
and vocational supports and supervision. The Fostering Connections to Success and
Increasing Adoptions Act allowed states to increase the age limit for youth to remain
in care from 18 to 21, allowing them continued access to support services including
SIL. In 2019 an estimated 2% of youth in foster care lived in SIL (U.S. DHHS, 2020b).
SIL is considered a promising practice, but there is great variation in the provi-
sion of services, and limited studies have examined its effectiveness. SIL has been
found to improve youths’ daily living skills and self-sufficiency, which are neces-
sary as youth transition to adulthood and leave care. (See Chapter 11 working with
special populations for more information about working with transition-aged youth.)
230 9 Foster Care Placement

Emergency Foster Care

Occasionally child welfare professionals determine a child is an imminent risk and

must be removed from their home immediately. This may be due to an unexpected
arrest or death of a caregiver or other situation where a caregiver cannot care for the
child. A child’s removal from their family can happen at any day or time in these
emergencies. In emergency foster care cases, a child may be placed in a foster home
for a short period of time, typically between 72 hours and 30 days. Efforts are made
during this time to find a more permanent placement for the child, which may be a
different type of placement.

Reflection
Determining the Least Restrictive Placement
Read the following brief scenarios, and consider the advantages and disadvan-
tages of the placement types.
Example 1: The case involves a 5-year-old child with health issues who has
experienced physical abuse from his mother, who is a single parent and strug-
gles with opioid use.
Placement options: Child placed in a nonrelative foster home; kin placement
with elderly grandmother
Example 2: Thirteen-year-old who has been sexually abused by stepfather
Placement options: Child placed with father and stepmother who live out of
state and have not seen the child for eight years; in a group home; with her
boyfriend’s parents
Example 3: Five siblings ranging from ages 2 to 14 who experienced neglect
Placement options: Children placed with an aunt and uncle who both work
full-time at entry-level positions to support their four school-age children;
divide the siblings with the older two going to one foster home, the youngest
going to another, and the other two children going to a third

Placement Trends

Within the last decade, the number of children in foster care has been fairly stable
and consistently has been around 400,000 children in care, with numbers rising
slightly over the last 5 years (US DHHS, 2020a). Over 690,000 children were served
by the foster care system in FY 2019, which also is an increase over the last 5 years
(US DHHS, 2020a). On June 23, 2020, the average age of children in foster care
was 8.4 years, and just over half (52%) were male (US DHHS, 2020b). Over 30,000
Placement Trends 231

children under the age of 1 entered foster care, comprising 7% of the children who
entered foster care in FY 2019 (US DHHS, 2020b). Of the children in the foster care
system, 44% were White/Caucasian, 23% were Black or African American, 21%
were Hispanic, and 2% were American Indian/Alaskan Native (US DHHS, 2020b).
It should be noted that this highlights the racial disparities in the child welfare sys-
tem, especially with Black or African American children and American Indian/
Alaskan Native children. The average length of time in foster care was 19.6 months
in FY 2019, which has decreased since 2010 (US DHHS, 2020b).
Children with certain characteristics are less likely to receive timely permanency.
Children who are younger, Caucasian, and without a mental health diagnosis are
more likely to exit care within ASFA’s guidelines (Becker et al., 2007). Older chil-
dren, children in a sibling group, and children with a disability or physical or mental
issues are more likely to remain in care (Akin, 2011; Glisson et al., 2000). African
American children are less likely to achieve reunification or adoption and have lon-
ger stays in foster care (Cheng, 2010). Children who remain in foster care without
achieving permanency may have poorer behavioral outcomes than those who achieve
timely permanency (Lawrence et al., 2006; Lloyd & Barth, 2011). Long stays in out-
of-home care places children at risk for poorer developmental outcomes.

Note from the Field

Child Welfare and Juvenile Justice Dual System Involvement
Carly B. Dierkhising, PhD
Naomi1 was first referred to child protective services at age 3 for severe neglect
and caretaker absence. Only the allegation of caretaker absence was substanti-
ated, and the family engaged in voluntary family maintenance services. The
case closed shortly after. What the social worker did not know was that
Naomi’s stepfather was abusive towards her mother and her mother was physi-
cally abusive towards her brothers. Around age 6, Naomi’s school records
indicated that she began getting into fights at school, and when she was nine
years old, there were additional child protection referrals for general neglect,
emotional abuse, and an at-risk sibling which were all found to be inconclusive.
When Naomi was in middle school, she experienced bullying which even-
tually led to a fight on school grounds and a referral to the probation depart-
ment, per school policy. She was assigned a court date and released to go
home. Before her court date came up, things became more abusive in the
household, and another referral to child protection was made for physical
abuse, an at-risk sibling, and general neglect: only the neglect allegation was
substantiated, and a case was opened. During this time, Naomi began running
away to get away from the chaos in the home. She would stay at her friend’s
house, began skipping school, and accidently missed her court date. Missing
her court date triggered an automatic warrant being issued for her arrest.
When she and her mother came to court, her mother told the judge that Naomi
232 9 Foster Care Placement

was “out of control,” and when the judge recommended community probation
with an ankle monitor, Naomi’s mother told the judge she didn’t want her in
the house because she believed she couldn’t take care of her. The judge, then,
sent Naomi to a group home and placed her on probation for 9 months.
At 13 years old, Naomi began living at a group home with ten other girls. In
the group home, she was somewhat receptive to the therapeutic services and
seemed to get along with one particular staff member at the group home. Three
months later, Naomi left the group home without permission with another one
of the girls who lived there. The group home staff reported this to her probation
officer who charged her with a violation of her probation which extended her
probation term 3 more months. Two months after this, Naomi was supposed to
get a family visit with her brothers and mother, but her mother canceled telling
Naomi she didn’t want her sons to be around Naomi since she was a bad influ-
ence. Naomi became distraught, began yelling at the group home staff, and
threw her phone across the room which struck one of the group home staff. The
staff member insisted on calling her probation officer and urged the probation
officer to charge Naomi with assault. Naomi was detained until her court date
because the group home, per policy, couldn’t let her stay in the home due to the
pending assault charge. It was at this court hearing that the judge discovered
that Naomi also had a case open in the child welfare system, and she referred
Naomi to the dual system unit for a multidisciplinary assessment.
Naomi is a more typical case for dual system youth. Group homes tend to
push these youth “deeper into the system,” and almost always the court
doesn’t know that the youth are dually involved. Youth like Naomi pay the
costs when systems to not work together and there is little understanding that
youth in the juvenile justice system may have experienced child maltreatment
which contributed to their juvenile justice system involvement.

1
All names and other personal identifiers in cases and examples throughout this book have
been changed to protect privacy and confidentiality.

Relevant Policies

There are multiple policies informing foster care placement options and decision-­
making. After CAPTA was passed in 1974, the number of children in foster care
drastically increased as record numbers of children were removed from their homes.
To address concerns about the number of children placed in foster care, legislation
was passed. The Indian Child Welfare Act of 1978 (ICWA) was passed with aims of
reducing the high numbers and inappropriate removals of American Indian and
Alaska Native children through awarding tribal courts’ jurisdiction over child mal-
treatment cases regarding American Indian and Alaska Native children.
Relevant Policies 233

The federal government passed the

Practice Highlight
1980 Adoption Assistance and Child
Welfare Act (AACWA) to address the Foster Care Awareness Month
issue of the children remaining in foster
May is National Foster Care
care for extended periods of time. The leg-
Month, a time to consider how we
islation required states to make reasonable
can each play a part in enhancing
efforts to keep children in their homes, to
the lives of children and youth in
reunite families, and required each child
foster care. Since 1988, leaders
in foster care to have a permanency plan.
across the United States issue proc-
In 1994, the Multi-Ethnic Placement
lamations in recognition of
Act (MEPA) was passed to decrease the
National Foster Care Month to
time that children remained in out-of-home
show appreciation and gratitude to
care. The key elements of the MEPA pro-
foster parents across the nation.
hibit child welfare agencies from consider-
Throughout the years, the purpose
ing race, color, or national origin when
and focus of Foster Care Awareness
approving a foster or adoptive parent and
Month has changed. Recently,
likewise cannot refuse to delay foster care
activities have focused on increas-
placements or adoption due to a child’s or
ing the visibility of the needs of
parent’s race, color, or national origin.
children and youth in foster care
Also, the MEPA requires agencies to
and ways to recruit and retain fos-
recruit foster and adoptive parents from
ter caregivers.
diverse racial and ethnic backgrounds that
reflect the diversity of children in care. The
Interethnic Placement Act (IEPA) amended the MEPA to clarify language about cul-
tural considerations and specified that race, color, or national origin could not be used
in any placement decisions. Additionally, the IEPA added an exception in individual
cases where it could be demonstrated that considering race, color, or national origin
was in a certain child’s best interest.
Despite the AACWA’s mandates, the number of children in out-of-home care
continued to increase. To address this, the Adoption and Safe Families Act (ASFA)
was passed in 1997. The primary goals of the ASFA are child safety and timely
permanency. The legislation prioritizes reunification and identifies adoption as the
preferred alternative permanent plan. The ASFA shortens the timeframes for case
plans and defines reasonable efforts required to preserve and reunify families,
including placing children within a timely manner. Reunification is to occur within
12 months of removal, and adoption within 24 months. ASFA endorses the use of
concurrent planning where there is a primary and an alternative plan simultaneously
being addressed. The provisions remain minimally changed since the legislation
was passed. Funding has been reauthorized, and in 2001, amendments were made to
address the increase in minority children awaiting adoption.
In 2008, the Fostering Connections to Success and Increasing Adoptions Act
(Fostering Connections Act) was passed with the goal of increasing the number of
adoptions and guardianships through improved incentives. The Fostering
Connections Act also sought to improve services to youth aging out through provi-
sions extending foster care to age 21. The legislation also increased support for
American Indian and Alaska Native children in the child welfare system.
234 9 Foster Care Placement

Landmark legislation Family First Prevention Services Act (Family First) was
passed in 2018 that changed how states could use Title IV-E funds and included
prevention services. Relevant to foster care, Family First emphasizes family foster
homes and seeks to reduce the use of congregate care facilities for out-of-home
placements. States may not be reimbursed by the federal government for children
placed in group care for more than 2 weeks, and the settings must be approved using
a trauma-informed care model and employ nursing and licensed clinical staff.
While it is technically a public education policy, the Every Student Succeeds Act
(ESSA) has mandates for states regarding children in foster care. Passed by the
U.S. Congress in 2015, the legislation requires that children can stay at their school
of origin unless it is not in the best interest of the child. The school districts and
child welfare agencies must have agreements about how to provide and fund trans-
portation for foster children to remain in their school of origin. If a child changes
schools, the enrolling school must contact the previous school to get the current
records. State education agencies are required to have a point of contact for child
welfare agencies, and at the local level, schools must have a point of contact for
child welfare if the child welfare agency has designated a point of contact for the
schools.

Services for Children in Foster Care

Many children who enter foster care require services due to the maltreatment and
trauma they experienced. Child welfare professionals collaborate with professionals
in other systems to make sure that the children’s needs are met. A wide range of ser-
vices are provided to children in foster care to meet their needs including their health
and mental health concerns. There could be early interventions to address develop-
mental delays, such as speech, occupational, and/or physical therapy (see Chap. 3 for
other examples). There may also be services to address behavioral concerns. Visitation
with family is also provided to children in foster care. All of these services are child-
specific, and appropriate assessments should be made to determine their needs and
corresponding services.
It is estimated that a third of the children in foster care have a chronic medical
condition such as asthma, severe allergies, repeated ear infections, and eczema
(Ringeisen et al., 2008). While not all of the medical conditions may be life-­
threatening, some are. The mortality of children in foster care is higher than chil-
dren in the general population (Chaiyachati et al., 2020). Children in foster care also
frequently have dental problems, with an estimated one in five children entering
care having significant dental issues (Szilagyi et al., 2015). Children in foster care
are more likely than their peers to have developmental delays, many of which can
be traced back to the maltreatment. The state is required to meet the medical and
dental needs of children. Initial assessments as well as ongoing treatments are
needed. Case managers work with the foster parents or congregate care facility to
facilitate the appropriate services.
Services for Foster and Kinship Care Providers 235

An estimated 40–80% of children in

Practice Highlight
foster care have a major behavioral or
mental health condition requiring treat- Psychotropic Medication and
ment (Clausen et al., 1998; Garland et al., Youth in Foster Care
2000; Halfon et al., 1995; Stahmer et al.,
Doctors prescribe children in foster
2005). Common diagnoses are attachment
care psychotropic medications at
disorders, depression, and anxiety. Like
rates 3.5 to 11 times higher than
with physical health, services are pro-
their peers not in care (Dos Reis
vided to children in foster care to address
et al., 2005), and they often pre-
their behavioral and mental health needs.
scribe children in foster care mul-
There are various interventions that have
tiple types of psychotropic
been found to have positive outcomes for
medications and higher doses than
addressing the needs of children in foster
the maximum recommended (Zito
care. Unfortunately, in some communities
et al., 2008). The rates of antipsy-
there may be limited availability and dif-
chotic medication for children in
ficulty accessing services. Interventions
foster care remains high, although
should be developmentally and culturally
in the last decade there has been a
appropriate.
decrease in the antipsychotic poly-
Visitation with biological parents, sib-
pharmacy (Matone et al., 2012).
lings, and other family members is also
Interventions can reduce the pre-
offered and is a critical component to a
scribing of psychotropic medica-
case. In almost all cases, with the excep-
tion for children in foster care
tion of some extenuating circumstances,
(Cohen et al., 2013).
all children are provided with visitation at
a minimum of once a week, sometimes
more. Visitation is not only an opportunity
for children to see their siblings and parents, but for parents to demonstrate changes
in their parenting behavior and receive guidance and advice from a parent aide or
case manager who is present at the visit. Visits can take place in a number of differ-
ent locations, including the agency office (least desirable), in-home, or in public
spaces such as visitation centers, libraries, restaurants, and local parks. The latter
locations are preferred so that children and their parents can be observed in more
natural settings. Visitation can change over time and depending on circumstances,
with increases in time together as a case moves towards reunification. Visitation
time can also be decreased if a parent is inappropriate during the visits or it has been
deemed detrimental to the child’s well-being.

Services for Foster and Kinship Care Providers

Foster and kinship care providers provide for the daily needs of children who have
been placed into their care. Due to the maltreatment and other traumas, many chil-
dren in foster care have significant behavioral and physical needs that can be emo-
tionally, physically, and financially demanding for the families who care for them
(Hayes et al., 2015). Recognizing this, foster parents are required to complete
236 9 Foster Care Placement

extensive training before they are licensed to provide foster care. There are different
standards for kinship care providers, and in many cases, there is not the same exten-
sive training and support of family members who are providing care for a child in
an out-of-home placement. Foster and kinship care providers express the need for
appropriate, ongoing training support from formal and informal sources, child wel-
fare agencies, and other foster and kinship care providers (Geiger et al., 2013), as
well as advocacy and having their voice heard (Geiger et al., 2014). There are vari-
ous national and local organizations that promote education, advocacy, and support
for families caring for children in the foster care system. Foster and kinship care
providers may need assistance in dealing with the child’s trauma and health, mental
health, and behavioral needs. There are interventions such as KEEP (Keeping Foster
Parents Trained and Supported) that are promising practices (Price et al., 2015). In
addition to training and guidance, the providers also may need concrete supports
(e.g., crib, booster seat, medical apparatus) as well as reimbursements for the costs
of taking care of the child (e.g., clothing, school supplies, transportation costs, rec-
reation activities). Most foster care providers receive some financial support from a
child welfare agency. This varies depending on the state, the child’s needs,

Practice Highlight
Assessing and Supporting Older Kinship Caregivers
The number of both older caregivers and the children placed in their care has
risen in recent years. The number of children who have achieved permanency
with older caregivers has risen significantly since 1997 as a result of the
Adoption and Safe Families Act. However, adoptions and subsidized guard-
ianships with older caregivers have disrupted because caregivers die, become
ill, or for other reasons are unable to provide for the children long term.
There are a number of challenges for older caregivers for children includ-
ing the following:
• Caregiver’s ability to meet the child’s need for safety, well-being, and
permanency
• Caregiver’s mobility, transportation, and health
• Increased need for attention and resource delivery involving older
caregivers
• Developing viable long-term care plans for the child(ren) in care
• Ability to access services for caregivers and/or other adults for whom they
provide care (spouses, parents, siblings) through the statewide aging network
When working with older caregivers as placement for a child, we consider
several things, including the caregiver’s current status and the changing devel-
opmental needs of the child. If the assessment suggests there may be factors
which could impact the safety and stability of the placement over the life of
the placement, caseworkers may request further assessment through trained
geriatric caseworkers licensed by the departments on aging. It is important to
consider a long-term plan as well as a backup plan.
Services for Foster and Kinship Care Providers 237

The long-term care plan identifies a permanency goal for the child,
includes services and supports needed for the child’s safety now and in
future, and identifies a viable and reliable backup caregiver and contingency
care plans. Backup plans should be developed for all cases. Closing to adop-
tion or guardianship, a backup caregiver must be identified – regardless of the
age of the caregivers. The backup plan is developed for ongoing care for the
child if the time comes when the older caregiver can no longer care for the
child. It should be detailed enough to cover any predictable contingencies,
and the identified backup caregiver should be informed about limiting factors
in the older caregiver’s situation so he/she can make a fully informed deci-
sion about their agreement to be the backup caregiver and their ongoing role
in the life of the child.

licensure, and cost of living. The foster and kinship care providers’ ability to pro-
vide the necessary care for the child is connected to availability and access to ser-
vices for the child.
Respite care is one service that may be available to foster and kinship care pro-
viders. With respite care, a child is sent to another placement short term for a set
period of time before returning to the original foster or kinship placement. Respite
care, sometimes called “short-term foster care,” may be used for various reasons
including giving the foster and kinship care providers a break from a child’s demand-
ing health needs or behavioral problems or when the providers may have to attend
to specific obligations (e.g., death in the family, out-of-town business trip). It often

Note from the Field

Advocating for Therapy and Academic Supports
Libby Fakier, MBA
Most of the children who have been placed in our care struggle academically,
either because of the circumstances in their birth home or due to changes in
school placement as a result of moves from placement to placement.
Exacerbating the issue is that many children in care have learning disabilities,
psychosocial challenges, and generalized anxiety that inhibit their ability
to learn.
When a child comes into our home, we meet with the case management
team to assess grades, individualized educational programs (IEPs), learning
disabilities, psychological evaluations, and supports that are currently in
place. Often, we find that the child has not been evaluated for services or that
evaluations were not followed up with approvals and implementation of
238 9 Foster Care Placement

therapeutic services. We see that children go years without services and suffer
academically, psychologically, and physically because by the time they are
evaluated at one placement, they are moved again before services are imple-
mented. At the outset of receiving a new placement in our home, I advocate
for my children to immediately receive psychological counseling with a pro-
fessional that I have worked with for years. This creates the foundation of care
for my kids on which we can build supports for all the other areas where the
child needs help.
Wading through the bureaucracy is not for the faint of heart and requires a
determined and unrelenting mindset to ensure that children in care get the
services and support they need and deserve. Foster parents must be vigilant
about advocating for their children’s needs and not give up when the case
management team or public school system either denies services or drags
their feet about getting evaluations completed and services implemented.
Daily calls, weekly emails, and constant follow-up with everyone on the case
management team is essential to securing services in a timely manner.
There’s a very small window to address children’s psychological or thera-
peutic (physical therapy, occupational therapy, and speech therapy) needs to
get them back on track. Medication evaluation and management must be
streamlined so children have continuity of care and mental health issues are
addressed before the child decompensates. Time is of the essence. Foster par-
ents have the moral obligation and responsibility to ensure that their chil-
dren’s needs are met as quickly as possible. They must remain unconquered
in their fight to advocate for the support services their children need to grow,
heal, and succeed.

takes place over a weekend and rarely lasts more than a couple of weeks. Some
families who are not able to make a commitment to being foster care parents pro-
vide respite care for children in foster care.

Services for Parents with Children in Foster Care

In most instances when child protective services remove a child from their parents,
there is a case plan developed that details what must be done before a child can be
reunified with their parents. These case plans are individualized for each family and
take into consideration the family’s needs and circumstances related to the maltreat-
ment. Federal legislation requires child welfare agencies to make “reasonable
Services for Parents with Children in Foster Care 239

efforts” to remedy the circumstances that led to a child being removed from
their family.
Depending on the reasons that a child entered foster care, services should be
offered to the parent that are consistent with the parents’ needs and the reasons the
child entered care and the parents’ needs. In many cases, the services are mandatory,
and it is only after there is documented successful completion may the child return
home. Services which are commonly offered include visitation, case management,
substance abuse treatment, transportation assistance, housing assistance, counsel-
ing, psychological evaluation, parenting education, anger management, and voca-
tional training. There is variation in the availability and offering of services by state
and agency. Some services the parents must pay for, while others are provided for
them at no cost, although there may be costs to them such as transportation, child
care (for children who are not in foster care), and missed work.
While parents are required to participate and complete services outlined by the
case plan and court decision, services may be unavailable or inaccessible. A lack of
funding is largely the reason this occurs. In some communities there may not be
services, or the services available are inadequate to meet the demands, and there
may be lengthy waitlists. As case plans require a parent to complete a service (e.g.,
parenting education, anger management, job training) in a certain timeframe to
ensure that the agency is in compliance with the ASFA guidelines, troubles arise
when services are not readily available. This can cause frustration and confusion for
the parents and may delay reunification. In some cases, the difficulty in accessing
services can lead to children not being reunified with their parents who were unable
to complete the requirements for reunification outlined in a case plan. Additionally,
the AFSA mandates a specific timeframe, which may be shorter than a timeline to
complete treatment (e.g., substance abuse treatment) and specific tasks (e.g., obtain-
ing housing and employment) which the case plan specifies.
In order to have successful reunifications, it is paramount that services provided
to parents with children in foster care are delivered in a timely and appropriate man-
ner. Parents must be able to access the services and to feel comfortable receiving
them. Concerns exist that services provided to child welfare-involved families are
not always appropriate and do not match the specific needs of the family (e.g.,
Bolen, McWey, & Schlee, 2008). There are concerns about parents being referred to
unnecessary services. Care should be taken in developing case plans to make sure
the servicesrequired will meet the specific needs of the parents and children.
Ultimately, the services offered to parents with children in foster care should be
designed to help the parents be able to provide for their children and family and
address the reasons that the child was placed in foster care.
240 9 Foster Care Placement

In-Home Services and Family Preservation Services

Not all children involved in the child welfare system are removed from their care-
givers and enter foster care. Some children living in families reported to child pro-
tective services for allegations of abuse and neglect receive in-home services. In
these cases, child welfare professionals determine there is a low risk for future mal-
treatment and determine a child can safely remain in the home while addressing the
conditions that led to the allegations of maltreatment. Services are provided in-­
home when children can remain safe to avoid potential traumas of removal. The fact
that most children are reunified with families further supports the arguments to
make efforts to keep children in their own homes.
When children remain in the home, services still may be provided to ensure child
safety and well-being. Sometimes the services are voluntary, while other times the
cases are supervised by the courts. These community-based services assist parents
in their caregiver role and can address the maltreatment or risks of maltreatments
through an array of services. Services offered may include counseling, financial
support, parenting education, case management, housing assistance, and referrals
for services. The goal of the services is to prevent child maltreatment and to
strengthen and support families. (See Chap. 7 for details about family preservation
services.)
Child welfare agencies may provide intensive family preservation services to
families in crisis where an imminent risk of out-of-home placement exists. With
family preservation services, children remain in the home, but child protection pro-
fessionals monitor cases. Often voluntary in nature, the family support and preser-
vation services often face challenges in engaging families. Vast differences exist
across programs; however, many programs have smaller caseloads, quick start
(within 24 hours of referral), more frequent contact and visits, after-hours availabil-
ity, short duration (4–6 weeks), concrete supports (e.g., financial, food, transporta-
tion), and a strengths-based approach. Family preservation services attempt to
address crises, improve family functioning, and encourage the use of families’ for-
mal and informal social support systems. Family support and preservation programs
are often voluntary and may have difficulties engaging families
Findings on program effectiveness in preventing out-of-home placement are
mixed. In a meta-analysis of 20 intensive family preservation programs, overall,
programs were found to have a medium and positive effect on family functioning
but were generally not effective in preventing out-of-home placement for families
experiencing maltreatment (Al et al., 2012). Several design and methodological rea-
sons may contribute to the inconsistency of family preservation services’ efficacy;
however, the practices continue to be used to prevent out-of-home placement (Tyuse,
Hong, & Stretch, 2010), and clients report overall positive family impact and expe-
riences with family preservation services (e.g., Lietz, 2009; Mullins, Cheung, &
Lietz, 2012).
Recruiting, Training, and Licensing Foster Parents 241

Recruiting, Training, and Licensing Foster Parents

With more than half of all children residing in nonrelative foster homes, it is impor-
tant for child welfare professionals to understand best practices in collaborating
with foster caregivers while also understanding the process for becoming a foster
parent and their experiences as foster parents. Further, many foster parents go on to
adopt the children in their home and serve as a critical member of the child welfare
team, as they provide care every day, all day to children in need. Foster parents
become the point person for many of the child’s needs, including their healthcare,
education, and social-emotional development. They ensure that their basic needs are
being met and that they are on task developmentally.
Despite their critical role, there is often a shortage of foster parents available to
meet the needs of the child welfare agency, partly due to failure to recruit adequate
numbers of foster caregivers for various reasons, a lack of training and support, and
issues related to retention. In fact, it was estimated that the median length of service
of foster parents in three states was 8–14 months (Gibbs & Wildfire, 2007). The
shortage of foster parents is of great concern to child welfare agencies as foster
parents provide the daily care for children in the system. There are many efforts to
increase the number of foster homes.
Foster parents become licensed foster caregivers for a number of reasons. Most
foster parents say they became licensed to become foster parents to help kids and
provide a loving home, while many say they had a calling to care for kids in need.
Some choose to foster with the hopes of later adoption, sometimes due to their
inability to have children or more children, or because their children were grown
and no longer in the home (Geiger, Hayes, & Lietz, 2013). Many have a desire to
give back to the community or know a child or family in need and went on to
become licensed.
Foster parent training and licensure requirements vary by state and jurisdiction.
One of the most commonly adopted training models is PRIDE (Parents’ Resources
for Information, Development, and Education). This training model is designed to
strengthen the quality of family foster care and adoption services by providing a
standardized, structured framework for recruiting, preparing, and selecting foster
and adoptive parents. The majority of states and jurisdictions will have a standard-
ized recruitment and training program for all foster caregivers. As part of the PRIDE
program, all foster caregivers must successfully complete nine sessions (27 hours)
of pre-service training before they can be licensed. To maintain the license, they
must participate in ongoing training, and most licenses are valid for 3–5 years unless
there is a reason to revoke the license or the foster caregiver chooses to end the
license. Relatives are also encouraged to pursue licensure as additional financial and
social support is often provided along with licensure. Goals of PRIDE are to ensure
that children are protected and nurtured and have their developmental needs met;
relationships between children and their families are supported; children are
242 9 Foster Care Placement

connected to long-term, safe, nurturing

Practice Highlight
relationships; and foster caregivers are
members of the child welfare team. PRIDE Training Session Topics
Training emphasizes several areas
• Session 1: Connecting
regarding roles and responsibilities of the
with PRIDE
foster caregivers and the child welfare
agency; helps new foster caregivers to • Session 2: Teamwork towards
understand the importance of parents and permanency
families involved with child welfare, man-
• Session 3: Meeting develop-
aging loss, and teamwork; and assists
mental needs: attachment
with understanding the value of diversity
and cultural competence and the various • Session 4: Meeting develop-
protocols and policies that occur with mental needs: loss
cases (e.g., mutual family assessment and
• Session 5: Strengthening family
informed decision-making).
relationships
In addition to pre-service training, fos-
ter caregivers pursuing licensure will also • Session 6: Meeting develop-
have a home and family assessment which mental needs: discipline
occurs in the home and through the gath-
• Session 7: Continuing family
ering of documents, reports, and forms.
relationships
This process ensures that a family is pre-
pared, appropriate, and safe when trusted • Session 8: Planning for change
to care for a child. A home study is con-
• Session 9: Taking PRIDE –
ducted to help the child welfare profes-
making an informed decision
sional and the agency decide if adoption
or foster care is right and identify the type
of child or children who will be the best match for the family. The process includes
interviews, home visits, documentation of key information, and reference checks
with people who know the family members well, criminal record check, and a home
inspection. One this assessment is complete, a recommendation is made regarding
fitness and the number and ages of children a foster caregiver’s license includes.
Unfortunately, foster caregiver retention continues to be challenging for many
child welfare agencies. In fact, it is estimated that up to 40% of foster families
discontinue fostering during the first year and 20% plan to do so (Rhodes, Orme,
& Buehler, 2001). Some of the reasons provided when a family chooses to discon-
tinue fostering are encountering issues with the child welfare agency/navigating
the system, concerns about a child’s behavior, stressful interactions with birth par-
ents, problems between foster children and birth children, and being named in
allegations of abuse. Foster parents were more likely to discontinue fostering if
they were dissatisfied with agency relationships or had poor communication with
workers (Rhodes et al., 2001). In studies comparing foster parents who chose to
stop fostering and those who plan to continue, many point to adequate training,
mentorship from seasoned foster parents, and support from the agency and other
parents (Geiger et al., 2013). Foster parents have identified the need for strong
relationships with child welfare professionals (Geiger, Piel & Julien-Chinn, 2017).
Recruiting, Training, and Licensing Foster Parents 243

Note from the Field

Saying Goodbye
Kris Jacober
It’s the first thing we heard as a foster family. “I could never do that. It would
be too hard to have to say goodbye.” And yet, over 15 years we did it over and
over and over again. Saying goodbye, and then sometimes saying hello again,
to 18 children who shared our home.
We’d cared for our first placement, two little girls, for more than 2 years. They
were moving 100 miles away with an aunt they, or we, had barely met. She seemed
nice enough and, over time, has proven to be a wonderful woman, but on the day
those two girls rode away, new pet goldfishes in their laps, van piled high with toys
and clothes, it was the end of our world. Next up, a brother and sister who stayed
for 3 months and then moved in with their aunt, 100 miles in a different direction.
Three months is not 2 years, but these two likewise left their mark on our family.
By now we had a little ritual. Dinner at Chuck E. Cheese. Letters from every mem-
ber of our family. Photo book of our adventures. “Oh, the Places You’ll Go” book
with all of our autographs and, most important, our home phone number. Over the
next years, more children, more painful goodbyes. We dropped off one little boy
who we’d cared for 2 years at his home, all of us wearing sunglasses so he couldn’t
see us cry. We cared for the next little boy for 2 years, as well, and he was adopted
by our friends. One day he was with us. The next day he was with them.
In the days before a child leaves, you sit in their room packing up all of their
clothing and toys. You hug them extra hard when you put them down to bed for
the last time. Your biological kids lay on the floor and cry, and you wonder over
and over if you’re doing the right thing. Three little girls were with us for more
than a year. Two were adopted by a new “forever family.” One, with a different
father, was adopted by her aunt. The scene when we dropped off two of the
sisters, but not the third, still haunts me. The two sisters in their “new bedroom”
at their new home, us walking away with their sister who would be with us for
a few more weeks until she moved in with her aunt. Two sisters, laying on their
beds, crying about where their sister is going. Those are the days when you feel
complicit in a crime. You’ve done the best you can, but the system is not
designed for children. It’s designed so that adults who interact with children
can check the boxes and break difficult decisions into manageable bites.
Over the years we’ve said “goodbye” in many different ways. Meeting new
families in fast-food restaurants halfway between their homes and ours.
Dropping children off at their new adoptive homes. After many years of expe-
rience, here’s what I say to people who say they could never do this because
it’s too hard. It is hard. And sad. And the losses pile up, one on top of another,
each time a child leaves.
It’s tough but we’re the adults here. Kids need us to be strong and to not be
afraid of the loss. We do the best we can while the children are with us. And
when they leave, inside the front cover of “Oh, the Places You’ll Go,” they’ll
find our home phone number. We’ve never changed it because, who knows
someday they may call and need us again.
244 9 Foster Care Placement

Conclusion

When a child is removed from their parents and placed in out-of-home care, there
are various types of placement options: relative/kinship, nonrelative family place-
ment, in-home, and congregate care. Children in foster care should be placements
that are in least restrictive environments, with siblings, with family/kin, culturally
appropriate settings, and in homes closest to a child’s neighborhood and school.
When it is possible to keep a child in their home, in-home perseveration services
should be offered. Placement stability is important for the well-being of children in
care. As such child welfare professionals should prioritize recruiting and training
foster parents so that they will be prepared to care for children. Various services
should be provided to children in care, parents providing foster care, and the parents
who have children in care.

Acknowledgments The authors thank Ashley Wilfong, MSW; Carly B. Dierkhising, PhD; Libby
Fakier, MBA; and Kris Jacober for their contributions to Chapter 9.

Discussion Questions
1. What types of placements are considered “least restrictive” and why?
2. What are two benefits to placing children with kin/relatives when they are
removed from their family of origin?
3. How can child welfare professionals promote cultural ties for children and youth
in care?
4. How can child welfare professionals ensure the medical, educational, and mental
health needs of children are being met?
5. What types of training do prospective foster parents engage in order to become
licensed?

Suggested Activities
1. Review this document from the American Bar Association regarding culture
among children in foster care: https://www.americanbar.org/groups/public_
interest/child_law/resources/child_law_practiceonline/january%2D%2D-­
december-­2019/supporting-­cultural-­identity-­for-­children-­in-­foster-­care/
On your own or with a classmate, think about ways you can promote culture with
children in care. Are current state and federal policies enough? Why or why not?
2. Review the case of “Baby Veronica” (Adoptive Couple v. Baby Girl, 570 U.S.
637 (2013)) http://nulawreview.org/extralegalrecent/2020/9/16/challenging-­the-­
narrative-­c hallenges-­t o-­i cwa-­a nd-­t he-­i mplications-­f or-­t ribal-­s overeignty.
Consider the ways in which this case is different than others.
3. Watch the video “Big Mama”, which won an Academy Award for Best Short
Documentary in 2001. Consider the implications for placing Walter with his
grandmother. What services could have been put in place to support her and
the family?
References 245

4. Read Geiger, Piel & Julien-Chinn (2017). Discuss with others how child welfare
agencies and child welfare professionals can incorporate the ideas of foster care
provides shared in the article.
Geiger, J. M., Piel, M. H., & Julien-Chinn, F. J. (2017). Improving relationships
in child welfare practice: Perspectives of foster care providers. Child and
Adolescent Social Work Journal, 34(1), 23–33. (Available: https://rdcu.
be/ccaPL).

Additional Resources
Child Welfare Information Gateway, National Foster Care Awareness Month:
https://www.childwelfare.gov/fostercaremonth/
Child Welfare Information Gateway Podcast: Supporting Kinship Caregivers Part 1:
https://www.acf.hhs.gov/cb/resource/child-­w elfare-­p odcast-­s upporting-
­kinship-­caregivers-­part1.
Child Welfare Information Gateway Podcast: Supporting Kinship Caregivers Part 2:
https://www.acf.hhs.gov/cb/resource/child-­w elfare-­p odcast-­s upporting-­
kinship-­caregivers-­part2
Annie E. Casey Foundation. Engaging Kinship Caregivers with Joseph Crumbley:
https://www.aecf.org/blog/engaging-­kinship-­caregivers-­with-­joseph-­crumbley/
Child Welfare Information Gateway, Sibling Issues in Foster Care and Adoption:
https://www.childwelfare.gov/pubs/siblingissues/

References

Akin, B. A. (2011). Predictors of foster care exits to permanency: A competing risks analysis
of reunification, guardianship, and adoption. Children and Youth Services Review, 33(6),
999–1011. https://doi.org/10.1016/j.childyouth.2011.01.008
Al, C. M., Stams, G. J. J., Bek, M. S., Damen, E. M., Asscher, J. J., & van der Laan, P. H. (2012). A
meta-analysis of intensive family preservation programs: Placement prevention and improve-
ment of family functioning. Children and Youth Services Review, 34, 1472–1479. https://doi.
org/10.1016/j.childyouth.2012.04.002
Barth, R. P. (2005). Residential care: From here to eternity. International Journal of Social Welfare,
14(3), 158–162. https://doi.org/10.1111/j.1468-­2397.2005.00355.x
Becker, M. A., Jordan, N., & Larsen, R. (2007). Predictors of successful permanency planning and
length of stay in foster care: The role of race, diagnosis and place of residence. Children and
Youth Services Review, 29(8), 1102–1113. https://doi.org/10.1016/j.childyouth.2007.04.009
Bell, T., & Romano, E. (2015). Permanency and safety among children in foster family and
kinship care: A scoping review. Trauma, Violence & Abuse, 18(3), 268–286. https://doi.
org/10.1177/1524838015611673
Berrick, J. D., & Hernandez, J. (2016). Developing consistent and transparent kinship care policy
and practice: State mandated, mediated, and independent care. Children and Youth Services
Review, 68, 24–33. https://doi.org/10.1016/j.childyouth.2016.06.025
246 9 Foster Care Placement

Bettman, J. E., & Jasperson, R. A. (2009). Adolescents in residential and inpatient treatment:
A review of the outcomes literature. Child & Youth Care Forum, 38, 161–183. https://doi.
org/10.1007/s10566-­009-­9073-­y
Boel-Studt, S. M., & Tobia, L. (2016). A review of trends, research, and recommendations for
strengthening the evidence-base and quality of residential group care. Residential Treatment
for Children & Youth, 33(1), 13–35. https://doi.org/10.1080/0886571X.2016.1175995
Bolen, M. G., McWey, L. M., & Schlee, B. M. (2008). Are at-risk parents getting what they need?
Perspectives of parents involved with child protective services. Clinical Social Work Journal,
36, 341–354. https://doi.org/10.1007/s10615-­008-­0173-­1
Chaiyachati, B. H., Wood, J. N., Mitra, N., & Chaiyachati, K. H. (2020). All-Cause Mortality
Among Children in the US Foster Care System, 2003–2016. JAMA Pediatrics. https://doi.
org/10.1001/jamapediatrics.2020.0715
Cheng, T. C. (2010). Factors associated with reunification: A longitudinal analysis of long-term
foster care. Children and Youth Services Review, 32(10), 1311–1316. https://doi.org/10.1016/j.
childyouth.2010.04.023
Children’s Bureau. (2015). A national look at the use of congregate care in child welfare.
U.S. Department of Health and Human Services.
Clausen, J. M., Landsverk, J., Ganger, W., Chadwick, D., & Litrownik, A. (1998). Mental health
problems of children in foster care. Journal of Child and Family Studies, 7, 283–296. https://
doi.org/10.1023/A:1022989411119
Cohen, D., Lacasse, J. R., Dan, R., & Senglemann, I. (2013). CriticalThinkRX may reduce pre-
scribing to foster youth: Results from an intervention trial. Research on Social Work Practice,
23, 284–293. https://doi.org/10.1177/1049731513477691
Dos Reis, S., Zito, J. M., Safer, D. J., Gardner, J. F., Puccia, K. B., & Owens, P. L. (2005).
Multiple psychotropic medication use for youths: a two-state comparison. Journal of Child
and Adolescent Psychopharmacology, 15, 68–77. https://doi.org/10.1089/cap.2005.15.68
Ehrle, J., & Geen, R. (2002). Kin and non-kin foster care-findings form a national survey. Children
and Youth Services Review, 24, 15–35. https://doi.org/10.1016/S0190-­7409(01)00166-­9
Garland, A. F., Aarons, G. A., Saltzman, M. D., & Kruse, M. I. (2000). Correlates of adolescents’
satisfaction with mental health services. Mental Health Services Research, 2, 127–139. https://
doi.org/10.1023/A:1010137725958
Geiger, J. M., Hayes, M. J., & Lietz, C. A. (2013). Should I stay or should I go? A mixed meth-
ods study examining factors influencing foster parents’ decision to continue or discontinue
fostering. Children and Youth Services Review, 35, 1356–1365. https://doi.org/10.1016/j.
childyouth.2013.05.003
Geiger, J. M., Julien-Chinn, F. J., & Lietz, C. A. (2014). Foster Parent Satisfaction Survey. Center
for Applied Behavioral Health Policy, School of Social Work, Arizona State University.
Geiger, J. M., Piel, M. H., & Julien-Chinn, F. J. (2017). Improving relationships in child wel-
fare practice: Perspectives of foster care providers. Child and Adolescent Social Work Journal,
34(1), 23–33. https://doi.org/10.1007/s10560-­016-­0471-­3
Gibbs, D., & Wildfire, J. (2007). Length of service for foster parents: Using administrative data
to understand retention. Children and Youth Services Review, 29(5), 588–599. https://doi.
org/10.1016/j.childyouth.2006.11.002
Glisson, C., Bailey, J. W., & Post, J. A. (2000). Predicting the time children spend in state custody.
Social Service Review, 74(2), 253–280. https://doi.org/10.1086/514479
Halfon, N., Mendonca, A., & Berkowitz, G. (1995). Health status of children in foster care:
The experience of the Center for the Vulnerable Child. Archives of Pediatrics & Adolescent
Medicine, 149, 386–392. https://doi.org/10.1001/archpedi.1995.02170160040006
Hayes, M. J., Geiger, J. M., & Lietz, C. A. (2015). Navigating a complicated system of care: Foster
parent satisfaction with behavioral and medical health services. Child and Adolescent Social
Work Journal, 32, 493–505. https://doi.org/10.1007/s10560-­015-­0388-­2
References 247

Hooper, S. R., Murphy, J., Devaney, A., & Hultman, T. (2000). Ecological outcomes of adolescents
in a psychoeducational residential treatment facility. American Journal of Orthopsychiatry, 70,
491–500. https://doi.org/10.1037/h0087807
Lawrence, C. R., Carlson, E. A., & Egeland, B. (2006). The impact of foster care on development.
Development and Psychopathology, 18(1), 57–76. https://doi.org/10.1017/S0954579406060044
Lietz, C. A. (2009). Examining families’ perceptions of intensive in-home services: A mixed
methods study. Children and Youth Services Review, 31, 1337–1345. https://doi.org/10.1016/j.
childyouth.2009.06.007
Lloyd, E. C., & Barth, R. P. (2011). Developmental outcomes after five years for foster chil-
dren returned home, remaining in care, or adopted. Children and Youth Services Review, 33(8),
1383–1391. https://doi.org/10.1016/j.childyouth.2011.04.008
Lyons, J. S., Terry, P., Martinovich, Z., Peterson, J., & Bouska, B. (2001). Outcome trajectories
for adolescents in residential treatment: A statewide evaluation. Journal of Child and Family
Studies, 10, 333–345. https://doi.org/10.1023/A:1012576826136
Malm, K., Vandivere, S., & McKlindon, A. (2011). Children adopted from foster care: Child and
family characteristics, adoption motivation, and well-being. Office of the Assistant Secretary
for Planning and Evaluation, U.S. Department of Health and Human Services.
Matone, M., Localio, R., Huang, Y. S., Dosreis, S., Feudtner, C., & Rubin, D. (2012). The rela-
tionship between mental health diagnosis and treatment with second-generation antipsychotics
over time: a national study of US Medicaid-enrolled children. Health Services Research, 47(5),
1836–1860. https://doi.org/10.1111/j.1475-­6773.2012.01461.x
Mitchell, M. B. (2018). “No one acknowledged my loss and hurt”: Non-death loss, grief, and
trauma in foster care. Child and Adolescent Social Work Journal, 35(1), 1–9. https://doi.
org/10.1007/s10560-­017-­0502-­8
Mullins, J. L., Cheung, J. R., & Lietz, C. A. (2012). Family preservation services: incorporating
the voice of families into service implementation. Child & Family Social Work, 17, 265–274.
https://doi.org/10.1111/j.1365-­2206.2011.00777.x
Price, J. M., Roesch, S., Walsh, N. E., & Landsverk, J. (2015). Effects of the KEEP foster par-
ent intervention on child and sibling behavior problems and parental stress during a ran-
domized implementation trial. Prevention Science, 16(5), 685–695. https://doi.org/10.1007/
s11121-­014-­0532-­9
Rauktis, M. E., Fusco, R. A., Cahalane, H., Bennett, I. K., & Reinhart, S. M. (2011). “Try to
make it seem like we’re regular kids”: Youth perceptions of restrictiveness in out-of-home
care. Children and Youth Services Review, 33(7), 1224–1233. https://doi.org/10.1016/j.
childyouth.2011.02.012
Rhodes, K. W., Orme, J. G., & Buehler, C. (2001). A comparison of family foster parents who quit,
consider quitting, and plan to continue fostering. Social Service Review, 75(1), 84–114. https://
doi.org/10.1086/591883
Ringeisen, H., Casanueva, C., Urato, M., & Cross, T. (2008). Special health care needs among
children in the child welfare system. Pediatrics, 122(1), e232–e241. https://doi.org/10.1542/
peds.2007-­3778
Sakai, C., Lin, H., & Flores, G. (2011). Health outcomes and family services in kinship care:
Analysis of a national sample of children in the child welfare system. Archives of Pediatrics &
Adolescent Medicine, 165(2), 159–165. https://doi.org/10.1001/archpediatrics.2010.277
Stahmer, A. C., Leslie, L. K., Hurlburt, M., Barth, R. P., Webb, M. B., Landsverk, J., & Zhang,
J. (2005). Developmental and behavioral needs and service use for young children in child
welfare. Pediatrics, 116, 891–900. https://doi.org/10.1542/peds.2004-­2135
Szilagyi, M. A., Rosen, D. S., Rubin, D., & Zlotnik, S. (2015). Health care issues for children
and adolescents in foster care and kinship care. Pediatrics, 136(4), e1142–e1166. https://doi.
org/10.1542/peds.2015-­2656
Tyuse, S. W., Hong, P. P., & Stretch, J. J. (2010). Evaluation of an intensive in-home family treat-
ment program to prevent out-of-home placement. Journal of Evidence-Based Social Work, 7,
200–218. https://doi.org/10.1080/15433710902911063
248 9 Foster Care Placement

U.S. Department of Health & Human Services, Administration for Children and Families,
Administration on Children, Youth and Families, Children’s Bureau. (2020a). Child
Maltreatment 2018. Available from https://www.acf.hhs.gov/cb/research-­data-­technology/
statistics-­research/child-­maltreatment
U.S. Department of Health & Human Services (2020b). The AFSCARS Report. https://www.acf.
hhs.gov/sites/default/files/documents/cb/afcarsreport27.pdf
Winokur, M., Holtan, A., & Batchelder, K. E. (2014). Kinship care for the safety, permanency,
and well-being of children removed from the home for maltreatment. Cochrane Database of
Systematic Reviews, 2014, 1–239. https://doi.org/10.1002/14651858.CD006546.pub3
Zito, J. M., Safer, D. J., Sai, D., Gardner, J. F., Thomas, D., Coombes, P., Dubowski, M., & Mendez-­
Lewis, M. (2008). Psychotropic medication patterns among youth in foster care. Pediatrics,
121, e157–e163. https://doi.org/10.1542/peds.2007-­0212
Chapter 10
Permanency in Child Welfare Practice

Introduction

Permanency, or a permanent plan for a child’s legal placement and relationships, is

a priority of the child welfare system. It is considered at every stage of the case.
Federal legislation has been enacted to increase permanency of children involved in
the child welfare system. Permanency refers to having nurturing relationships with
adults who provide support to children and youth in their care. Ideally, permanency
takes the form of a long-term relationship that includes a legal component. The
child welfare system is charged with finding a permanent placement for each child
who enters the foster care system, one that is stable and healthy. In most cases, chil-
dren will be reunited with their biological parents/caregivers. However, many chil-
dren may not be able to return home, and a plan for guardianship or adoption must
be made and carried out.
In the most recent Adoption and Foster Care Analysis and Reporting System
(AFCARS) report for children in care, 55% of children had a case plan goal of fam-
ily reunification, and 28% had a goal of adoption (US DHHS, 2020). Of the children
who had exited during the same time period, 47% had been reunited with their
parents, 26% had been adopted, 11% had entered in a permanent guardianship, 8%
had emancipated, and 6% were living with other relatives (US DHHS, 2020).

Permanency Planning

There are several factors that child welfare professionals must balance when mak-
ing decisions and plans for permanency. For example, the reason for the child enter-
ing care – is this an issue that can be resolved within a timely manner so that a child
can safely return home? There are a number of legal timelines and guidelines that
child welfare professionals must consider with permanency, such as laws and

© Springer Nature Switzerland AG 2021 249

J. M. Geiger, L. Schelbe, The Handbook on Child Welfare Practice,
https://doi.org/10.1007/978-3-030-73912-6_10
250 10 Permanency in Child Welfare Practice

policies regarding time, caregivers, and expectations, which will be discussed

below. All efforts in preventing a family from becoming involved with the child
welfare system are made through family preservation services/intact family services
to alleviate issues among families who are considered low-risk. These families may
be in need of resources (educational, medical, financial, housing, food, etc.) and
psychoeducation about discipline or parenting skills or require supports such as
childcare or health insurance.
Permanency planning begins at the first contact with a family and extends
through the life of a case (intake, investigation, case management, closure). Effective
permanency planning requires uniform
implementation of basic social work prac-
tice fundamentals and permanency prin- Practice Highlight
ciples. Family reunification (discussed in Guiding Principles in Permanency
Chap. 7) is the preferred outcome and is Planning
always the case plan goal for families
becoming involved with the child welfare 1. Base decision-making on the
system, with exceptions for cases involv- child’s sense of time and urgency
ing aggravated circumstances that require 2. Focus service on achieving
expedited termination of parental rights health, well-being, and safety
(e.g., “when the maltreatment of children for children
is so egregious that efforts should not be
made to preserve the family”). Focus is 3. Respect child’s family and value
always placed on having children return the importance of family
home as soon and safely as possible. connectedness
When this is not possible, child welfare 4. Prioritize ongoing, thorough,
professionals identify other families, par- and complete assessments of
ticularly relative or kinship caregivers, as children and families.
well as nonrelative licensed caregivers
(foster parents) who will care for the child 5. Embrace shared deci-
or children while family reunification is sion making
pursued. Permanency is not only an out- 6. Ensure full disclosure
come but a process. It involves making
decisions about placement, services, time 7. Conduct frequent reviews
frames, goals, and the responsibilities of 8. Ensure thorough assessment
all parties involved. Parents are often and services that match
asked to complete a series of services,
tasks, and/or work towards building skills 9. Involve child welfare profes-
related to caring for the child or children sionals as change agents work-
involved in order for family reunification ing with families, children, and
to occur. service providers
Permanency Planning 251

Principles Guiding Policy Highlight

Permanency Planning
Examples of Aggravated
Circumstances that May Require
Child welfare professionals lead perma- Expedited Termination of
nency planning efforts, in collaboration Parental Rights
with parents, family, children and youth,
and service providers. There are several The parent committed murder of
principles guiding permanency planning to another child of the parent.
consider in child welfare practice. First, The parent committed voluntary
child welfare professionals must be sure to manslaughter of another child of
base their decision-making on the needs of the parent.
the child in terms of time and urgency. For
example, the law designates specific time The parent aided or abetted,
frames for service completion. As soon as it attempted, conspired, or solicited
appears that reunification may not occur, to commit such a murder or volun-
and that it is no longer an appropriate or tary manslaughter.
achievable goal, it is the child welfare pro- The parent committed a felony
fessional’s responsibility to consider chang- assault that resulted in serious
ing the permanency goal to meet the needs bodily injury to the child or another
of the child or children. Second, the child child of the parent.
welfare professional should prioritize ser-
vices that specifically address the needs of The parental rights of the parent to
the parent(s) and child that caused the child a sibling of the child were termi-
to be placed in out-of-home care. Services nated involuntarily.
provided to the parent and/or the child The parent abandoned the child.
should focus on the child’s health, safety,
and well-being. Family is extremely impor- The parent was convicted of the
tant in permanency planning. Immediate crime of trafficking in persons.
and extended family should be involved in The parent has sexually exploited
the case and planning and considered as or allowed the sexual exploitation
placement when children cannot be placed of the child.
with their parents. Family members should
always be treated with respect and con- The child was removed from the
sulted when important decisions are made. home previously due to abuse or
Child welfare professionals must determine neglect and was removed again due
the conditions that children can safely return to a subsequent incident of abuse or
home. Ongoing, thorough, and complete neglect.
family and child assessments are critical in The parent was convicted of a sex-
making these decisions. This also allows ual offense that resulted in the
one to ensure safety and minimize risk to child’s conception.
the well-being of the child. Shared decision-
making is key when determining the options
for placement and permanency for children. When interdisciplinary teams work together
to support children and families, children and their parents are more likely to access
more services and are more motivated to work towards their goals while feeling sup-
ported in the process. Child welfare professionals should be honest about how the case
252 10 Permanency in Child Welfare Practice

is progressing and provide clear, concise information about the case to all parties in the
case (parents, children [as appropriate], caregivers, and service providers). This is not
always easy as decisions made can often not be what everyone would like to see happen
(e.g., termination of parental rights); however, when approached honestly, with empa-
thy and sensitivity, parents and other parties can better understand how decisions are
made, especially when they are kept apprised of changes and communicated with regu-
larly. Child welfare professionals should conduct frequent reviews to evaluate progress,
make any necessary changes, and determine the continued appropriateness of the plan,
relevance of the services, and frequency and duration of child-parent visitation.
Throughout the case, assessment and subsequent recommendations should always
inform and match services provided as well as the child’s placement.

Practice Highlight
Actions Speak Louder than Words!
Parents’ behavior is the ultimate determinant of permanency outcomes.
However, a child welfare professional can also positively impact the case out-
comes and child and family well-being, especially when providing appropri-
ate, timely, and culturally sensitive services within the mandated time limits.

Permanency: Policies and Laws

A number of federal and state level policies have been enacted to improve perma-
nency outcomes for children and youth involved in the child welfare system. Over
the last century, child welfare in the United States has shifted between a focus on
safety to one of family preservation. In the 1970s, there was an increased focus on
reducing the time a child spent in foster care and less time towards permanency. In
1997, the Adoption and Safe Families Act (ASFA, P.L. 105-89) was the first legisla-
tion that addressed permanency by highlighting the need for both safety and perma-
nency for children and families to achieve child well-being. The AFSA provided a
clear definition and guidelines for permanency for children in care. This ground-
breaking legislation required states to improve the safety of children, promote adop-
tion and permanent placements for children, and support families. It also required
child protection agencies to offer timely assessments and services (e.g., substance
abuse, psychological assessment and treatment, parenting, etc.) to children and fami-
lies involved in the child welfare system. Following the AFSA, states were required
to report “reasonable efforts” to provide services, find permanent homes and fami-
lies for children, and conduct concurrent planning for permanency (secondary goal
for permanency if reunification was not possible). If child protection agencies/states
did not demonstrate reasonable efforts, they were subject to fines and/or other legal
sanctions. This is particularly relevant for child welfare professionals, who are
responsible for identifying the needs of the family to meet permanency goals and
offering services to parents and children in a timely and consistent manner. Court
proceedings will involve the reporting of findings for reasonable efforts for each case.
Permanency Goals 253

In 2008, the Fostering Connections to Success and Increasing Adoptions Act

(P.L. 110–351) amended the Social Security Act to improve outcomes for children in
foster care, connect and support relative caregivers, and offer incentives for adoption.
Fostering Connections enhanced services for youth aging out of care and created
new programs to help children and youth in or at risk of entering foster care to recon-
nect with family members. Through this legislation, permanency was prioritized.
More recently, the Family First Prevention Services Act (Family First Act) was
signed into law as part of Division E in the Bipartisan Budget Act of 2018 (HR
1892). It provides additional guidance and funding to reduce the number of children
entering foster care through prevention services, supporting families, and promot-
ing family-based care for children in care. With regard to permanency, the law pro-
motes permanent families for children by establishing an electronic interstate
case-processing system to help states expedite interstate placement of children
(ICPC) in care, adoption, or guardianship. It also extends the Adoption and Legal
Guardianship Incentive Payment program for 5 years so that states can receive
incentives for increasing the number of children leaving care through adoption or
guardianship. Family First also outlines steps to ensure that states are investing in
post-adoption services to decrease the number of children re-entering foster care.

Permanency Goals

Reunification with the biological parents/caregivers is the preferred initial perma-

nency goal when children enter care, except in cases where aggravated circum-
stances exist. When this is not possible, other permanency goals must be considered
concurrently or after a reasonable amount of time has elapsed, as a new goal. As a
case moves forward and parents have
been unable to remedy the circumstances Practice Highlight
for which a child entered care within a
reasonable time frame, the child welfare Types of Permanency Goals
professional and legal counsel may make Reunification with the parent
a recommendation for the termination of
parental rights (TPR) and adoption. In Termination of parental rights
these circumstances, it is preferred that a (TPR) and adoption
child is already placed in a permanent Guardianship with a permanent
placement with a family who wishes to guardian
adopt them. However, it is not always the
case that a family has been identified and Guardianship with a “fit and will-
the child welfare professional, often one ing relative” while remaining in the
who specializes in adoption, will work state’s legal custody
towards identifying a family that meets Another planned permanent liv-
the needs of the child or children and ing arrangement (APPLA) while
begin working towards a transitioning to a remaining in the state’s
permanency placement with this family. legal custody
254 10 Permanency in Child Welfare Practice

Other permanency goals include guardianship with a permanent guardian and

guardianship with a “fit and willing” relative while remaining in the state’s custody.
Guardianship is a permanent arrangement that involves a court order appointing a
specific caretaker for the child without having to terminate parental rights.
Guardianship accounts for approximately 11% of case outcomes in the United
States (US DHHS 2020). Appointed guardians have similar rights and duties of a
biological or adoptive parent (e.g., health care, educational, etc.). Plans of guardian-
ship are often used when children are placed with kinship caregivers and in situa-
tions where permanency options of adoption and family reunification have been
ruled out. Finally, revocation of guardianships can be requested by a parent at any
time, with court involvement and review.
The least desirable permanency goal is “another planned permanent living
arrangement” or APPLA. This goal is the least frequently used and mostly used
among older youth in care for which an adoptive or legal guardian permanent place-
ment was not identified. It is possible in these circumstances that a parent’s rights
were not terminated, therefore ruling out adoption. Additionally, it is possible that a
youth is choosing not to be adopted or enter into a legal guardianship. The case
manager will work with the older child to identify another planned permanent living
arrangement when reunification, adoption, and guardianship are not appropriate
options. In this scenario, the child welfare professional attempts to build upon and
foster permanent supports and connections and to provide independent living ser-
vices that help prepare the youth for self-sufficiency in adulthood.

Case Study: Adoption with a Kinship Caregiver

Maria,1 7, had been in foster care for 1 year. The courts had just changed her
case plan from family reunification to adoption. Her mother and father had
not been able to successfully complete the case plan tasks to have them
reunited with Maria. Maria had been living with her aunt, Susanna, since
being removed from her parents’ care. Susanna was willing to adopt Maria
and provide a permanent placement with her. Once her parents’ parental rights
were terminated by the courts, Susanna worked with an attorney to file for
adoption. Within 3 months, Maria was adopted by Susanna.

1
All names and other personal identifiers in cases and examples throughout
this book have been changed to protect privacy and confidentiality.

Regardless of the older youth’s permanency plan, any child 16 years of age or
older should receive an independent living assessment and services while they are
living in any type of foster care. They may be working towards achieving any of the
permanency goals (i.e., reunification, adoption, guardianship, or APPLA).
Independent living services generally include assistance with money management
skills, educational assistance, household management skills, employment prepara-
tion, and other life skills services. A case plan of APPLA typically involves older
youth who will most likely age out of care at the age of 18 or 21, depending on their
state of residence. The process of aging out and special considerations for working
with older youth are discussed further in Chap. 11.
Permanency Goals 255

Reunification, adoption, guardianship, and APPLA are general permanency goal

options used within federal guidelines; however, states and tribal communities often
use more specific options or more expansive permanency goals. For example, in
Illinois, permanency goals are expanded within family reunification. Options include
reunification after 5 months, 12 months, and pending status hearing, among others.

Case Study: APPLA: Another Planned Permanent Living Arrangement

Jeremiah was 16 when he entered foster care after his mother died. He had not
known his father and did not have any family able to care for him. Jeremiah
lived in two different group homes before moving to live with a foster family
when he was almost 17 years old. The foster family was an older couple living
in his neighborhood. It was a perfect living arrangement and fit for Jeremiah.
Jeremiah struggled with the death of his mother and was not ready to be
adopted by another family. Given his age and his wishes, he chose to continue
his case plan as APPLA. His caseworker would have preferred that he have
more of a legal permanency plan of adoption or guardianship; however,
Jeremiah was not willing to consider those options. He continued to have an
excellent relationship with his caregivers, Anna and Joseph, into adulthood.

Adoption

The goal of adoption is selected when the parental rights of both parents are termi-
nated or relinquished through adoptive surrenders or consents, including consents to
adoption by specified persons. In 2019, 26% of children exiting foster care were
adopted (US DHHS, 2020). The court must first terminate parental rights following
a motion to the court from a party to the case, most often the child welfare agency
and/or their legal representative. Adoption needs to be determined to be in the best
interest of the child or children. Many jurisdictions also consider the consent of
older youth in their own adoption.

Practice Highlight
National Adoption Month
November is National Adoption Month, a month set aside to raise awareness
about the need for adoptive families for children and youth in foster care and
celebrate adoptions across the country. National Adoption Month began in
1976 when Massachusetts Governor Mike Dukakis announced the first
Adoption Week. The idea of having time set aside to create awareness around
adoption grew in popularity and spread nationwide. In 1984, President Ronald
Reagan proclaimed the first National Adoption Week, and in 1995, under
President Bill Clinton, the week was expanded to the entire month of November.
256 10 Permanency in Child Welfare Practice

Adoption is a common concurrent case

Practice Tip
plan goal, after family reunification.
Adoption is promoted to ensure a child’s How to Facilitate a Healthy
relational and legal permanency. When Adoption
placing a child, a child welfare profes-
• Create a “Lifebook” to help the
sional should always consider the case
child understand their past and
and likelihood of reunification and
placement history
whether the current placement is one that
would consider adoption. These circum- • Identity and enlist important
stances, however, are very difficult to pre- attachment figure (e.g., family,
dict, and planning and having options will caregivers, mentors, etc.)
help guide the case as it moves forward.
• Acknowledge the child’s prefer-
When parental rights are severed, a child
ences and give permission to
is free for adoption. Ideally, there should
love another caregiver
already be a family that is identified who
will adopt the child when legal proceed- • Acknowledge the past and its
ings to sever the parents’ rights occur. impact on the future
• Honor and support racial and
cultural identity
There are a number of agencies that spe-
cialize in promoting and facilitating private Practice Tip
adoptions and adoptions from foster care. Talking to Children About
For example, AdoptUsKids is an initiative Adoption
to connect children in foster care who are
awaiting adoption with families interested • Talk about adoption with all
in adoption (Adopt Us Kids 2020). Child children – not just those who are
welfare professionals who specialize in adopted.
cases at the adoption phase rely on foster • Tell the truth.
and adoptive agencies, kinship care provid-
ers, and foster care providers as the case • Use age-appropriate language.
moves along from foster care to adoption. • Follow the child’s lead and let
To ensure a successful adoption, child wel- them ask questions.
fare professionals can do several things. In
addition to ensuring that all legal steps have • Seek professional help
been taken to move forward, caseworkers if needed.
should consider the fit of the current care- • Start talking about adoption as
givers as long-term adoptive parents. They early as possible and as much as
should consider whether this is a placement necessary.
with caregivers who are physically, finan-
cially, and emotionally able to care for the • Express excitement about the
child. The child welfare professional possibility of adoption.
should think about what the child and fam-
ily may need during the transition and in the long term to ensure a stable and healthy
placement for the child and the caregiver. This requires a thorough assessment and
talking with the various players involved (biological parents, potential adoptive par-
ents, providers, the child, and family members). There are benefits to considering
Permanency Goals 257

foster parent adoption where the child is currently placed, such as maintaining the
secure relationship already established; promoting a psychological shift in a sense of
identity, connection, and belonging by making the placement permanent; remaining in
a familiar school, community, and neighborhood; and having a shorter time to perma-
nency (adoption). It is also important to consider the positive and negative changes that
may occur when adoption occurs and the child welfare agency is no longer responsible
for monitoring the case. For example, decision-making shifts from the child welfare
agency (i.e., caseworker) to the adoptive parents, children and families may lose some
of the resources and supports, they no longer have contact with the biological family,
and the parents become financially responsible for the child. This points to the need to
be forthcoming, honest, and prepared throughout this process.
Child welfare professionals considering placement for adoption with a new fam-
ily should be honest and open and assist with a thoughtful transition from foster care
to adoption. Foster and adoptive parents should talk with children about the transi-
tion and use resources available to assist with this process. They should provide all
of the information about the child’s past, current needs, and resources available
during the transition and after the adoption. For all adoptive parents, child welfare
professionals should provide information about expectations and the potential
impact on their current family unit and extended family, the legal steps, access to the
adoption assistance subsidy, federal adoption tax credit, family counseling, and
making decisions about maintaining contact with the biological family.

Guardianship

Guardianship involves the transfer of guardianship for the children from the state
(or tribe) to an individual or couple. This permanency goal may be selected if reuni-
fication and adoption have been ruled out as permanent goals, the children reside
with relatives or foster home caregivers with whom they have formed emotional
attachments, and these caregivers are willing to accept legal responsibility for the
child or children and assume commitment to a permanent relationship that meets
the child’s or children’s needs. The court will typically have to approve and/or order
guardianship as a goal for permanency.

Case Study: Guardianship

Eloise, age 15, lived with her grandmother since she was 12. She just became a
ward of the court when the temporary power of attorney her mother signed to have
her grandmother care for her expired and her mother was unable to be located.
Cheryl, her grandmother, wanted Eloise to be reunited with her mother, but her
mother did not participate in the services offered by the child welfare agency
within the time allotted. Eloise wanted to stay with her grandmother but was
always hopeful her mother would return to care for her. She still called occasion-
ally, and Eloise deeply cared for her mother. After several child and family team
meetings, it was decided that they would pursue guardianship as the case plan so
that Eloise could have permanency and maintain the relationship with her mother.
258 10 Permanency in Child Welfare Practice

Practice Highlight
Best Interests of the Child
This term refers to the factors that courts consider when deciding what type of
services and actions are needed to best serve a child as well as who should do
them. “Best interests” determinations are made by taking into account the child’s
circumstances as well as the parent or caregiver’s circumstances and capacity to
parent, with the child’s safety and well-being the most important concern.
Some factors considered are as follows:
• The emotional ties and relationships between the child and his or her par-
ents, siblings, family and household members, or other caregivers
• The capacity of the parents to provide a safe home and adequate food,
clothing, and medical care
• The mental and physical health needs of the child
• The mental and physical health of the parents
• The presence of domestic violence in the home
• Child’s wishes
• Maintaining sibling and other close family bonds
• Federal and/or state constitution protections

Concurrent Permanency Planning

Even when the child welfare agency is working with the family on reunification, it
may also implement concurrent planning to ensure that permanency is achieved for
the child in as timely a manner as possible and within ASFA guidelines. Concurrent
planning involves identifying and working towards a child’s primary permanency
goal, such as reunification, while simultaneously identifying and working on a sec-
ondary goal, such as adoption or guardianship. This practice, when implemented
correctly, can shorten the time to achieve permanency because progress has already
been made towards the concurrent goal if efforts towards the other goal prove unsuc-
cessful. This provides caseworkers with a structured approach to move children
quickly from foster care to the stability of a safe and continuous family home.
It is important to remember that although the child welfare professional and
agency are responsible for providing and monitoring service participation and the
case, there is also a legal side to permanency planning. When it is determined that
the case plan goal should change, child welfare professionals should consult with
legal counsel about the grounds for doing so based on state laws and policies. The
legal department will make the ultimate decision based on evidence, timing, and
case progression. Legal screenings or legal staffings occur when a petition or motion
needs to be filed (related to case plan goal changes, placement, etc.). The child wel-
fare professional is responsible for documentation regarding services offered and
Achieving Permanency 259

the parent’s progression or lack thereof towards case plan goals. Decisions about
these legal processes are often made in consultation with all parties to the case (e.g.,
guardian ad litem, parents’ attorneys, court appointed special advocate [CASA]).

Achieving Permanency

Permanency must be a priority due to the many negative consequences (e.g., health,
development, behavior disorders, substance abuse, neurological functioning) when
it is not achieved (Fisher et al., 2013). Permanency planning will look different
depending on the child and their family. For example, permanency planning is dif-
ferent for older youth. Planning can vary depending on the number of children in the
family and their ages and the child’s needs. There may be different cultural back-
grounds (e.g., Austin et al., 2020). Difference in the child’s experiences can also
shape planning and options for permanency. For example, some variables that are
considered when considering long-term placement options are the number of chil-
dren in the home, pets, proximity to services (medical and behavioral health), prox-
imity to family, educational needs and preferences, age of caregiver (if a child is
very young), age of child, contact with biological family, and social-emotional
needs of the child. Every child and caregiver is different; however, best practice is
to consider all of the factors and talk to all of the parties about all options to ensure
that permanency is successful. The administrative approach and process to achiev-
ing permanency is similar across age groups; however there are different strategies
to promote permanency among children across age groups.

Practice Highlight:
The Importance of Creating Therapeutic Transition Plans
Libby Fakier, MBA
Over the past 3 ½ years, my family has fostered four sibling sets for periods
ranging from 9 months to 2 years. At the outset of our placements, we created
a therapeutic environment to help children address their trauma resulting from
unpredictable parenting responses, sudden or frequent placement changes,
and a sense of general isolation, insecurity, and helplessness. We created a
stable, structured home with a predictable routine, clear communication, and
plenty of time to adjust to any changes we were told the child would encoun-
ter. In addition, we have partnered with members of our faith community and
paired our children with supporting mentors who invest time in the kids, take
them on outings, act as an additional layer of support, and instill in the child
the belief that they are loved, special, and worthy.
260 10 Permanency in Child Welfare Practice

Our children’s response has been nothing short of miraculous. We’ve

watched them transform from dissociative, frightened, frenetic, detached chil-
dren to happy, carefree, trusting human beings. Because of the documented
success we’ve experienced, I believe it is imperative that the case manage-
ment team set up structured, predictable transition periods that allow children
to slowly let go of the family they’ve bonded with while creating healthy
bonds with their forever family or birth family. This plan recognizes the
child’s innate need to hold on to the bonds they’ve created with the families
and mentors who have supported them during their time in care. A successful
model includes scheduled communication between the children and the prior
foster families and mentors and constant reinforcement from the new family
that the children are welcome to reach out to their support systems as often as
they need to until they adjust to their new placement or permanency option.
Our experience is the kids want to call and FaceTime daily for the first
week or two, and then the frequency slowly subsides in weeks two through
five. What makes this model so successful is that it reinforces to the child that
he or she has a voice and some element of control over his or her situation.
This alone sets the child up psychologically and emotionally to view transi-
tion and permanency in a positive, healthy way. This approach is essential to
repairing a child’s ability to trust and create healthy attachments in the future.

For frontline child welfare professionals, it is important to have adequate training

about the community-specific needs that are being served, including culture, his-
tory, and the community’s relationship with the child welfare system. Child welfare
professionals must know who the community includes, what their needs are, and
what resources are available to them. Collaboration among multiple systems (edu-
cation, health care, behavioral and mental health care, etc.) is key when improving
permanency outcomes for children in care. (See Chap. 6 for detailed information
about collaboration.) A focus on prevention through timely and quality services and
supports to parents and children before child welfare system involvement must be
considered in permanency. (For further discussion, see Chap. 7 on child maltreat-
ment prevention and family preservation.)
Obtaining permanency for every child can be a challenge in general, and certain
populations have a more difficult time with achieving permanency. Older youth,
children from racial/ethnic minority groups, children with disabilities and signifi-
cant health needs, and immigrant/refugee children and youth are populations with
lower rates of permanency. Parents working towards reunification may need addi-
tional resources and services that are specific to their child or children. This should
be a priority for child welfare professionals. Further, as child welfare professionals,
there are multiple ways to promote permanency among all children, particularly
those identified at risk for not achieving timely permanency when reunification is
not possible. For example, child welfare professionals can begin early with
Achieving Permanency 261

permanency planning and concurrent permanency planning options. Children

should be placed with families that are a good match for the child’s needs as early
as possible. Communication with caregivers and youth about permanency options
early is important when determining options for the child’s permanency. Child wel-
fare agencies can work to recruit and retain a diverse group of foster parents and
adoptive parents that are representative of the children and youth in care in their
state or jurisdiction.

Factors Influencing Permanency

There are several child- and system-level factors that have been shown to influence
permanency outcomes. With regard to children, age, race, physical and mental
health, and disabilities are strong predictors. For example, older youth are less likely
to achieve permanency compared to younger children (Courtney & Wong, 1996;
Snowden et al., 2008). African American children are less likely to be reunified with
their biological parents than white children (Connell et al., 2006; Romney et al.,
2006). Among older youth, factors such as truancy, running away, and gang mem-
bership negatively influence permanency outcomes (Orsi et al., 2018). Family struc-
ture and experiences, such as single parenthood, poverty, parental mental health,
and substance abuse, have also been shown to play a role in permanency outcomes.
Families experiencing mental health and intimate partner violence have been shown
to have negative permanency outcomes (Risley-Curtiss et al., 2004), and single par-
ents take longer to reunify when compared with married couples (Courtney, 1994).
Some studies have examined the influence of system-level factors such as child
welfare professional turnover as well as the influence of substitute caregivers on
permanency outcomes. For example, higher turnover rates among case managers
have been associated with lower rates of reunification and slower permanency
(Davis et al., 1996; Ryan et al., 2006). A recent study conducted by Katz et al.
(2018) showed that when respite was available for out-of-home caregivers and com-
munication was positive between child welfare professionals and substitute caregiv-
ers, permanency was more likely.

Permanency Planning for Older Youth

Youth represent a subgroup of children involved in the child welfare system that
may require a different approach when developing and implementing plans for per-
manency. Adolescents are less likely to be adopted than children under the age of 5.
In 2019, 56% of the adoptions were of children under age 5, and only 10% of adop-
tions involved children over the age of 13 (US DHHS, 2020). Youth are also more
likely to spend more time in care, have more placements while in care, and are more
likely to live in congregate care settings. This might be due to systemic issues and
262 10 Permanency in Child Welfare Practice

agency policies that may not fully promote permanency among older youth. This,
however, does not minimize the need for permanency among youth. Research has
found that permanency is critical to youths’ mental well-being (e.g., McGuire et al.,
2018). In fact, youth are in great need for relational and legal permanence through
adoption, guardianship, and/or kinship care. Youth in care will benefit from strong
relationships, including those with peers (Hu et al., 2020).
Older youth are closer to “aging out of care,” meaning many will leave care within
a relatively short period of time and will need the guidance and support of caring
adults to help prepare them for this transition and equip them with skills to care for
themselves independently. In addition, all youth require those long-lasting relation-
ships with family members, caring adults, and peers to rely on when in need. Chapter
11 discusses working with special populations, including older youth in care in more
depth; however, this section will focus on
permanency for older youth in care.
Policy Brief
Several policies focus on promoting
permanency and stability for older youth Fostering Connections Act and
in care, including the Preventing Sex Permanency Among
Trafficking and Strengthening Families Older Youth
Act (PSTSFA) of 2014, the Family First
• Requires Title IV-E agencies to
Prevention Services Act (FFPSA) of
identify and notify all adult rela-
2018, and, most comprehensively, the
tives within 30 days of removal
Fostering Connections to Success and
of their option to become a
Increasing Adoptions Act of 2008
placement resource for a child
(Fostering Connections). Further PSTSFA
limits the use of another planned perma- • Creates a new plan option to
nent living arrangement (APPLA) to provide kinship guardianship
youth age 16 and older, and when used, assistance payments under Title
places certain requirements. IV-E on behalf of children who
There are numerous barriers to achiev- have been in foster care and
ing permanency among youth in care. For have a relative who is taking
example, there are myths about older legal guardianship
youth in care, such as they might be more
• Allows youth who leave foster
likely to have behavioral problems or to
care for kinship guardianship
run away. On a systems level, caseworkers
or adoption after age 16 to
and administrators might have difficulty
receive services under the
in identifying and supporting family-like
Chafee Program
placements, a lack of resources for youth
in care and their providers, and/or a need • Permits states to extend Title
for education and involvement of youth, IV-E assistance to otherwise eli-
staff, and providers about permanency gible youth remaining in foster
and youth in care. care after reaching age 18 and to
In order to increase permanency among youth who at age 16 or older
older youth, agencies should do what they exited foster care to either a kin-
can to involve youth in the permanency ship guardianship or adoption
planning process. The most important and are in school, employed, or
component to consider is involving youth incapable for a medical reason
Achieving Permanency 263

in the permanency planning process. This helps both the caseworker and the youth
with youth bringing ideas to the table while enhancing their self-esteem, self-effi-
cacy, and decision-making skills. Child welfare professionals should prioritize these
conversations with youth early and frequently, as appropriate. Similarly, child wel-
fare professionals should begin exploring options with concurrent plans in place and
expose youth to various options and individuals they already have or can develop
strong, long-lasting relationships with. Caseworkers should allow youth to set their
own permanency agenda, including deciding who is invited to meetings, establish-
ing long- and short-term goals, and determining how they want to participate in
their case and court hearings.
Child welfare professionals can also
Practice Highlight
strengthen reunification services for
youth. Return to family is the preferred Reasons to Adopt a Teen
case plan goal for most children and
• No diapers to change.
youth, and more than half of children in
• They sleep through the night.
care have a case plan goal of family reuni-
• They will move out sooner, but
fication. Therefore, child welfare profes-
can still visit.
sionals can work toward this goal through
• Parents don’t just get a child;
regular parent-child visits, family and
they get a friend.
individual therapy, and providing critical
• They will keep parents up to
services to facilitate family reunification.
date on the latest fashion.
Further, consider that factors leading to
• No more carpools – they can
family reunification related to safety are
drive others places!
often different for older youth than they
• No bottles, formula, or burp
are for young children. Even if reunifica-
rags required.
tion is not possible while youth are in
• They can help around the house.
care, it is possible the youth will return to
• They can learn from parents.
stay with their biological parents after
• They can help to operate the
they leave care. Therefore, it is important
computer and other devices.
to provide services while the child welfare
agency is involved to prepare youth and
biological parents for this.
Legal permanency is important to ensure there is a plan for permanency and that
all of the formal steps are being taken with court proceedings. However, research
shows that relational permanency – connections with caring adults – is paramount
to youth well-being (e.g., Salazar et al., 2018). These relationships with caregivers,
family, peers, and others are often fractured or discontinued when a child enters
care. Child welfare workers can help to establish new and maintain existing rela-
tionships through mentoring programs, reducing placement instability, providing
opportunities to visit family and friends, and communicating with them regularly.
This not only helps with improving youth’s mental health and well-being but also
provides a group of individuals that support the youth and their permanency through
placement, guidance, and relationships.
264 10 Permanency in Child Welfare Practice

Child welfare professionals can also promote relationships with kin and fictive
kin to optimize permanency options and decisions. By promoting communication
and contact with kin, relationships develop further and can become options for
placement, deeper connections, and permanency for youth. One method to seek
out relatives is called Family Finding, where youth work with their caseworker to
identify family members and explore relationships with them. Child welfare pro-
fessionals can also promote guardianship as a permanency option vs. only view-
ing adoption as the optimal permanency option. Many youth would prefer not to
be adopted as a teenager or choose to have less formal arrangements in their
placement.
Systemically, the child welfare system can improve how they establish perma-
nency for youth. For example, child welfare agencies can work toward recruiting
more nonrelative foster and adoptive families for older youth. Older youth may
have different needs and have different skills and qualities to bring to that relation-
ship that should be highlighted. Agencies can specifically recruit a different demo-
graphic or group of foster parents who choose to foster older youth. Further,
educating the workforce and the public about the needs of older youth in foster
care, an opportunity to foster and adopt older youth, and about some of the ways
we have discussed how approaching permanency differs for older youth is a step
toward improving permanency for this subgroup in care. Child welfare agencies
can work toward evaluating policies that impact youth and work closely with per-
sonnel in the court system (e.g., judges, attorneys, CASAs, etc.) to determine best
practices when working with older youth and prioritizing relational and legal
permanency.

Family-Centered Practice

Family-centered practice in child welfare, as discussed in Chap. 6 at length, is a

theoretical framework that informs practice with families (Briar-Lawson et al.,
2001; Epley et al., 2010) and sets forth a set of principles guiding prevention, assess-
ment, and intervention with families identified at risk for child abuse and/or neglect.
Family-centered practice provides guidance during various stages of child welfare
practice that involves establishing a relationship and rapport with families, ensuring
safety, permanency, and well-being that prioritizes the family in terms of its strengths
and needs. Adopting a family-centered approach means focusing on the family unit,
engaging and preserving the family when possible, and drawing on the family’s
strengths and resources to assist with change.
Achieving Permanency 265

The permanency options and strategies

Practice Tip
discussed earlier are consistent with a
family-centered approach. When the fam- Talking to Youth in Care About
ily is prioritized, planning and decision-­ Permanency
making involves all family members, and
Begin planning early and keep con-
the professional-family relationship is
versation going
critical in creating healthy change.
Implementation of family-centered prac- Use words youth understand
tice is often cited as the foundation to Explain the meaning of adoption
child welfare agencies’ missions; how- and permanency
ever, family-­ centered practice is not Assess and be aware of your own
always infused into child welfare practice thoughts and attitudes
due to a variety of conflicting policies and
Keep in mind that the word “adop-
protocols, lack of training, and other orga-
tion” can be perceived as negative
nizational factors. In order for child wel-
fare professionals and the agencies they Support youth in understanding
work with to truly adopt a family-centered and exploring options
approach to practice in general and in Consider engaging family and
matters of permanency, a major shift will team members in planning
require federal and state policies, court Involve youth in their own recruit-
systems, and approaches to case manage- ment for caregivers
ment, and the provision of services will
Consider whether everyone has
have to be reinforced on multiple levels.
done everything they can to sup-
port permanency

Foster Care Re-entry

Foster care re-entry refers to the recurrence of child maltreatment after an earlier
episode of out-of-home care that resulted in reunification with biological family.
Federal mandates require that states track and report the percentage of children who
re-enter foster care within 12 months of reunification with their biological families.
Although varying, estimates for foster care re-entry show that 10–30% of children
will come back into contact with the child welfare system within 12 months of
reunification (U.S. DHHS, 2020; Wulczyn et al., 2000 Wulczyn et al., 2020). Risk
for re-entry is greater among infants and older youth (Wulczyn et al., 2020).
There are a number of child, parent, and environmental factors that increase the
risk of a child re-entering foster care following reunification with biological parents.
For example, child’s age (younger children, preteens, and teenagers) and the pres-
ence of a disability and educational, mental health, developmental, or behavioral
problems increase the risk of foster care re-entry as well as parental substance abuse
and mental health conditions (Lee et al., 2012). Further, factors such as receipt of
benefits and placement with relatives were associated with lower risk of re-entry
(Lee et al., 2012).
266 10 Permanency in Child Welfare Practice

Foster care re-entry is unpredictable, and many factors play a role in the likeli-
hood of its occurrence. Foster care re-entry can be extremely traumatic and harmful
for a child (Berrick et al., 1998; Rzepnicki, 1987). There are, however, some things
that child welfare professionals and child welfare agencies can do to reduce the
likelihood of foster care re-entry, such as ensuring proper family assessment, case
planning, and follow-up with families. Professionals can assess for parental readi-
ness and ambivalence about reunification while finding ways to increase engage-
ment and stability. Child welfare agencies can provide intensive services during the
reunification stage to support the transition home and ensure all of the families’
needs are being met.

Practice Highlight
Returning to Foster Care
As a child welfare professional, a big part of the job is helping a child achieve
permanency. While they are in care, they experience a lot of changes and often
feel confused and uncertain about what will happen next. People often think
of permanency as adoption, but permanency is really finding a permanent
home or placement. It is legal permanency – the court orders, but also rela-
tional permanency – the people and the relationships. This could be adoption
with a relative, a foster-adopt family, guardianship with a relative or fictive
kin, or reunification with one’s family of origin. The goal is not just finding a
good permanent placement for the child. It is fostering relationships that will
create the right circumstances for the placement to be permanent. That means
getting the right services in place before an adoption and making sure the
transition home is a healthy one.
One of the hardest things to see when working in child welfare is having a
child come back into foster care after going home after being reunited or hav-
ing an adoption or guardianship not work out. We can’t judge the caregiver’s
decision or choices that caused this to happen, but we see the hurt and disap-
pointment in the child’s eyes. These circumstances often leave a child feeling
shame, blame, hurt, confused, and at fault. There are many reasons this hap-
pens and these feelings often linger. The best we can do is get it right the first
time and be as supportive as possible during the transition. There are going to
be times when we can’t control the circumstances or the hurt. Recognizing the
impact of these events on children is critical, and reassuring them we will
work to make it better does make a difference.

Conclusion

Ensuring timely permanency for all children and families is critical in child welfare.
There are different options for permanency outcomes that vary depending on the
case, the child, and the family. The child welfare professional can promote
Conclusion 267

permanency by understanding the child and their needs and making sure the parents
have access to services to be able to achieve reunification. In cases where reunifica-
tion is not possible and when another option is appropriate for permanency, the
child welfare professional can use various strategies in helping a child and family
prepare for the transition.

Acknowledgments The authors thank Libby Fakier, MBA, for the contribution to Chap. 10.

Discussion Questions
1. What are the two most common permanency outcomes for children in care?
2. What is one federal policy that governs permanency for children in care?
3. What factors are considered in determining the best interests of the child?
4. What are two reasons to adopt a teen from foster care?
5. Under what circumstances should child welfare professionals consider guardian-
ship over adoption?
Suggested Activities
1. Research what your state is doing to promote permanency (reunification and
adoption). Think of 2–3 ways that your state and/or child welfare agency could
work towards better permanency outcomes in general, for youth, and for children
with special needs.
2. Make a list of agencies that recruit and train foster and adoptive parents in your
community. What are some services they provide? How could they improve the
number of children who need a permanent placement?
3. Read the investigative reporting coverage of “The Child Exchange” https://www.
reuters.com/investigates/adoption/#article/part1, and write a reflection paper.
Consider exploring how child welfare can learn from the failures of permanency
in the international adoptions presented in the report and what we need in society
to keep all children safe.
4. Read Austin et al. (2020). Consider the risk and protective factors presented
about Alaska Native/American Indian children and non-native children. Write a
reflection paper exploring how these factors could be considered in determining
permanency for the groups of children.
Austin, A. E., Gottfredson, N. C., Marshall, S. W., Halpern, C. T., Zolotor, A. J.,
Parrish, J. W., & Shanahan, M. E. (2020). Heterogeneity in risk and protection
among Alaska Native/American Indian and non-native children. Prevention
Science, 21(1), 86–97. https://doi.org/10.1007/s11121-­019-­01052-­y (Available:
https://rdcu.be/ccglr).

Additional Resources
Adopt US Kids: https://adoptuskids.org/
Annie E. Casey Foundation: https://www.aecf.org/
Child Welfare Information Gateway, Achieving and Maintaining Permanency:
https://www.childwelfare.gov/topics/permanency/
268 10 Permanency in Child Welfare Practice

Juvenile Law Center, What is “Permanency” and Why should you Care?: https://jlc.
org/news/what-­permanency-­and-­why-­should-­you-­care
Child Welfare Information Gateway, National Adoption Month: https://www.
childwelfare.gov/topics/adoption/nam/
National Center for Youth Law, Promoting Permanency for Teens: A 50 State
Review of Law and Policy: https://youthlaw.org/wp-­content/uploads/2018/02/
Promoting-­Permanency-­for-­Teens.pdf

References

Adopt Us Kids. (2020). Information. Available: https://www.adoptuskids.org/

Austin, A. E., Gottfredson, N. C., Marshall, S. W., Halpern, C. T., Zolotor, A. J., Parrish, J. W., &
Shanahan, M. E. (2020). Heterogeneity in risk and protection among Alaska Native/American
Indian and non-native children. Prevention Science, 21(1), 86–97. https://doi.org/10.1007/
s11121-­019-­01052-­y
Berrick, J. D., Needell, B., Barth, R. P., & Jonson-Reid, M. (1998). The tender years: Toward devel-
opmentally sensitive child welfare services for very young children. Oxford University Press.
Briar-Lawson, K., Lawson, H. A., Hennon, C., & Jones, A. (2001). The meaning and signifi-
cance of families and threats to their well-being. In Family-centered policies and practices
(pp. 21–24). Columbia University. https://doi.org/10.7312/bria12106-­003
Connell, C. M., Katz, K. H., Saunders, L., & Tebes, J. K. (2006). Leaving foster care-the influence
of child and case characteristics on foster care exit rates. Children and Youth Services Review,
28(7), 780–798. https://doi.org/10.1016/j.childyouth.2005.08.007
Courtney, M. E. (1994). Factors associated with the reunification of foster children with their fami-
lies. Social Service Review, 68(1), 81–108. https://doi.org/10.1086/604034
Courtney, M. E., & Wong, Y. L. I. (1996). Comparing the timing of exits from substitute care. Children
and Youth Services Review, 18(4–5), 307–334. https://doi.org/10.1016/0190-­7409(96)00008-­4
Davis, I. P., Landsverk, J., Newton, R., & Ganger, W. (1996). Parental visiting and foster
care reunification. Children and Youth Services Review, 18(4–5), 363–382. https://doi.
org/10.1016/0190-­7409(96)00010-­2
Epley, P., Summers, J. A., & Turnbull, A. (2010). Characteristics and trends in family-­
centered conceptualizations. Journal of Family Social Work, 13(3), 269–285. https://doi.
org/10.1080/10522150903514017
Fisher, P. A., Mannering, A. M., Van Scoyoc, A., & Graham, A. M. (2013). A translational neuro-
science perspective on the importance of reducing placement instability among foster children.
Child Welfare, 92(5), 9.
Hu, A., Van Ryzin, M. J., Schweer-Collins, M. L., & Leve, L. D. (2020). Peer relations and delin-
quency among girls in foster care following a skill-building preventive intervention. Child
Maltreatment, 26(2), 205–215. https://doi.org/10.1177/1077559520923033
Katz, C. C., Lalayants, M., & Phillips, J. D. (2018). The role of out-of-home caregivers in the
achievement of child welfare permanency. Children and Youth Services Review, 94, 65–71.
https://doi.org/10.1016/j.childyouth.2018.09.016
Lee, S., Jonson-Reid, M., & Drake, B. (2012). Foster care re-entry: Exploring the role of foster
care characteristics, in-home child welfare services and cross-sector services. Children and
Youth Services Review, 34(9), 1825–1833. https://doi.org/10.1016/j.childyouth.2012.05.007
McGuire, A., Cho, B., Huffhines, L., Gusler, S., Brown, S., & Jackson, Y. (2018). The relation
between dimensions of maltreatment, placement instability, and mental health among youth
in foster care. Child Abuse & Neglect, 86, 10–21. https://doi.org/10.1016/j.chiabu.2018.08.012
References 269

Orsi, R., Lee, C., Winokur, M., & Pearson, A. (2018). Who's been served and how? Permanency
outcomes for children and youth involved in child welfare and youth corrections. Youth Violence
and Juvenile Justice, 16(1), 3–17. https://doi.org/10.1177/1541204017721614
Risley-Curtiss, C., Stromwall, L. K., Hunt, D. T., & Teska, J. (2004). Identifying and reducing bar-
riers to reunification for seriously mentally ill parents involved in child welfare cases. Families
in Society, 85(1), 107–118. https://doi.org/10.1606/1044-­3894.240
Romney, S. C., Litrownik, A. J., Newton, R. R., & Lau, A. (2006). The relationship between child
disability and living arrangement in child welfare. Child Welfare, 85(6), 965–984.
Ryan, J. P., Garnier, P., Zyphur, M., & Zhai, F. (2006). Investigating the effects of caseworker
characteristics in child welfare. Children and Youth Services Review, 28(9), 993–1006. https://
doi.org/10.1016/j.childyouth.2005.10.013
Rzepnicki, T. L. (1987). Recidivism of foster children returned to their own homes: A review and new
directions for research. Social Service Review, 61(1), 56–70. https://doi.org/10.1086/644418
Salazar, A. M., Jones, K. R., Amemiya, J., Cherry, A., Brown, E. C., Catalano, R. F., & Monahan,
K. C. (2018). Defining and achieving permanency among older youth in foster care. Children
and Youth Services Review, 87, 9–16. https://doi.org/10.1016/j.childyouth.2018.02.006
Snowden, J., Leon, S., & Sieracki, J. (2008). Predictors of children in foster care being adopted:
A classification tree analysis. Children and Youth Services Review, 30(11), 1318–1327. https://
doi.org/10.1016/j.childyouth.2008.03.014
U.S. Department of Health & Human Services (2020). The AFSCARS report. https://www.acf.hhs.
gov/sites/default/files/cb/afcarsreport27.pdf
Wulczyn, F., Hislop, K. B., & Goerge, R. M. (2000). Foster care dynamics 1983–1998. Chapin
Hall Center for Children.
Wulczyn, F., Parolini, A., Schmits, F., Magruder, J., & Webster, D. (2020). Returning to foster
care: Age and other risk factors. Children and Youth Services Review, 116, 105166. https://doi.
org/10.1016/j.childyouth.2020.105166
Chapter 11
Special Populations in Child Welfare
Practice

Introduction

There are a number of groups within child welfare that may require a different
approach or specialized knowledge, training, or experience to work with effec-
tively. One subgroup is children and youth with disabilities involved with the child
welfare system. They may differ greatly when compared to other youth in care.
Assessment, services, and permanency may affect children with physical or other
disabilities as well as children with complex medical needs differently than other
children. Another group that has unique needs are youth aging out or youth who
have transitioned from care and have chosen to participate in extended foster pro-
gramming. They are a subgroup within child welfare that require a special skill set
and who also may receive specialized services and supports as youth in care.
Immigrant and refugee children and families are another unique group who come
in contact with the child welfare system. There are several differences in how child
welfare professionals work with children and families who are refugees or immi-
grants, which can vary based on the state we live it, the culture and nationality of
the family child welfare professionals work with, and the needs of the family. Child
welfare professionals also may find that working with sibling groups requires a
different approach and additional skills. Another group in child welfare that
requires special skills and approach is children who have been involved in human
and sex trafficking. Within any of these groups, there is going to be great variation,
and each child and family should be seen as individuals; yet child welfare profes-
sionals understanding commonalities within a subgroup can facilitate a more effi-
cient and appropriate response.

© Springer Nature Switzerland AG 2021 271

J. M. Geiger, L. Schelbe, The Handbook on Child Welfare Practice,
https://doi.org/10.1007/978-3-030-73912-6_11
272 11 Special Populations in Child Welfare Practice

Children and Youth with Disabilities and Special Needs

Children with disabilities are a subset of vulnerable children involved with the child
welfare system. It is estimated that one out of 10 children nationwide and half of the
children in the social service system has a physical, mental, emotional, or develop-
mental disability and that half of the children within our country’s social service
system (Lightfoot et al., 2011). Disabilities are defined as temporary or permanent
physical or intellectual disabilities present at birth or acquired later. It is estimated
that approximately 50 percent of the 50,000 children available for adoption in the
United States have a disability and half of all foster children have developmental
delays (Glidden, 2000). Child welfare professionals are in critical positions to rec-
ognize the signs of developmental delays, to ensure proper referrals for evaluation,
and to help families access related services. It is important for child welfare profes-
sionals to have an understanding of the definitions of such disabilities and how
specific state and federal statutes treat such a disability or condition with regard to
services, case planning, and court proceedings. Child welfare professionals should
be prepared to identify and assess for such conditions and refer and monitor services
to address those challenges. Interactions, such as interviewing, visiting, meeting,
with children with disabilities may also differ, and caseworkers should be adaptable
and flexible to such accommodations. They also could benefit from training on how
to develop working relationships with agencies that provide early intervention and
special education services. Partnering with these agencies and other professionals is
important due to their expertise in assessment for children with specific needs. For
example, children diagnosed with autism spectrum disorders may have symptoms
that are overlapping with trauma symptoms; thus having the ability to differentiate
and develop a treatment plan will require professionals with advanced training (Van
Scoyoc et al., 2018).
Children with disabilities are more likely to experience maltreatment and have
substantiated maltreatment cases than children without a disability. Further, chil-
dren with emotional and behavioral disorders and children with developmental dis-
abilities are more likely than those with other types of disabilities (Jonson-Reid
et al., 2004; Lightfoot et al., 2011). Children with disabilities are more likely to
experience neglect than other types of maltreatment, with neglect being related to
their disability (e.g., withholding medication or necessary device or equipment).
Especially in the cases where there is a child experiencing developmental delays
or disabilities, it is important to understand ways to support children and their fami-
lies at various stages of a case to be able to provide early, appropriate, and consistent
services. (See Chap. 3 for an in-depth discussion of child development; it identified
indicators of developmental delays and disabilities and described how to ensure
proper assessment and service provision.) Services designed for children with dis-
abilities and their families often involve a number of individuals, stages, and a series
of approvals as well as insurance coverage. Services should always be culturally
grounded, trauma-informed, and family-centered. That means that support should
be offered within the context of the family and the community in which they live.
Children and Youth with Disabilities and Special Needs 273

Families (biological and substitute parents) are often a key part in supports and
services designed for children with disabilities.
It is important to consider the impact of a child’s disability on a family through-
out a case. For example, during the investigation stage, parents and families may
experience difficulty in balancing the demands of caring for a child with disabilities.
There are often financial, social, emotional, and physical barriers to optimal care for
a child with disabilities. This may lead to increased stress on the parent and family,
which increases the risk for child maltreatment. Families often report feeling
socially isolated, overburdened, and overwhelmed by the demands associated with
the care and coordination of a child with disabilities. It is also important to note that
disability and its cases are perceived differently among different socioeconomic,
ethnic, racial, and organizational cultures and these groups and systems respond
differently to acceptance and provision of support and services for families caring
for children with disabilities. When a child with disabilities enters foster care, there
may be different plans and provisions for ensuring their safety, permanency, and
well-being. Further, children with disabilities may require specialized placement,
care, and supervision.
Child welfare professionals can help to support biological families and substitute
caregivers by understanding the child’s disability and needs, help to identify
strengths, set realistic expectations for the case plan, support a healthy environment
for the child, and act as a liaison between the foster family and biological family to
ensure both are aware of the care provided and to promote family reunification and
permanency.
It is essential that the child welfare
Practice Highlight
professional integrate multiple service
providers and representatives from vari- The Role of the Child Welfare
ous systems to participate in child and Professional when Working with
family team meetings and communicate Children with Disabilities and
regularly with those parties to ensure their Family
the child’s needs are being met. Child
• Conduct a comprehensive assess-
welfare professionals should be in
ment of the child and family
touch regularly with any speech, occu-
• Identify, coordinate, and monitor
pational, or physical therapists, mental
services for the child and family
health professionals, physical health-
• Identify the child and family’s
care providers, and in-home supports.
strengths and resources
In addition, it is likely the child requires
• Advocate for the child and family
an individual educational plan (IEP)
• Assist families to identify services
and supports at school, which child
and supports in their community
welfare professionals will be required
to be a part. As child welfare profes-
sionals learn more about the child’s disabilities and needs, they are able to respond in
a way that facilitates communication, comfort, and understanding. When interacting
with the child, it is important to understand how they communicate, what they are and
are not able to physically do, and what their daily living looks like. Communicating
and interacting with the child directly shows care, respect, and concern for their
well-being.
274 11 Special Populations in Child Welfare Practice

When children with disabilities who are involved with the child welfare system
are in the home with biological parents or are ready to be reunified with their family,
it is important to promote continuity of care and supports to ensure stability and
permanency for the child. In order to do this, professionals working with the family
should involve the family in treatment, promote family interaction, provide educa-
tion about the child’s needs, increase involvement of extended family and the family
network as appropriate, and help the family in accessing supports in the community.

Achieving Permanency for Children with Disabilities

Achieving permanency for children with disabilities can be challenging. Children

with disabilities often have greater needs and require additional time and services,
which may include additional costs or investments on behalf of the caregiver.
Caregivers may need to have additional training, resources, or equipment. However,
many foster and adoptive parents are willing and able to provide a long-term place-
ment for children with disabilities. States and child welfare agencies have been
working towards providing additional training, support, and resources to ensure per-
manency for children with disabilities.
Not all children and cases are alike. Cases involving children with disabilities
require additional practice competencies among child welfare professionals. When
working with children with disabilities in foster care, child welfare professionals
should be prepared to identify and coordinate specialized care as recommended by
professionals. Children may need specialized medical care, developmental assess-
ments, special education and supports, psychological or psychiatric services, finan-
cial assistance, and recreational programming. These may be services the child
welfare agency is already contracted with to provide services; however, it may be
that the child’s caseworker must find an appropriate service provider to meet the
needs of the child and/or their caregiver. These services should be assessed for and
monitored throughout the case, including at the time of adoption.
Disabilities include mental, emotional, intellectual, and behavioral health chal-
lenges as well. Child welfare professionals should be prepared to identify and assess
for such conditions and refer and monitor services to address those challenges.
Interactions, such as interviewing, visiting, and meeting with children with disabili-
ties, may also differ, and caseworkers should be adaptable and flexible to such
accommodations.

LGBTQ Youth

Lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ) youth are over-
represented in the child welfare system. An estimated 15.5% of all child welfare
system involved youth ages 11 or older identified as lesbian, gay, or bisexual
LGBTQ Youth 275

(Dettlaff et al., 2018). Lesbian and bisexual females as well as LGB youth of color
are overrepresented in the child welfare system. An analysis of a nationally repre-
sentative sample of children and youth found LGBTQ youth are almost 2.5 times
likely as their heterosexual peers to be in foster care and are overrepresented in
receiving child welfare services (Fish et al., 2019). One study of children and youth
in foster care in Los Angeles found almost one-fifth (10%) identify as LGBTQ
(Wilson et al., 2014).
The reasons that LGBTQ youth enter the child welfare system are varied, yet
most of the reasons are similar to the reasons their heterosexual and cisgender peers
become involved in the child welfare system. The sexual orientation, gender iden-
tity, or gender expression of LGBTQ youth may be one of the reasons they entered
care. One study found more than two in five LGBTQ youth (44%) attributed their
sexual orientation or gender identity as being related to the reason they were placed
in out-­of-­home care (Ryan et al., 2009). These youth could have been maltreated by
family due to the youth’s identity or orientation by either being rejected or physi-
cally abused. The youth may have run away from their homes due to safety concerns.
Within the child welfare system, LGBTQ youth may experience problems with
permanency and continued violence. LGBTQ youth have been found to have lower
rates of permanency. LGBTQ youth experience have been found to have more
movement among placements (Wilson et al., 2014). LGBTQ youth are more likely
than their heterosexual peers to age out of the child welfare system (Courtney et al.,
2010). There are higher rates of LGBTQ youth running away from placements.
Many LGBTQ experience verbal harassment or physical violence when they are in
foster care.
In many regards working with LGBTQ youth is like working with any other
youth involved with the child welfare system. Their needs for safety, permanency,
and well-being are the same as other youths’ needs. However, their experiences as
an LGBTQ youth may also have created circumstances different than their hetero-
sexual peers in foster care (e.g., reasons for entering care, trauma due to abuse
related to being LGBTQ). They may be facing homophobia and heterosexism and
dealing with issues related to coming out. LGBTQ youth should be accepted for
who they are, and they should be supported in their self-expression. There have been
innovated initiatives such as the RISE Care Coordination Team that specifically
integrate LGBTQ-specific education and support strategies to assist youth in care
(Lorthridge et al., 2018). The Child Welfare League of America has practice recom-
mendations for serving LGBT youth in out-of-home care which encourages child
welfare agencies to adopt nondiscrimination policies and make sure to have proto-
cols that address the needs of LGBT youth (Wilber et al., 2006).
Child welfare professionals have the obligation to understand how best to serve
LGBTQ youth. This begins by adopting a stance where discrimination of any type,
including homophobia and heterosexism, is not tolerated. LGBTQ youth notice
when adults in their lives either use or do not address homophobic statements or
name-calling. It is important for child welfare professionals to create a safe space
for LGBTQ youth and communicate that they are affirming of people of all sexual
orientations, gender identities, and gender expressions. To communicate this, child
276 11 Special Populations in Child Welfare Practice

welfare professionals may display “hate-free zones” or signs that denote a safe
space such as rainbow flags in their workspace. More importantly, child welfare
professionals can signal that they are accepting by using inclusive language and not
making assumptions. For example, when asking about romantic relationships, use
gender-neutral language and do not assume that the relationship is heterosexual.
Child welfare professionals can ask “are you dating someone?” rather than “do you
have a boyfriend/girlfriend?” It is important that child welfare professionals use the
youth’s requested name and pronouns, even when these may be different than what
parents or others have used. When working with LGBTQ youth, child wel-
fare professionals should refer to services that serving people from diverse sexual
orientations and gender identities. Some LGBTQ youth may wish for services
where they can explore their sexual orientation, gender identify, and gender expres-
sion. This could be in school with a gay-straight alliance group, a community center
for LGBTQ people, or a therapist. It is important for child welfare professionals to
be able to identify these appropriate resources. Above all, conversation therapy or
any other intervention that seeks to change someone’s sexual orientation or gender
identity should never be used, as these interventions have been found to be extremely
harmful (SAMHSA, 2015).

Research Brief
Pregnant and Parenting Foster Youth
Justin S. Harty, MSW, LCSW
Youth in foster care often have life experiences that increase the likelihood of
them becoming pregnant (or for males getting a female pregnant). Furthermore,
young parenthood among youth in foster care is difficult and may lead to
adverse outcomes and conditions that make their transition to adulthood
difficult.
Research has found several factors associated with early pregnancy among
foster youth. Risk factors increasing the likelihood of early pregnancy among
foster youth include being maltreated, experiencing trauma, early sexual
intercourse, running away from placement, and low social supports. Sexual
health education, family planning education, access to contraception, and
having social connections with adults are some protective factors associated
with lower probabilities of early pregnancy among this population.
The stress and struggles of parenting while in foster care are compounded
by difficulties that foster youth in general experience such as victimization,
behavioral problems, mental health issues, low educational attainment,
employment difficulties, and housing instability. These added stressors may
explain risks associated with early parenthood among youth in care such as
lower educational attainment, decreased employment, homelessness,
increased reliance on public assistance, and increased risk for maltreatment
and child welfare involvement of their children.
Youth Aging Out/Transition-Age Youth 277

Early pregnancy and parenthood among foster care youth are further com-
plicated by three concurrent transitions they must face as they reach the age of
majority. First, these youth are approaching an age where they must exit the
foster care system and lose related care and support. Second, these youth must
prepare for a transition to adulthood at an early age and without the prepared-
ness and supports their non-foster care peers often have. Third, they have the
added stressor of being a young parent, often without the support, preparation,
and resources to be the kind of parent they desire to be.
There are strategies that child welfare practitioners can use to help prepare
and support pregnant and parenting foster youth for young parenthood,
including the following:
• Understanding the risk and protective factors associated with early preg-
nancy and parenthood and target prevention and services accordingly
• Knowing that not all pregnancies are unintentional and talking to youth
about their desire to become pregnant as well as their reproductive rights
• For pregnancies that do not lead to childbirth, talking to parents about child
loss and monitoring how the loss of a child may affect youth
• Talking to young parents about pre-/postnatal health, pediatric child health,
and safe and appropriate childcare
• Discussing services and supports for youth designed to increase parenting
skills, knowledge, and resources (including extended foster care if
available)
• Understanding how young parenthood may affect youths’ ability to meet
requirements of extended foster care (if available)
• Connecting youth with financial, emotional, mental health, social, and par-
enting support that will help improve parent- and child-related outcomes
• Allowing youth to participate in normative activities that will help them
develop as young parents
• Considering that the needs of fathers in care differ from mothers in care
and tailor services for fathers appropriately

Youth Aging Out/Transition-Age Youth

Nationally, there are an estimated 400,000 children in the foster care system as a
result of child maltreatment, with 28% between the ages of 12 and 18 (US DHHS,
2020). In the United States each year, it is estimated that about 20,000 youth “age
out” of the foster care system when they are no longer eligible for services because
of their age or reach the age of majority and decide to leave care. Youth transitioning
into adulthood from the foster care system experience significant difficulties in
adjusting to independent living. They also have overall poorer outcomes related to
psychosocial adjustment, physical and mental health, financial stability, and early
278 11 Special Populations in Child Welfare Practice

childbearing and pregnancy in addition to low educational attainment, homeless-

ness, and poverty than children who have never been in foster care (e.g., Courtney
et al., 2010). The heterogeneity among youth aging out means that there is a need
for individualized transition planning and services offered (Miller et al., 2017).
The transition to adulthood is a period in life of particular heightened stress and
uncertainty that includes critical decision-making related to relationships and career.
This time is generally more difficult for youth in care because of their experiences
involving traumatic events, emotional and social instability, and the lack of prepara-
tion for the transition. In addition, youth in care are expected to make this transition
sooner, more quickly, and without parental support (Antle, et al., 2009; Sullivan,
et al., 2010). Youth in care may not be engaged in school and experience educational
difficulties (Mihalec-Adkins & Cooley, 2020). They graduate from high school at a
lower rate and often lack the life skills, work experience, and the emotional and
financial support other youth have (Dworsky & Perez, 2010; Greeson & Bowen,
2008). Youth in care often lose their housing, health insurance, and financial assis-
tance upon reaching the age of eighteen (Antle et al., 2009). During this time, many
youth in care are embracing the freedom they did not have while in state care and
struggle with the responsibilities associated with this newfound independence.
Youth in care are often ill-prepared to live on their own and to financially support
themselves and are less likely to pursue postsecondary education (Courtney et al.,
2010). Many are unemployed, become homeless within months of “aging out” of
the foster care system, and experience mental health and substance abuse issues.
Youth in care may have difficulty achieving financial stability as a result of low
educational attainment, lack of employment, and overall independent living skill
preparation. Despite research indicating postsecondary aspirations of youth in care,
it is estimated that 7–13% of youth enroll in higher education, with approximately
3–5% of young adults with foster care histories going on to earn a bachelor’s degree
compared with a third of the general population (Courtney et al., 2010). The known
financial and social benefits of postsecondary education are well documented; how-
ever there are few programs promoting education among youth in care in the United
States (Dworsky & Perez, 2010; Geiger et al., 2018). Without education and ade-
quate preparation to live independently, foster youth are at risk of living in poverty.
Youth in foster care have similar and very distinct needs from their same-aged
peers who are not in foster care. They share many of the same developmental pro-
cesses and want to be part of a family and have friends and romantic relationships.
They want to experience normal adolescent experiences that their peers who are not
in care have, such as dating, having a job, going to camp, and obtaining a driver’s
license. Being in care, however, can also create barriers to having these experiences.
For example, some child welfare policies do not allow for youth to have sleepovers
with friends, have a job, or drive a car. Child welfare professionals can play a key
role in easing the transition to adulthood through early, consistent, and intentional
development and implementation of case planning, setting goals, and service provi-
sion. They can also consider ways they can promote “normal” adolescent experi-
ences for youth in care. Service provision during adolescence for youth in care can
help them be ready for adulthood responsibilities; however, ensuring youth have
Youth Aging Out/Transition-Age Youth 279

long-term, supportive relationships is

Practice Tip
even more critical to ensure that youth
have people in their lives they can Ways to Help Youth with Transition
count on to support them and serve as a to Adulthood
safety net of sorts when they need them.
• Help to build supportive relation-
Federal law requires that the child
ships and connections.
welfare agency assist the youth in
• Help youth to manage money.
developing a personalized transition
• Encourage and support youth in
plan during the 90-day period before a
pursuing educational and voca-
youth turns 18 or is scheduled to leave
tional opportunities.
foster care; however it is recommended
• Provide opportunities for youth to
that this planning occurs as early as
find and maintain employment.
possible to ensure referrals and services
• Help youth secure safe and afford-
are in place when a youth turns 18. The
able housing.
plan must address specific options
•  Support youth in maintaining
related to housing, education, employ-
physical and mental health
ment, health insurance, mentoring, and
wellness.
support services. To develop the plan,
• Help youth in exploring identity
the youth’s caseworker will typically
and culture.
meet with the youth as well as other
trusted adults of the youth’s choosing,
which may include a foster parent or another supportive adult. While the law refers to
a 90-day period, most youth will benefit from more time to prepare.

Research Brief
The Risk of Suicidal Behavior for Transition-­Age Youth in Foster Care
Colleen Cary Katz, PhD, LCSW
Youth who are preparing to emancipate from foster care are more likely than
their peers in the general population to report suicidal ideation and attempt
(Courtney et al., 2014). In a recent study of youth emancipating from care in
California, over 40% of the participating youth reported having contemplated
suicide and 24% reported having attempted suicide when they were asked at
age 17 (Courtney et al., 2014). Rates appear to be even higher for female-
identified participants, with 51% reporting past ideation and 30% reporting at
least one past suicide attempt. These rates are alarming, especially in light of
the fact that mental health service utilization tends to drop as youth formally
emancipate from the system (Brown et al., 2015; Butterworth et al., 2017).
High rates of suicidal behavior are likely a result of interacting risk factors
present in the lives of these youth. First, nearly all youth in the foster care sys-
tem have a history of child maltreatment (U.S. DHHS, 2020), with many
reporting more than one form (Havlicek, 2014; Katz et al., 2017). Youth who
have a history of child maltreatment are known to be at enhanced risk for sui-
cidal behavior, especially those youth with experiences of sexual maltreatment
280 11 Special Populations in Child Welfare Practice

(Norman et al., 2012; Ullman & Najdowski, 2009). This finding may relate to
the high rates of ideation and attempt in girls, as they are more likely than boys
to report past sexual maltreatment (Courtney et al., 2014). Second, relatedly,
studies have shown that one third to one half of all youth preparing to emanci-
pate from care have a mental health or behavioral health disorder, with major
depression and substance abuse being two of the most common (McMillen
et al., 2005; Courtney et al., 2016). Mental illness is the most robust predictor
of suicidal behavior in the general population, with both depressive disorders
and substance abuse disorders placing youth at particularly heightened risk
(Cash & Bridge, 2009). Third, the transition from foster care is known to be
extremely stressful, particularly if youth have inadequate social support to call
upon when challenges arise (Iglehart & Becerra, 2002; Cunningham & Diversi,
2013; Samuels, 2008). Both stress and lack of social support are known risk
factors for suicidal behavior (Zhang et al., 2012; Kleinman & Liu, 2013).
Despite these known risks, most youth who are preparing to transition
from foster care are not routinely or systematically assessed for mental illness
and suicidal behavior. While some youth may be known to child welfare staff
as high risk, suicidal behavior in others may go undetected (especially when
youth are high-­functioning in other areas of their lives). Frontline child wel-
fare caseworkers and independent living program staff members can access
evidence-supported assessment tools that could enable the timely detection of
suicidal behavior in the youth they are serving. Tools such as the Columbia
Suicide Severity Rating Scale (Posner et al., 2011), the Suicide Behaviors
Questionnaire-Revised (Osman et al., 2001), and the Adolescent Suicide
Questionnaire (Horowitz et al., 2012) are some of the most appropriate assess-
ment tools for use with youth preparing to emancipate from care. Child wel-
fare professionals can save lives by referring these youth to appropriate mental
health treatment once risk for suicidal behavior has been detected.

Transition planning is a process and requires thought, support, and guidance. A

transition plan should include long- and short-term goals and objectives that the
youth, caseworker, and provider can work toward. Transition plans should also
include important documents (e.g., birth certificate, social security card, state ID or
driver’s license, health insurance information, and medical records). As with all
matters concerning the youth, they should be engaged in the planning and execution
of the transition plan. This can often be challenging, as with all youth, in consider-
ing options, making decisions about the future, and following through with plans.

Supporting Youth During the Transition

There are a number of ways that child welfare professionals can assist young people
with the transition into adulthood. First, it is critical that they help youth to establish
and build supportive relationships and connections with caring adults, family, and
Youth Aging Out/Transition-Age Youth 281

friends. When youth experience the grief and loss of being separated from their
family, friends, and community, many have not had the opportunity to develop the
social skills necessary that comes with safety and stability. A child welfare profes-
sional can ask youth to identify one reliable, caring adult in their life such as a
teacher, coach, foster parent, or another person and help them make that connection
through support and opportunities for connection. Many youth will benefit from a
mentor, extra time with a family member, joining a group or team, or being involved
with CASA or Big Brothers, Big Sisters. Many youth will return to their biological
families upon their 18th birthday, so it is important to explore ways that youth can
improve family relationships with the support of therapy or extended visitation
while they are still in care. Case managers can have conversations about romantic
relationships and have discussions about healthy relationships, sex, and plans for
the future. Some youth transitioning out of foster care may be parenting, and the
needs of the young family should be taken into consideration (Eastman et al., 2017).
Many young people struggle with managing money as they transition into adult-
hood and face challenges related to making ends meet, paying bills, and accessing
financial support. Child welfare professionals can refer youth to programming that
offers firsthand experience along with instruction on how to save, balance a check-
ing account, invest, and make good choices with money. They can also use moments
in conversations to talk about smart shopping, paying bills, and what credit is, estab-
lishing credit, and using credit. Additionally, child welfare professionals can help
youth open bank accounts before they age out and help them to develop a budget in
real time and when planning for the future.
Postsecondary education and training promote social mobility, especially for
many marginalized populations and vulnerable groups. There are a number of finan-
cial, academic, and social supports available for youth to attend postsecondary edu-
cational programs; however, many youth face barriers while in high school related
to being adequately prepared and meeting the institutional criteria (e.g., testing,
grade point averages, application fees, etc.) as well as submitting materials on time.
In the past two decades, several federal laws have focused on supporting older
foster youth in their transition to adulthood and creating opportunities to access
postsecondary education, training, and employment. The most comprehensive leg-
islation, first passed in 1999 and amended several times since, is the Foster Care
Independence Act (FCIA). The FCIA allocates $140 million per year to states to
offer independent living skills to youth in care. FCIA was amended in 2001 to create
a separate program that funds up to $5000 per year in the form of education and
training vouchers (ETV) for postsecondary education and training. Although states
have discretion with age limits, youth who were in care on or after their 16th birth-
day can receive an ETV up to the age of 23 (and now up to age 26 under a 2018
federal law). Additionally, almost half of US states offer some form of a tuition and
fee waiver program for postsecondary education and training for youth formerly in
foster care (Hernandez et al., 2017); however, very little is known about waiver
utilization among students across states or the impact of tuition and fee waivers on
postsecondary education and employment outcomes. The Fostering Connections to
Success and Increasing Adoptions Act (2008) was a monumental law that provides
282 11 Special Populations in Child Welfare Practice

federal reimbursements for states to extend the foster care age limit beyond age 18
and up to the age of 21.
Child welfare professionals can connect youth with educational and vocational
opportunities by ensuring they are adequately prepared, aware of their options, and
provide the space for them to make decisions before and after high school. Specifically,
child welfare professionals can talk with youth about their goals, interests, and talents
and present them with options that might be a good fit. They can work with youth to
organize documents and other materials they might need for applications and inter-
views (e.g., identification, school records and transcripts, application fees, etc.) and
connect youth with a wide array of individuals who can give information or mentor
them while also showing them their options through campus visits, talking to counsel-
ors, admissions, and financial aid offices. Further, child welfare professionals can
provide youth with information about financial aid options. Many youth do not pursue
postsecondary education and training because they think they cannot afford it; how-
ever, if done responsibly they can access a wide variety of financial aid through schol-
arships, waivers, student loans, and other programs. Finally, child welfare professionals
must begin the discussion about the importance of education and employment early
and create a norm of attending college or obtaining a certificate. In addition, when
youth make the decision that is right for them, support them, check in on them, and
provide guidance in accessing supports and community while they are enrolled.
Related, youth should be aware of what employment opportunities are available to
them during and after high school. Research shows that youth who have early employ-
ment and internship opportunities have better economic and social outcomes
(Dworsky, 2005; Goerge et al., 2002; Stewart et al., 2014). After high school, many
youth struggle to find part-time and full-time employment and often earn lower wages
than young people who haven’t experienced foster care. Child welfare professionals
can play a role in promoting employment by helping them to explore different job
options, career paths, and what the requirements might be (degrees, licensures, expe-
rience, etc.) and accompanying them to job fairs. Child welfare professionals can sit
down and help them develop a resume and cover letter and help them identify outlets
to find jobs. They can give youth opportunities to gain experience through intern-
ships, volunteering, and job shadowing. Finally, child welfare professionals can find
ways to include youth in networking events or opportunities to meet potential
employers.
Obtaining safe and stable housing during the transition to adulthood is particu-
larly challenging for many youth in care. While many young people who have not
experienced foster care stay in their parents’ home well after the age of 18, many
youth in care do not have that option. They struggle with the costs of education,
employment, and housing expenses, without experiencing short- and long-term
homelessness after leaving care. Funding for housing is sometimes available
through federal and state funds (e.g., Section 8, public housing, etc.) and child wel-
fare funds (i.e., Chafee, ETV); however, there are often restrictions, regulations, and
other issues that create barriers for youth formerly in care to access these benefits
and supports. As a child welfare professional, we can ensure that housing is a criti-
cal part of the transition plan developed with youth and ensure all applications and
Youth Aging Out/Transition-Age Youth 283

outlets for housing supports are in place early and the youth is aware of what these
options are for them. Child welfare professionals can spend time identifying safe
and affordable housing with youth and discussing their responsibilities as a renter
(e.g., rent, repairs, rules, etc.). Also, workers can help youth to identify a plan should
they need assistance or need alternate housing arrangements in case of an emer-
gency. They can serve as a safety net and help youth address barriers in obtaining
stable and safe housing.
Youth aging out of foster care are at a greater risk for health and mental health
issues (Courtney et al., 2011). Some receive regular treatment and care for chronic
illnesses prior to leaving care, and their coverage and services may change when
they turn 18. Child welfare professionals can support youth in ensuring a smooth
transition with physical and mental health coverage, services, and supports prior to
leaving care. This includes ensuring appointments, providers, and prescriptions are
in order. While in care, youth should be educated and supported in engaging in a
healthy diet and exercise, and child welfare professionals and caregivers can have
discussions about mental and physical health and well-being. Further, child welfare
professionals can help with gathering medical records, lists of providers, and insur-
ance options and discuss managing health and well-being as an adult.
Youth in care are at a developmental phase where they are exploring their own
identity and establishing a sense of self. With their experiences of foster care, it is
common for them to have questions about their family, their identity, and their
desire to understand the meaning of family and their background. There are ways to
support healthy identity development for youth, such as helping them create a life-
book or account of their family, personal history, key events, and photos; supporting
them in their efforts to seek out culture and spirituality through activities, discus-
sions, and experiences; and helping them to collect and safely organize their belong-
ings and important documents.
Adolescents in foster care may have a different experience as they transition into
adulthood than young people who have not been in care. As child welfare profes-
sionals, we are in a position to be a support, provide guidance, ensure a healthy
transition through programs, provide information, and be available to youth during
this process. It is also our responsibility to assist youth with developing a transition
plan that will fit their needs and help them achieve independence and stability.

Note from the Field

The Importance of Unconditional Support
Kizzy Lopez, EdD
My life as a child and young adult was challenging and full of trauma. When
I was 11 years old, my sisters and I were placed into foster care. At 18, I was
homeless for the first 3 months of being enrolled in community college.
Today, I have a beautiful family of my own, I have earned advanced degrees,

(continued)
284 11 Special Populations in Child Welfare Practice

and I have a successful career in education. Based on the statistics, though,

my life should have looked very different. I am often asked how was I able to
succeed given all of the challenges I faced.
There are many factors that contributed to my successful outcomes, but, in
my opinion, the most important factor was my relationship with my sisters.
My sisters provided me with my first experience of unconditional love and a
trusting relationship. The connection with my sisters was critical in my ability
to cope and survive the trauma. Fortunately, we were together during most of
our time in foster care, which was a tremendous protective factor. Knowing
the value of a healthy, permanent connection would give me a deep under-
standing of its importance in my relationships while shaping the way I served
youth in the future.
Twenty-five years later, I went on to coordinate a program for students who
experienced foster care or homelessness at the university. These lessons of
unconditional love and support stayed with me. One example is Trey,1 a stu-
dent who transferred from a local community college, who had been living in
his car with his partner and was primarily surviving off of financial aid. Trey
had to travel almost an hour, one way, just to get to school.
I informed Trey that he could live on campus and the program would cover
the cost for the first semester until we were able to develop a plan for him to
move into an apartment. Trey asked if his partner could live on campus with
him. Unfortunately, due to the campus restrictions, his partner was unable to
stay on campus with him. Trey’s relationship with his partner was critical to
his emotional well-being and he was not willing to be without her. He
explained that they had been living in a car for about a year and they found a
way to make it work. I told Trey that I completely understood how important
this person was to him. Instead of trying to convince him to stay on campus, I
asked, “What support would be helpful to you?” He said gas cards to cover his
travel costs and gift cards for food would give them some immediate relief.
He also mentioned that assisting him with finding a job and an apartment
would be helpful. This was something I could help with.
The practical thing for this student was to live on campus. It may seem
strange to some that I did not push a little harder to encourage him to live on
campus so that he could have free room and board and not commute. However,
I understood that having a permanent connection is often one of the most criti-
cal factors to a person’s ability to survive and thrive. Sometimes meeting
young people where they are is more important than trying to do and get
everything for someone. Showing you understand what and who is important
to them can go a long way in helping them achieve stability and success.

1
All names and other personal identifiers in cases and examples throughout this book have
been changed to protect privacy and confidentiality.
Immigrant and Refugee Children and Families 285

Immigrant and Refugee Children and Families

Immigrants are a diverse group that includes foreign-born children and adults, as
well as second-generation children and adults. All individuals and families have
different stories related to their immigration journey. A relatively small proportion
of immigrant and refugee families come into contact with the child welfare system.
An analysis of the National Survey of Children and Adolescent Well-Being data
found 8.6% of children reported to child protective services lived with a foreign-
born parent and 82.5% of these children were born in the United States (Dettlaff &
Earner, 2012). Approximately two-thirds (67.2%) of these children were Hispanic.
Children of immigrants may enter the child welfare system when their parents are
detained or deported. Immigrants with undocumented legal status may face signifi-
cant challenges in accessing services to care for their children (Finno-­
Valasquez, 2014).
When immigrant and refugee families become involved in the child welfare sys-
tem, it is important to recognize how their status and experiences as immigrants and
refugees in the United States play a role in their case and service provision.
Immigrant and refugee families may share similar and very different experiences
than other families involved with the child welfare system based on their experi-
ences of trauma, interaction with various law enforcement agencies and systems,
potential language and cultural differences, and unfamiliarity with the structure of
systems in the United States. It may also be influenced by racism and discrimination
due to their race/ethnicity and/or immigration status in the United States.
There is a need to better understand the different experiences among immigrant
and refugee families. Currently, research seeks to deepen the knowledge about risk
and protective factors in different immigrant families. For example, recent research
examining mothers born in Mexico
who were raising their children in the
United States found that mothers’ Practice Tip
depressive symptoms and economic
Potential Questions to Ask Immigrant
hardship uniquely predicted increased
Parents About Their Family
parenting stress and their romantic
relationship quality decreased parent- • Tell me about your life as a child –
ing stress and that these influenced what positive things do you remem-
their engagement in harsh parenting ber? What was difficult?
practices (Mortensen & Barnett, 2015). • How was your journey to this
Given the growing number of immi- country?
grant children and families in the • What do hope for your children?
United States, it is important for child What dreams do you have for them?
welfare professionals to be prepared to • What is your relationship with your
apply existing elements of family-cen- children? Your parents?
tered, strengths-based, and trauma- Extended family?
informed practice in child welfare to • What makes your children happy?
working with immigrant families. This • What can I do to help you and
includes conducting sound and your family?
286 11 Special Populations in Child Welfare Practice

appropriate investigations, assessments, making necessary referrals for services,

and monitoring progress on each case that are grounded in the culture and language
that the family prefers. Although for some languages it may be challenging to find
a translator, children should not be used as translators within cases. As with all fami-
lies, child welfare professionals must assess strengths and resources, cultivate resil-
ience, and focus on solutions in developing a case plan and supports for the child
and family. With immigrant and refugee families, we must also learn and respect
cultural norms and practices through our everyday interactions and through cultur-
ally grounded services and interventions.
While immigrant families have many strengths, they may be at an increased risk
for poor outcomes with the child welfare system due to the effects of the traumatic
experiences related to the immigration process (Dettlaff & Earner, 2012). These
experiences may be exacerbated due to cumulative effects of other highly stressful
conditions such as poverty, housing and employment instability, and anti-immigrant
attitudes, policies, and behaviors that lead to fear, uncertainty, and social isolation.
A child welfare professional can effectively engage immigrant families by pre-
senting with a warm, empathic, and supportive approach with families, avoiding
stereotypes and assumptions, recognizing the importance of the family, respecting
cultural and family traditions and preferences, and providing as much information
and guidance as necessary for the family.
There are a number of ways the child welfare system can foster best practices to
support immigrant families involved with the child welfare system. Many child wel-
fare systems and states have begun to implement sound policies to support immi-
grant and refugee families; however many have work to be done. Child welfare
agencies should promote cross-systems collaboration by establishing partnerships
with local immigration legal clinics, developing relationships with foreign consul-
ates, ensuring workforce, and training for child welfare professionals that includes
information about legal relief options and how to prepare families for possible
detention and/or deportation (e.g., safety planning, attorney information, custody/
guardianship/power of attorney documentations).
Child welfare agencies can review and update policies and procedures to reflect
a more immigrant family-friendly approach, which would include provisions about
eligibility for noncitizen/undocumented caregivers and the development of clear
policies on confidentiality and information sharing about families with authorities
and ensure documents and forms are in languages needed by clients. Child welfare
systems should continue to recruit and retain culturally and linguistically diverse
groups of foster parents to care for children in care. The child welfare system should
continue to develop and nurture community partnerships with agencies that advo-
cate for immigrant families and provide culturally grounded services to immigrant
and refugee families.
Immigrant and Refugee Children and Families 287

Practice Highlight
Interviewing Immigrant Families in Child Welfare Investigations
Elizabet Bonilla Escobar, MSW
The child welfare field is filled with a number of challenges. Anytime a new
investigation comes in, families become uncomfortable and at times resistant
to cooperate due to fear, frustration, anger, and many other reasons. When it
comes to immigrant families in the United States, the feeling of fear, in par-
ticular, is often prevalent. A lack of knowledge and a perceived lack of power
are the biggest contributors to such fear. Being faced with a child abuse or
neglect investigation is preoccupying in any case, but for immigrant families,
that feeling intensifies. Immigrant families often share stories about their
upbringings and the way in which they were disciplined as children. Those
stories may include details of actions that are deemed as “normal” in the fam-
ily’s culture, but that are considered abuse in the United States.
There was one occasion when a new investigation came in due to allega-
tions that an 8-year-old child had gotten hit with a belt on the thighs and had
received bruises as result. When first meeting with the family, who was origi-
nally from Mexico, the father indicated the following: “In Mexico, we used to
get pulled by the hair, dragged around, and get hit with everything from shoes,
chords, irons, and other things when we misbehaved.” He added, “I have
never done those things to my child… I have hit him with a belt when he talks
back, but that’s just discipline.” This father’s explanation was honest and
direct. It’s important as a child welfare worker to listen and validate the expe-
riences of those who we interview. Once that’s been done, the challenge lies
in explaining that what may be within the “norm” in other cultures is consid-
ered abuse in the United States. The best way to do that, in my experience, is
by avoiding being “preachy” and taking an educational approach. I let the
parent know that I understand his/her perspective. However, I also add that
there are rules and regulations that must be followed when residing in the
United States and the state we live in and state that the regulations are there
for the protection of all children. Parents often respond well when I explain
that the goal of my work is to ensure that their children are safe.
At times, depending on the allegation (s) and the facts of the case, the alle-
gations still need to be indicated. When this is the case, parents are often
upset. While I cannot change the way they feel, I do find that when I work to
build a relationship in which I take the time to listen and to answer any ques-
tions the parents may have, they appreciate it. Even when I have indicated
reports before, families have thanked me at the conclusion of an investigation.
I think that they come to understand that there is a protocol that I must adhere
to, and they appreciate that I inform them as much as possible of why each
step and decision must take place.
Overall, I think one of the most valuable lessons I’ve learned as a child
protection specialist is that it’s of utmost importance to be willing to listen and
educate the families we work with while holding a nonjudgmental attitude.
288 11 Special Populations in Child Welfare Practice

Siblings in Foster Care

There is no doubt that sibling relationships are important in one’s development and
well-being throughout the lifespan. Sibling relationships can provide support, sta-
bility, and joy. Research shows that siblings placed together can increase the chance
of reunification and other types of permanency (Jones, 2016, Akin, 2011) and expe-
rience more placement stability. Siblings placed together also experience fewer
externalizing behaviors (Wojciak et al., 2013) and improved mental health (Jones,
2016) and school performance (Hegar & Rosenthal, 2011). Despite the known ben-
efits of sibling relationships, it is not always possible for them to be placed together
in out-of-home care. There are a number of barriers that can exist, such as siblings
having different needs, difficulty in accommodating a large sibling group, differ-
ence in age, and entering care at different times. It is estimated at least one-third of
children placed in care will be separated from at least one of their siblings while in
foster care (Shlonsky et al., 2003).
Child welfare systems should make every effort to enact policies that support
siblings staying together in placement. Systems can ensure that child welfare staff
have adequate training about sibling placement and relationship promotion, recruit
foster caregivers willing to foster sibling groups, and have events that promote sib-
ling contact. Child welfare professionals should make every effort to place children
together in the same setting when they are initially placed and when permanency
options are explored later in the case. Assessment throughout the case is important
as information may come at different times. Child welfare professionals should ask
questions about who is considered a sibling and possible caregivers (e.g., relatives,
teaches, other kin). In these cases, it is extremely important and often mandated that
child welfare professionals go above and beyond to ensure siblings have regular in-­
person visits and regular contact via phone or video chat. Child welfare profession-
als should discuss the siblings’ preferences for maintaining contact and visits. If
children are placed apart, child welfare professionals can ensure that their respec-
tive placements have contact information to allow for phone calls and video chats
and encourage visits, as appropriate. Child welfare professionals can arrange for
sibling therapy, clinical support during visitation, and offer extracurricular activi-
ties, joint outings, or camp that both can participate in together. If siblings cannot be
placed together, they could be placed in close proximity or in the same school dis-
trict or school. Sibling relationships should be prioritized in child welfare, and those
professionals and caregivers working with youth should ensure that they have opti-
mal and appropriate contact and support.

Human and Sex Trafficking

Human trafficking has been referred to as “modern-day slavery.” Through the use
coercion, deception, fraud, threat, and force, traffickers exploit people and deprive
them of their rights and freedoms. It is “involuntary servitude” that includes both
Human and Sex Trafficking 289

forced labor and sexual exploitation. Labor trafficking includes having a person
work against their will in any number of settings and types of work (e.g., service
industry, manufacturing, housekeeping, agriculture, domestic servitude). It includes
debt bondage where a person pledges their personal services to another person and
the value of those services are not applied towards the debt or the length and nature
of the services are not limited and defined. Sexual exploration includes forcing a
person into sexual acts where there is financial gain for someone, such as prostitu-
tion or pornography. Sex trafficking includes the acts of recruiting, harboring, trans-
porting, obtaining, patronizing, and soliciting a person for the purposes of any
commercial sex act. Human trafficking is a multi-billion-dollar “industry” that
exploits children and adults from the United States and other countries. While peo-
ple who have been trafficked should not be punished for having been trafficking, it
is an ongoing concern that survivors of trafficking are involved with the justice
system because of events they did due to their circumstances of being trafficked
(Marsh, 2019).
Annual estimates are that over 100,000 children are sex trafficked domestically
in the United States and up to 325,000 more children are at risk of being trafficked
(Estes & Weiner, 2001). Sex trafficking of children is also often referred to as the
commercial sexual exploitation of children. Research has identified multiple risk
factors for commercial sexual exploitation of children, although there is more work
that needs to be done, especially to understand how to predict risk for sex traffick-
ing (Panlilio et al., 2019). Risk factors include having experienced child maltreat-
ment, having been involved in the child welfare or juvenile justice system,
previously run away from home, homelessness, and identifying as LGBTQ
(National Resource Council, 2013). Being in out-of-home care is a known risk fac-
tors for human trafficking. It is estimated between 50% and 90% of children who
were involved in sex trafficking had a history of being involved in the child welfare
system (ACF, 2013).
Traffickers are known to target youth in care because of their trauma history and
their weaker social connections. They may lure youth away from their placements.
Or they prey upon those who run away from placements (Gibbs et al., 2018).
Traffickers do not just violently kidnap youth; they use a range of behaviors to build
trust and convince youth to come with them. They may shower them with affection
initially and promise to provide for their basic needs. Youth may see the trafficker as
a romantic partner and not realize they are being manipulated into trafficking.
Traffickers also use drugs and violence to continue to control youth they are
trafficking.
The child welfare system is involved in the response to human trafficking and the
commercial sexual exploitation of children (CSEC; Gibbs, et al., 2018). In several
states commercial exploitation is a specific reportable child abuse offense (Bounds
et al., 2015). Much of the child welfare system involvement with trafficking is in
dealing with the aftermath. Many states have included trafficking of children as a
form of child maltreatment regardless if the perpetrator is a parent or caregiver.
Child welfare agencies have collaborated with systems to provide services to
290 11 Special Populations in Child Welfare Practice

children and youth who were trafficked. Children and youth who were sex trafficked
and engaged in pornography are recognized as victims and not arrested or prose-
cuted. There are “safe harbor” laws in many states that ensure that children who
were trafficked are served by the child welfare system and not the juvenile justice
system. Special services including specific housing are often required due to the
nature of trafficking. Youth may run away from placement to return to those who
were trafficking them. In providing housing for youth who have been trafficked, it
is important to consider their wishes and needs (Dierkhising et al., 2020). It is
imperative to understand that youth may not wish to disclose that they were involved
in commercial sexual exploitation (Lavoie et al., 2019). They may not perceive
themselves as victims and may not wish to be removed from those who were traf-
ficking them.
Those working with children and youth who were trafficked must understand the
nature of trafficking. Specialized training on understanding trafficking and working
with youth who have been trafficked is available, and child welfare workers should
participate in the trainings. Identification of trafficking is important as youth may
not necessarily conceptualize the nature of what they experienced as trafficking.
There are multiple screening tools available that can be used by agencies. Likewise,
child welfare workers can be trained to recognized signs of trafficking. For example,
the presence of an older boyfriend who is controlling, youth’s loyalty to the traf-
ficker, a youth working long hours, or a youth living with their employer or many
other people (Center for the Human Rights for Children & International Organization
for Adolescents, 2011). Awareness about trafficking is necessary as is knowing how
to work with those who have experienced trafficking.
While in many regards working with children and youth who have been traf-
ficked is like working with children and youth who have experienced other trau-
mas, there is a uniqueness to trafficking (Bounds et al., 2015). (See Chap. 5 for
information on trauma-informed care). Those who have been trafficked have expe-
rienced trauma and may react in a wide variety of ways. The range of reactions may
be from rage and aggression to withdrawn and dissociated. Children and youth who
have been trafficked may strongly seek their independence and find programs and
services as restrictive. While they were being trafficked, youth may have felt more
freedoms to engage in behaviors that are restricted in care (e.g., drink alcohol, do
drugs, have sex). To address youth feeling the lack of control, engaging the youth
in the case plan and empowering them to make decisions impacting their life can be
helpful. Additionally, having more flexibility in how services are provided may be
helpful. Building trust and rapport with youth who had been trafficked is important
and can take time. Youth who have been trafficked may have a difficult time trust-
ing someone and may not feel safe (Hurst, 2019). They may have had negative
experiences with systems and authorities that contribute to their distrust. Their
focus on safety and survival may result in behaviors and attitudes perceived as chal-
lenging. They may engage in risky behaviors or self-harm. Youth who have been
trafficked may have health problems and experience delays in their development.
Many youth who have been trafficked have had disruptions in their education.
Human and Sex Trafficking 291

Prevention of commercial exploitation of children is also relevant to child wel-

fare because children and youth in foster care are at greater risk than their peers to
being trafficked. Risk factors for being trafficked include not having a stable living
environment, being isolated from family and friends, and emotional vulnerability,
all of which are frequent characteristics of those in out-of-home care. Child welfare
agencies have the responsibility to ensure that children in their care are not targeted
by trafficking. This cannot be done alone though; collaboration across systems is
necessary to prevent and address human trafficking.

Case Study: Commercial Sexual Exploitation

Carly B. Dierkhising, PhD
Brielle was born with drugs in her system and entered foster care the day after
she was born. She was taken from her mother at the hospital. At this time,
there were already substantiated allegations of emotional abuse and severe
physical abuse of her siblings, which led to bruises and marks on their bodies.
For the next several years, her mother worked to address her substance use
issues so she could reunify with Brielle. Brielle lived in two foster homes dur-
ing her first 3 years until she was able to return home to her mother. When
Brielle was 13 years old, her brother was born with drug exposure which trig-
gered a removal for Brielle who went to live with her aunt. Two years later,
her mother passed away.
While grieving for her mother, Brielle began to leave her aunt’s house
without permission and would be gone for days at a time. Her aunt connected
with the social worker who referred Brielle for a mental health assessment
which indicated that she had been diagnosed with major depressive disorder
and cocaine and methamphetamine abuse. Brielle reported using drugs to
numb her grief and trauma reactions. The report also stated that she would
trade sex for drugs or steal when needed. Brielle and her aunt were referred to
trauma-focused cognitive behavioral therapy, but before services began,
Brielle disappeared and her social worker reported her to the National Center
for Missing and Exploited Children.
One month later, she was recovered by law enforcement in a sting opera-
tion focused on recovering commercially sexually exploited children and
youth. At the station her social worker and a community-based survivor advo-
cate were called. Brielle was able to go home to her aunt that night, but a few
weeks later, her aunt called her social worker and said that Brielle had been in
an altercation with her “boyfriend” and law enforcement had been involved.
Brielle had bruises and cuts on her body. Her aunt told the social worker that
she was no longer willing or able to take care of Brielle and asked that she find
her another place to live. She was placed in short-term shelter care as her
social worker looked to find a new place for her to live.
292 11 Special Populations in Child Welfare Practice

Conclusion

Child welfare practice is enhanced significantly through an understanding of the

needs of those with unique experiences. Child welfare professionals can improve
their practice by being flexible and understanding in meeting the needs of the chil-
dren and families they serve. Best practice in child welfare also includes acknowl-
edging varied approaches with special populations such as youth aging out of foster
care, children with disabilities, and immigrant and refugee populations and in spe-
cific contexts such as sibling groups or human and sex trafficking.

Acknowledgments The authors thank Justin S. Harty, MSW, LCSW; Colleen Cary Katz, PhD,
LCSW; Kizzy Lopez, EdD; Elizabet Bonilla Escobar, MSW; and Carly B. Dierkhising, PhD, for
their contributions to in this chapter.

Discussion Questions
1. What are two ways to improve permanency among children with disabilities who
are involved in the child welfare system?
2. How can child welfare professionals support pregnant and parenting youth in
foster care?
3. What are strategies that child welfare professionals can use to support youth in
their transition into adulthood and independence?
4. What are some ways that the child welfare system can foster best practices in
supporting immigrant families?
5. How do human and sex trafficking intersect with the child welfare system?

Suggested Activities
1. Listen to the stories of youth transitioning out of foster care. Visit the Digital
Stories of youth involved with Florida Youth SHINE: https://www.floridayouth-
shine.org/digital-­stories. Discuss with others these youths’ experiences. Reflect
about the importance of child welfare professionals and other adults in their lives
in shaping the experiences of youth.
2. Visit The Center on Immigration and Child Welfare’s website (https://cimmcw.
org/), and review current events in the news. Write a brief paper on one of the
events. Reflect on to what extent the child welfare system (or other systems)
addressed the safety, permanency, and well-being of immigrant children and
families.
3. Watch the Video: “Youth Voices: Life after Foster Care” https://www.davetho-
masfoundation.org/library/video-­youth-­voices-­life-­after-­foster-­care-­full-­length/.
Reflect on some of the similarities and differences between your experiences and
those of the youth during the transition to adulthood. Consider what types of
supports are necessary during this process.
4. Read Eastman et al. (2019), and discuss with others the similarities and differ-
ences between pregnant and parenting youth in foster care and (1) youth in care
who do not have children, (2) youth without foster care experience who may be
parenting, and (3) youth without foster care experience who are not parenting.
References 293

Eastman, A. L., Palmer, L., & Ahn, E. (2019). Pregnant and parenting youth in care
and their children: A literature review. Child and Adolescent Social Work Journal,
36(6), 571–581. (Available: https://rdcu.be/cb8US).

Additional Resources
Child Welfare League of America Best Practice Guidelines, Serving LGBT Youth in
Out-of-Home Care: https://www.nclrights.org/get-­help/resource/
child-­welfare-­league-­of-­america-­cwla-­best-­practice-­guidelines-­serving-­lgbt-­
youth-­in-­out-­of-­home-­care/
The Center on Immigration and Child Welfare: https://cimmcw.org/
The Center on Immigration and Child Welfare, A Social Workers Tool Kit for
Working with Immigrant Families: https://cimmcw.org/wp-­content/uploads/
Trauma-­Immigrant-­Families.pdf
Lambda Legal, Getting down to basics: Tools to support LGBTQ Youth in Care:
https://www.lambdalegal.org/publications/getting-­down-­to-­basics
Foster Care Alumni of America: https://fostercarealumni.org/
U.S. Department of Education, Foster Care Transition Toolkit: https://www2.ed.
gov/about/inits/ed/foster-­care/youth-­transition-­toolkit.pdf
Human Rights Campaign, LGBTQ Resources for Child Welfare Professionals:
https://www.thehrcfoundation.org/professional-­r esources/all-­c hildren-­a ll-­
families-­lgbtq-­resources-­for-­child-­welfare-­professionals
Child Welfare Information Gateway, Human Trafficking and Child Welfare: A
Guide for Caseworkers: https://www.childwelfare.gov/pubs/
trafficking-­caseworkers/
The National Child Traumatic Stress Network, The 12 Core Concepts of
Understanding Traumatic Stress Responses in Children and Families Adapted
for Youth who are Trafficked: https://www.nctsn.org/resources/
12-­core-­concepts-­understanding-­traumatic-­stress-­responses-­children-­and-­famili
es-­adapted
ReSHAPING (Research on Sexual Health and Adolescent Parenting in Out-of-­
Home Environments Group): https://www.reshapingnetwork.org/reshaping
Child Welfare Information Gateway, Supporting your LGBTQ Youth: A Guide for
Foster Parents: https://www.childwelfare.gov/pubs/LGBTQyouth/
Youth.Gov, LGBTQ youth in child welfare: https://youth.gov/youth-­topics/lgbtq-­
youth/child-­welfare

References

Administration on Children and Families. (2013) Report to Congress: The child welfare system
response to sex trafficking of children. Retrieved from: https://www.acf.hhs.gov/sites/default/
files/cb/report_congress_child_trafficking.pdf
Akin, B. A. (2011). Predictors of foster care exits to permanency: A competing risks analysis
of reunification, guardianship, and adoption. Children and Youth Services Review, 33(6),
999–1011. https://doi.org/10.1016/j.childyouth.2011.01.008
294 11 Special Populations in Child Welfare Practice

Antle, B. F., Johnson, L., Barbee, A., & Sullivan, D. (2009). Fostering interdependent versus inde-
pendent living in youth aging out of care through healthy relationships. Families in Society,
90(3), 309–315. https://doi.org/10.1606/1044-­3894.3890
Bounds, D., Julion, W. A., & Delaney, K. R. (2015). Commercial sexual exploitation of children
and state child welfare systems. Policy, Politics, & Nursing Practice, 16(1–2), 17–26. https://
doi.org/10.1177/1527154415583124
Brown, A., Courtney, M. E., & McMillen, J. C. (2015). Behavioral health needs and service use
among those who’ve aged-out of foster care. Children and Youth Services Review, 58, 163–169.
Butterworth, S., Singh, S. P., Birchwood, M., Islam, Z., Munro, E. R., Vostanis, P., et al. (2017).
Transitioning care-leavers with mental health needs: ‘They set you up to fail!’. Child and
Adolescent Mental Health, 22(3), 138–147.
Cash, S. J., & Bridge, J. A. (2009). Epidemiology of youth suicide and suicidal behavior. Current
Opinion in Pediatrics, 21(5), 613–619. https://doi.org/10.1097/MOP.0b013e32833063e1
Center for the Human Rights for Children & International Organization for Adolescents. (2011).
Building child welfare response to human trafficking. https://www.luc.edu/media/lucedu/chrc/
pdfs/BCWRHandbook2011.pdf
Courtney, M. E., Dworsky, A. L., Lee, J. S., & Raap, M. (2010). Midwest evaluation of the adult
functioning of former foster youth: Outcomes at ages 23 and 24. Chapin Hall at the University
of Chicago.
Courtney, M. E., Charles, P., Okpych, N. J., Napolitano, L., & Halsted, K. (2014). Findings from
the California youth transitions to adulthood study (CalYOUTH): Conditions of foster youth at
age 17. Chapin Hall at the University of Chicago.
Courtney, M. E., Okpych, N. J., Charles, P., Mikell, D., Stevenson, B., Park, K., Kindle, B., Harty,
J., & Feng, H. (2016). Findings from the California Youth Transitions to Adulthood Study
(CalYOUTH): Conditions of foster youth at age 19. Chicago, IL: Chapin Hall at the University
of Chicago.
Cunningham, M. J., & Diversi, M. (2013). Aging out: Youths’ perspectives on foster care and the
transition to independence. Qualitative Social Work, 12(5), 587–602.
Dettlaff, A. J., & Earner, I. (2012). Children of immigrants in the child welfare system:
Characteristics, risk, and maltreatment. Families in Society, 93(4), 295–303. https://doi.
org/10.1606/1044-­3894.4240
Dettlaff, A. J., & Washburn, M. (2018). Lesbian, gay, and bisexual (LGB) youth within in welfare:
Prevalence, risk and outcomes. Child Abuse & Neglect, 80, 183–193. https://doi.org/10.1016/j.
chiabu.2018.03.009
Dierkhising, C. B., Brown, K. W., Ackerman-Brimberg, M., & Newcombe, A. (2020).
Recommendations to improve out of home care from youth who have experienced com-
mercial sexual exploitation. Children and Youth Services Review, 116, 105263. https://doi.
org/10.1016/j.childyouth.2020.105263
Dworsky, A. (2005). The economic self-sufficiency of Wisconsin’s former foster youth.
Children and Youth Services Review, 27(10), 1085–1118. https://doi.org/10.1016/j.
childyouth.2004.12.032
Dworsky, A., & Pérez, A. (2010). Helping former foster youth graduate from college through
campus support programs. Children and Youth Services Review, 32(2), 255–263. https://doi.
org/10.1016/j.childyouth.2009.09.004
Eastman, A. L., Putnam-Hornstein, E., Magruder, J., Mitchell, M. N., & Courtney, M. E. (2017).
Characteristics of youth remaining in foster care through age 19: A pre-and post-policy cohort
analysis of California data. Journal of public child welfare, 11(1), 40–57.
Estes, R. J., & Weiner, N. A. (2001). The commercial sexual exploitation of children in the US,
Canada and Mexico. University of Pennsylvania, School of Social Work, Center for the Study
of Youth Policy.
Finno-Velasquez, M. (2014). Barriers to support service use for Latino immigrant families reported
to child welfare: Implications for policy and practice. Available: http://childwelfaresparc.
org/wp-­content/uploads/2014/07/Barriers-­to-­Support-­Service-­Use-­for-­Latino-­Immigrant-­
Families-­Reported-­to-­Child-­Welfare.pdf
References 295

Fish, J. N., Baams, L., Wojciak, A. S., & Russell, S. T. (2019). Are sexual minority youth over-
represented in foster care, child welfare, and out-of-home placement? Findings from nation-
ally representative data. Child Abuse & Neglect, 89, 203–211. https://doi.org/10.1016/j.
chiabu.2019.01.005
Geiger, J. M., Piel, M. H., Day, A., & Schelbe, L. (2018). A descriptive analysis of programs serv-
ing foster care alumni in higher education: Challenges and opportunities. Children and Youth
Services Review, 85, 287–294. https://doi.org/10.1016/j.childyouth.2018.01.001
Goerge, R.M., Bilaver, L., Lee, B.J., Needell, B., Brookhart, A., & Jackman, W. (2002).
Employment outcomes for youth aging out of foster care. US Department of Health and Human
Services, Office of the Assistant Secretary for Planning and Evaluation.
Gibbs, D. A., Feinberg, R. K., Dolan, M., Latzman, N. E., Misra, S., & Domanico, R. (2018). Report
to congress: The child welfare system response to sex trafficking of children. U.S. Department
of Health and Human Services, Administration for Children and Families.
Glidden, L. M. (2000). Adopting children with developmental disabilities: A long-term perspec-
tive. Family Relations, 49(4), 397–405. https://doi.org/10.1111/j.1741-­3729.2000.00397.x
Greeson, J. K., & Bowen, N. K. (2008). “She holds my hand” the experiences of foster youth
with their natural mentors. Children and Youth Services Review, 30(10), 1178–1188. https://doi.
org/10.1016/j.childyouth.2008.03.003
Havlicek, J. (2014). Maltreatment histories of foster youth exiting out-of-home care through
emancipation: A latent class analysis. Child Maltreatment, 19(3–4), 199–208. https://doi.
org/10.1177/1077559514539754
Hegar, R. L., & Rosenthal, J. A. (2011). Foster children placed with or separated from siblings:
Outcomes based on a national sample. Children and Youth Services Review, 33(7), 1245–1253.
https://doi.org/10.1016/j.childyouth.2011.02.020
Hernandez, L., Day, A., & Henson, M. (2017). Increasing college access and retention rates of
youth in foster care: An analysis of the impact of 22 state tuition waiver programs. Journal of
Policy Practice, 16(4), 397–414. https://doi.org/10.1080/15588742.2017.1311819
Horowitz, L. M., Bridge, J. A., Teach, S. J., Ballard, E., Klima, J., Rosenstein, D. L., et al. (2012).
Ask suicide-screening questions (ASQ): A brief instrument for the pediatric emergency depart-
ment. Archives of Pediatrics & Adolescent Medicine, 166(12), 1170–1176.
Hurst, T. E. (2019). Prevention of child sexual exploitation: Insights from adult survivors. Journal
of Interpersonal Violence. https://doi.org/10.1177/0886260519825881
Iglehart, A. P., & Becerra, R. M. (2002). Hispanic and African American youth: Life after foster
care emancipation. Journal of Ethnic and Cultural Diversity in Social Work, 11(1–2), 79–107.
Jones, C. (2016). Sibling relationships in adoptive and fostering families: A review of the inter-
national research literature. Children & Society, 30(4), 324–334. https://doi.org/10.1111/
chso.12146
Jonson-Reid, M., Drake, B., Kim, J., Porterfield, S., & Han, L. (2004). A prospective analysis of
the relationship between reported child maltreatment and special education eligibility among
poor children. Child Maltreatment, 9(4), 382–394. https://doi.org/10.1177/1077559504269192
Katz, C. C., Courtney, M. E., & Novotny, E. (2017). Pre-foster care maltreatment class as a predic-
tor of maltreatment in foster care. Child and Adolescent Social Work Journal, 34(1), 35–49.
Kleiman, E. M., & Liu, R. T. (2013). Social support as a protective factor in suicide: Findings from
two nationally representative samples. Journal of Affective Disorders, 150(2), 540–545. https://
doi.org/10.1037/e556952013-­003
Lavoie, J., Dickerson, K. L., Redlich, A. D., & Quas, J. A. (2019). Overcoming disclosure reluc-
tance in youth victims of sex trafficking: New directions for research, policy, and practice.
Psychology, Public Policy, and Law, 25(4), 225. https://doi.org/10.1037/law0000205
Lightfoot, E., Hill, K., & LaLiberte, T. (2011). Prevalence of children with disabilities in
the child welfare system and out of home placement: An examination of administrative
records. Children and Youth Services Review, 33(11), 2069–2075. https://doi.org/10.1016/j.
childyouth.2011.02.019
296 11 Special Populations in Child Welfare Practice

Lorthridge, J., Evans, M., Heaton, L., Stevens, A., & Phillips, L. (2018). Strengthening family
connections and support for youth in foster care who identify as LGBTQ: Findings from the
PII-RISE evaluation. Child Welfare, 96(1), 53–78.
Marsh, E. (2019). Relief not arrests: Strengthening laws for survivors of human trafficking.
Available: https://www.legalexecutiveinstitute.com/polaris-­arrests-­human-­trafficking/
McMillen, J. C., Zima, B. T., Scott, L. D., Jr., Auslander, W. F., Munson, M. R., Ollie, M. T., &
Spitznagel, E. L. (2005). Prevalence of psychiatric disorders among older youths in the foster
care system. Journal of the American Academy of Child & Adolescent Psychiatry, 44(1), 88–95.
Mihalec-Adkins, B. P., & Cooley, M. E. (2020). Examining individual-level academic risk and pro-
tective factors for foster youth: School engagement, behaviors, self-esteem, and social skills.
Child & Family Social Work, 25(2), 256–266. https://doi.org/10.1111/cfs.12681
Miller, E. A., Paschall, K. W., & Azar, S. T. (2017). Latent classes of older foster youth:
Prospective associations with outcomes and exits from the foster care system during the transi-
tion to adulthood. Children and Youth Services Review, 79, 495–505. https://doi.org/10.1016/j.
childyouth.2017.06.047
Mortensen, J. A., & Barnett, M. A. (2015). Risk and protective factors, parenting stress, and harsh
parenting in Mexican origin mothers with toddlers. Marriage & Family Review, 51(1), 1–21.
https://doi.org/10.1080/01494929.2014.955937
National Research Council. (2013). Confronting commercial sexual exploitation and sex traffick-
ing of minors in the United States. National Academies Press.
Norman, R. E., Byambaa, M., De, R., Butchart, A., Scott, J., & Vos, T. (2012). The long-term health
consequences of child physical abuse, emotional abuse, and neglect: A systematic review and
meta-analysis. PLoS Medicine, 9(11), e1001349.
Osman, A., Bagge, C. L., Gutierrez, P. M., Konick, L. C., Kopper, B. A., & Barrios, F. X. (2001).
The suicidal behaviors questionnaire-revised (SBQ-R): Validation with clinical and nonclinical
samples. Assessment, 8(4), 443–454. https://doi.org/10.1177/107319110100800409
Panlilio, C. C., Miyamoto, S., Font, S. A., & Schreier, H. M. (2019). Assessing risk of commer-
cial sexual exploitation among children involved in the child welfare system. Child Abuse &
Neglect, 87, 88–99. https://doi.org/10.1016/j.chiabu.2018.07.021
Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., et al. (2011).
The Columbia-suicide severity rating scale: Initial validity and internal consistency findings
from three multisite studies with adolescents and adults. American of Psychiatry, 168(12),
1266–1277. https://doi.org/10.1176/appi.ajp.2011.10111704
Ryan, C., Huebner, D., Diaz, R. M., & Sanchez, J. (2009). Family rejection as a predictor of nega-
tive health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics,
123(1), 346–352. https://doi.org/10.1542/peds.2007-­3524
Samuels, G. M. (2008). A reason, a season, or a lifetime: Relational permanence among young
adults with Foster Care backgrounds. Chapin Hall Center for Children at the University of
Chicago.
Shlonsky, A., Webster, D., & Needell, B. (2003). The ties that bind: A cross-sectional analysis of
siblings in foster care. Journal of Social Service Research, 29(3), 27–52.
Stewart, C. J., Kum, H. C., Barth, R. P., & Duncan, D. F. (2014). Former foster youth: Employment
outcomes up to age 30. Children and Youth Services Review, 36, 220–229. https://doi.
org/10.1016/j.childyouth.2013.11.024
Substance Abuse and Mental Health Services Administration. (2015). Ending conversion therapy:
Supporting and affirming LGBTQ youth (HHS Publication No. (SMA) 15-4928). Substance
Abuse and Mental Health Services Administration.
Sullivan, M. J., Jones, L., & Mathiesen, S. (2010). School change, academic progress, and behav-
ior problems in a sample of foster youth. Children and Youth Services Review, 32(2), 164–170.
https://doi.org/10.1016/j.childyouth.2009.08.009
U.S. Department of Health & Human Services. (2020). The AFSCARS report. https://www.acf.
hhs.gov/sites/default/files/cb/afcarsreport27.pdf
References 297

Ullman, S. E., & Najdowski, C. J. (2009). Correlates of serious suicidal ideation and attempts in
female adult sexual assault survivors. Suicide and Life-threatening Behavior, 39(1), 47–57.
https://doi.org/10.1521/suli.2009.39.1.47
Van Scoyoc, A., Marquardt, M. B., & Phelps, R. A. (2018). The challenge and importance of dif-
ferentiating trauma and stress-related disorders from autism Spectrum disorders. In J. Fogler
& R. Phelps (Eds.), Trauma, autism, and neurodevelopmental disorders. Springer. https://doi.
org/10.1007/978-­3-­030-­00503-­0_5
Wilber, S., Ryan, C., & Marksamer, J. (2006). CWLA best practice guidelines: Serving LGBT
youth in out-of-home care. Child Welfare League of America.
Wilson, B. D., Cooper, K., Kastanis, A., & Nezhad, S. (2014). Sexual and gender minority youth in
foster care: Assessing disproportionality and disparities in Los Angeles. The Williams Institute.
Wojciak, A. S., McWey, L. M., & Helfrich, C. M. (2013). Sibling relationships and internalizing
symptoms of youth in foster care. Children and Youth Services Review, 35(7), 1071–1077.
https://doi.org/10.1016/j.childyouth.2013.04.021
Zhang, X., Wang, H., Xia, Y., Liu, X., & Jung, E. (2012). Stress, coping and suicide ideation in
Chinese college students. Journal of Adolescence, 35(3), 683–690. https://doi.org/10.1016/j.
adolescence.2011.10.003
Chapter 12
Supervision and Professional Development
in Child Welfare

Introduction

To best serve children and families, child welfare professionals must be committed
to accepting feedback and assistance as well as learning throughout their career.
Child welfare agencies are structured to ensure that feedback, assistance, and learn-
ing opportunities are available for child welfare professionals. A large way in which
this occurs is having child welfare professionals report to supervisors who oversee
the cases and assist the child welfare professionals on their team. Child welfare
professionals should take an active role in their supervision. Supervision is not
something that is given to them; rather, it is a process in which they are engaged.
Child welfare professionals should be committed to using supervision as a tool to
improve how they work with children and families.
Learning occurs within supervision, but it extends beyond to professional devel-
opment which broadly encompasses various learning opportunities that improve the
skills and abilities to perform within their positions. While some professional devel-
opment trainings may be required of child welfare professionals by a child welfare
agency or certification, it also includes activities that child welfare professionals
undertake to improve their ability to perform in the position. Taking classes, attend-
ing webinars, and reading books and articles are all forms of professional develop-
ment. The topics of professional development are quite varied; they can be technical
about a new protocol or broader and focus on something like self-care or safety.
Child welfare professionals should actively participate in their professional devel-
opment to ensure that they are effective in their work as well as the work brings
meaning to their lives.

© Springer Nature Switzerland AG 2021 299

J. M. Geiger, L. Schelbe, The Handbook on Child Welfare Practice,
https://doi.org/10.1007/978-3-030-73912-6_12
300 12 Supervision and Professional Development in Child Welfare

Supervision in Child Welfare Practice

Supervision in child welfare practice involves the everyday practice that supervisors
engage in that involve assigning, monitoring, and closing cases that they or their unit
are responsible for. Supervision also includes the regular communication, support,
and feedback that supervisors provide for their supervisees or caseworkers.
Supervisors also serve as the liaison between the child welfare agency and the sys-
tems they work for and alongside (e.g., judicial, educational, mental health and
behavioral, healthcare) and ensure the implementation of policies in the field. These
policies and practices must be communicated effectively and timely with child wel-
fare professionals working in the field. Supervisors hold an important role in decision-­
making and are ultimately responsible for the decisions and actions of the staff they
supervise. Therefore, in addition to the case management and administrative role that
supervisors have, they are also responsible for ensuring that departmental and perma-
nency goals are reached and their staff are adhering to proper conduct in the field,
following policies and protocols, and providing the best service to the children and
families they interact with. Other administrative supervision includes a focus on job
performance and how it relates to the agency’s mission. For example, supervisors in
child welfare establish performance objectives, measure and monitor work perfor-
mance, track required client contacts and other mandates, and enforce discipline.
Supervisors act as supporters, case consultants, teachers, advocates, and experi-
enced colleagues. They provide emotional support to reduce barriers in practice while
helping the staff they supervise explore their role in child welfare practice. They often
assist in resolving conflict and help to foster self-awareness and empathy. As case con-
sultants, they offer advice and leadership in difficult and routine situations and how to
implement practice effectively and intervene appropriately in cases as needed.
Supervisors are typically more experienced than the individuals they supervise and can
offer their expertise, knowledge, and wisdom from their time working in the field. They
can share resources and advice about professional development, models of practice,
and intervention techniques. Supervisors are charged with ongoing training regarding
policies, assessing staff knowledge and skills, providing an orientation in practice to
the agency’s policies and procedures, and helping to develop a plan for ongoing profes-
sional development. Supervisors are often in positions to advocate for the needs of their
staff so they can better serve their communities. Supervisors can support child welfare
professionals by initiating policy changes and sharing feedback about policies and pro-
cedures to improve systems. They listen and act on staff concerns and issues and create
a positive environment for staff. In addition to supervising, they serve their staff in a
variety of ways that can improve practice, morale, and well-being.

Importance of Supervision in Child Welfare

Research has shown that the quality and capacity of child welfare supervision in child
welfare practice is critical to service delivery that ensures child safety and well-being
(Kadushin & Harkness, 2002). Supervisors have an impact on the quality and
Supervision in Child Welfare Practice 301

effectiveness of staff and can influence child welfare professional retention and the
culture and climate at the agency (Collins-Camargo & Royce, 2010; Landsman, 2007).
Supervisors and their staff can be effective in ensuring child safety and family well-
being when working in settings that support high, yet reasonable expectations (e.g.,
caseloads), supportive, timely, and high-quality supervision. The impact of quality
supervision goes beyond retention in that it can reduce stress, improve critical thinking
and decision-making (Lietz, 2009; Rezepnicki & Johnston, 2005), improve job satis-
faction (Faller et al., 2010), and offer important guidance as frontline workers negotiate
challenging situations associated with child welfare practice (Mor Barak et al., 2001;
Kadushin & Harkness, 2002). Supervision can also improve perceived worker empow-
erment (Cearley, 2004), help with retention of frontline staff (DePanfilis & Zlotnik,
2008), and support the implementation
of child welfare practice models (Frey
et al., 2012). Accessing supervisory sup- Practice Tip
port often requires workers to take ini-
Common Components of Clinical
tiative (Radey & Schelbe, 2020).
Supervision
As child welfare professionals,
supervision can improve our practice. It Collins-Camargo and Millar (2010)
helps to ensure that we are acting in the outlined common components of clin-
best interest of the children, gives us the ical supervision, which include the
opportunity to learn from our supervisor following:
and colleagues, affords needed emo-
• Scheduling regular or group super-
tional support from our supervisor, and
vision meetings
provides accountability in our work.
• Enhancing caseworker critical
Having a good relationship with our
thinking skills
supervisor as they are the one who com-
• Encouraging and providing case-
pletes our annual performance evalua-
workers with time to engage in
tions teaches us how to do our job
self-­reflection so as to examine and
effectively and can improve our satis-
consider ways to improve their own
faction with our work. There are several
practice
times of supervision in child welfare
• Facilitating the identification of
practice, including clinical supervision
crucial casework questions that are
and administrative supervision.
meant to critically evaluate issues
related to family maltreatment and
applying knowledge gained from
Clinical Supervision the critical thinking sessions to
assessment and treatment activities
• Developing workers’ skills and
Clinical supervision focuses on the
focusing on evidence-based prac-
work that caseworkers do with children
tice by looking to the professional
and families. Good clinical supervision
literature for guidance in casework
is critical to building worker competen-
and implementing successful pro-
cies, including reinforcing positive
grams that promote positive out-
social work ethics and values, encour-
comes for children and families
aging self-­reflection and critical think-
• Using case review and observation
ing skills, building upon training to
to assess workers’ skills and evalu-
enhance performance, and supporting
ate progress
302 12 Supervision and Professional Development in Child Welfare

the worker through casework decision-making and crises. Clinical supervision can
also help promote a trauma-informed approach to casework. In clinical supervision,
supervisors discuss safety and risk factors in specific cases with their staff, review
service plans and family progress towards permanency goals, help to determine pos-
sible service needs, and help in making critical decisions. Clinical supervision focuses
more on providing knowledge and support to caseworkers to apply in practice with
children and families. These interactions build competence in practice, self-reflec-
tion, critical thinking, and making connections between training and performance.
Supervisors are often required by policy to support staff and/or approve staff’s
critical case decisions, as well as provide clinical guidance related to case work. In
many states, supervisors often have to approve decisions related to placement
changes, change of case plan, change of parental visitation schedule, and a child’s
placement in congregate care and/or with siblings. Supervisors can help to identify
underlying conditions they observe or suspect in cases (e.g., intimate partner vio-
lence, substance abuse), identify parallel processes (e.g., transference and counter-
transference), identify the impact of personal beliefs and values on practice, and
help to recognize knowledge and skills as well as area for growth.
Several models of supervision in child welfare have been developed and adopted
in various child welfare agency settings, including strengths-based supervision,
trauma-informed supervision in group supervision, solution-focused supervision,
and family-centered supervision. Child welfare agencies and supervisors may use
one of these specific models of supervision. It is helpful for child welfare profes-
sionals to understand the model they are functioning within.

Strengths-Based Supervision

Strengths-based supervision is based in a family-centered framework of practice in

child welfare (Lietz, 2013) that focuses on six organizing principles: (1) prioritizing
the family as the unit of attention, (2) creating and maintaining supportive partner-
ships with families to create change, (3) being grounded in empowerment, (4)
allowing for individualized practice to meet the needs of the family, (5) using a
holistic view of the family, and (6) using a strengths-based perspective. A core prin-
ciple of family-centered practice is to keep families together when possible and
draw on family strengths and resources to meet the needs of families and children.
Strengths-based supervision is a model of supervision that “enhances the intention-
ality and quality of supervision provided in public and private child welfare organi-
zations. The purpose is to support implementation of family-centered practice by
using supervisor activities that are theoretically consistent with this model” (Lietz
& Julien-Chinn, 2017, p. 146). Strengths-based supervision involves four compo-
nents: (1) parallel processes, (2) integration of crisis-oriented and in-depth supervi-
sory processes, (3) individual and group clinical supervision, and (4) administrative,
educational, and support functions to supervisees (Lietz et al., 2014). Strengths-­
based supervision is associated with higher levels of satisfaction with supervision
among child welfare specialists (Lietz & Julien-Chinn, 2017) and self-reported
positive changes in supervision provided (Lietz et al., 2014).
Supervision in Child Welfare Practice 303

Research Note
Strengths-Based Supervision
Cynthia A. Lietz, PhD, LCSW
Providing quality supervision is essential to supporting the child welfare
workforce. An extensive body of literature demonstrates the connection
between supportive supervision and the ability of agencies to ensure the reten-
tion and job satisfaction of their workers. As a young child welfare profes-
sional, I remember experiencing this reality firsthand. I was just 21 years old
when I first started working as an ongoing caseworker for a nonprofit organi-
zation that contracted with the Department of Children and Family Services
in Illinois. I was young, enthusiastic, and completely unprepared for the
important yet complex work of ensuring the safety, permanency, and well-­
being of the children and youth in my care. My first child welfare supervisor
took her role as my supervisor quite seriously. She understood the duality of
both monitoring and mentoring her workers. She paid close attention to my
work and held me accountable to ensure my practice was consistent with fed-
eral, state, and agency policies and procedures. At the same time, she offered
me quick feedback and ongoing coaching such that I was able to learn quickly
how best to engage, assess, and intervene with the clients we served. She also
taught me about documentation, court procedures and testimony, and how
best to manage my workload. Not only was my career positively influenced
by her, but more importantly, the children, youth, and families I served also
were better off as a result of her commitment to providing quality and consis-
tent supervision.
Because of this and other ongoing experiences as a supervisee and supervi-
sor in social work, I have become committed to advancing the practice of
child welfare supervision. I developed Strengths-Based Supervision (SBS;
Lietz, 2013), a model of supervision that was created to support effective
implementation of family-centered practice. SBS has four components that
can be helpful as supervisors consider how best to support investigators and
ongoing workers in ensuring the quality of child welfare practice. First, child
welfare supervisors should think about parallel process and consider how
their modeling influences the ways in which their workers develop profes-
sional relationships with their clients. Supervisors simultaneously provide
support and feedback to their workers. They set goals and hold their workers
accountable. They have to effectively lean on their supervisory authority
when necessary. In the same ways, workers much also build professional rela-
tionships with clients that involve goal-setting, support, and effective use of
authority. These similarities create an opportunity for supervisors to not just
tell but actually show their workers how to conduct these professional
activities.

(continued)
304 12 Supervision and Professional Development in Child Welfare

Child welfare supervisors should also consider ways to integrate the use of
scheduled supervisory conference while also meeting urgent decision-making
through crisis supervision. Too often, child welfare settings rely heavily on
crisis supervision. It is true that being available in a crisis is fundamental to
successful child welfare supervision. However, to only provide supervision in
an emergency means that important yet nonurgent questions and concerns are
overlooked. Child welfare workers need the ability to develop critical and
analytical thinking skills. Having some scheduled, in-depth supervisory con-
ferences is equally as important to mentoring the child welfare workforce.
Third, supervisors should consider utilizing both one-on-one and group
supervisory modalities. Individual supervision is important for coming to
know the strengths, needs, and competency of each worker. Individual super-
visory sessions also allow for supervisory support. On the other hand, group
supervision is important for developing a team approach and for cultivating
peer-driven mutual aid. The diversity of perspectives that emerge in group
supervisory conferences also allows for enhancing critical thinking.
Finally, child welfare supervisors should be sure to fulfill all three func-
tions of supervision; the administrative, educational, and support roles are all
essential. Monitoring the quality of practice, mentoring workers to grow in
their knowledge and skills and doing all of this in the context of a supportive
professional relationship allow supervisors to oversee child welfare practice
effectively.
Let me close by saying how grateful I am that several wonderful supervi-
sors were so influential for me and my work in my early years as a social worker.

Trauma-Informed Supervision

Trauma-informed supervisory practice involves using a trauma-informed approach

to supervising child welfare professionals or caseworkers in their practice (e.g.,
working with clients, decision-making), as well as using this approach to better
understand supervisees as individuals and attempt to minimize secondary trauma
responses, burnout, and compassion fatigue. According to the National Child
Traumatic Stress Network (NCTSN, 2020), “a trauma-informed child and family
service system is one in which all parties involved recognize and respond to the
impact of traumatic stress on those who have contact with the system including
children, caregivers, and service providers. Programs and agencies within such a
system infuse and sustain trauma awareness, knowledge, and skills into their orga-
nizational cultures, practices, and policies. They act in collaboration with all those
who are involved with the child, using the best available science, to maximize phys-
ical and psychological safety, facilitate the recovery of the child and family, and
support their ability to thrive.” Trauma-informed care in child welfare refers to a
Supervision in Child Welfare Practice 305

systems approach to all aspects of administration and service delivery, including

supervision.
When using a trauma-informed approach to supervision, a trauma-informed lens
is used when assessing clients and their families, making decisions, and mitigating
the effects of trauma and secondary trauma on direct service workers such as child
welfare professionals. This approach, therefore, ensures regular screenings and
check-ins regarding trauma exposure and symptoms, whether that be a particularly
difficult interaction with a client, reviewing a difficult case, or managing possible
transference with a client or case. A trauma-informed system and supervisor uses
evidence-based, culturally responsive assessments and treatments, highlights
strengths and resilience among clients and workers, and recognizes parent and child
experiences of trauma and their impact on the family and/or circumstances. Trauma-­
informed supervision also ensures the continuity of care and collaboration among
various systems to minimize re-traumatization. Strategies within this approach
include building meaningful relationships and partnerships within and outside of
the child welfare agency and addressing the intersection of trauma with history,
race, gender, and culture (NCTSN, 2020).

Solution-Focused Supervision

The solution-focused supervision approach is rooted in principles of solution-­

focused brief therapy (SFBT) based on the work of Steve de Shazer and Insoo Kim
Berg and their team at the Milwaukee Brief Family Therapy in the early 1980s. The
overall philosophy to therapeutic intervention is to focus on solutions rather than the
problems clients are facing. Main assumptions of the approach are that (1) all cli-
ents have strengths and resources; (2) the relationship between the client and thera-
pist has significant therapeutic value; (3) change happens all the time; (4) the focus
remains on the present and future, rather than the past; (5) small change leads to
bigger change, (6) clear goals are essential, and (7) it is not essential to know the
cause of a problem in order to find a solution.
By using a solution-focused approach in supervision, supervisors guide child
welfare professionals to support families in identifying and building strengths while
developing clear goals and strategies to address the problem the family is currently
facing. Solution-focused supervision also involves a reciprocal and supportive pro-
cess where supervisors identify and promote solutions to professional behavior
(e.g., work with clients, professional development and training). Child welfare pro-
fessionals on the frontline may feel more empowered, supported, and motivated in
their work with clients. They also can use similar strategies used in the supervision
relationship with their own clients.
306 12 Supervision and Professional Development in Child Welfare

Group Supervision

In addition to individual consultation and supervision, child welfare professionals

often have the opportunity for group supervision with caseworkers organized in
units or groups assigned to one supervisor. This type of organization is efficient and
allows teams to work together, communicate, share accountability, and peer support
(Hanna & Potter, 2012). Within child welfare, having the ability to be safe psycho-
logically can reduce worker turnover (Kruzich et al., 2014). Group supervision ses-
sions should be structured, have an agenda that is created by all members, and
include discussion and sharing opportunities and themes for learning. Supervisors
can provide education and feedback, offer opportunities for practice or role-playing,
and learn from supervisees about their experiences to gauge their needs personally
and professionally. This type of supervision allows for brainstorming and critical
thinking by bringing multiple perspectives, idea sharing, and developing solutions.
With caseworkers often sharing similar experiences, it is advantageous to learning
to hold group supervision sessions regularly and consistently.

Note from the Field

It Takes Time to Learn the Ropes!
Lisa Garcia, MSW
I discovered my passion for social work and the child welfare field during my
undergraduate program where I learned about abuse and neglect and the
effects of these adverse childhood experiences, especially on adults. As a new
worker coming into the field of child welfare, I had this mentality that I want
to help and save these children. Case managers are the people who are first on
the scene and the ones who build the rapport with these families. This can be
very scary, especially as a new worker.
When you become a child welfare worker, you go through a long, tedious
training and are required to take several exams to make sure you know the
material. These exams are supposed to train you to know the policy and pro-
cedure. However, the real exam is when you get “thrown to the sharks” and
you are expected to know what you’re doing, straight out of training.
For the first 6 months on the job, I was just going through the motions and
really had no idea what I was doing. How horrible is that? As a social worker,
I hold the power to make decisions that affect the lives of these families, and
I get to go in front of the judge and tell the court whether these parents can
have their children back in their care. Throughout my experience as a worker
in the field, I have discovered a possible solution to bridge the gap of sending
workers straight out of training to the field. The child welfare field requires
hands-on experience and training to really know what you are doing. After the
first 6 months of trial and error and guessing my way through, I finally felt
confident enough to say I knew what my job consisted of.
Maximizing Supervision 307

To be in the child welfare field, you must advocate for yourself in order
to be able to advocate for your families. Here is my best advice: ask ques-
tions, ask for supervision, and ask for a timeline for your expectations.
Luckily, my agency was able to see my strength to train, and I was able to
create a handbook with the most used procedures with step-by-step instruc-
tion on how to complete the task. Ask for this! Ask for more training when
you need it, and ask to shadow another worker. As a new worker coming to
the field, you will experience other workers who have been in the field for
decades and workers who are burned out; be that breath of fresh air for your
agency, and be confident enough to find a gap and try to bridge it. The child
welfare system is broken, and it needs workers who truly care to help these
children and families. It took me a couple years to get to this point, and I’m
still learning, but I want to be the worker who the children remember
20 years from now.

Maximizing Supervision

As a child welfare professional receiving supervision, there are several things

child welfare professionals can do to maximize the time and interaction with their
supervisors. First, they should ask to schedule a regular time to meet with their
supervisor. With a regular time to meet, child welfare professionals can be better
prepared and have a set aside time to talk to their supervisor every week or every
other week. It also means that they can discuss cases outside of a crisis. Along
with the supervisor, child welfare professionals should make some “guidelines”
about their supervision time. For example, what will be talked about and for how
long? Will the meeting be structured or not? Where will the meet take place? Will
the meeting be one-on-one or in a group or both? Child welfare professionals
should acknowledge that it will take some time to feel comfortable talking about
things that are beyond cases (e.g.,
feelings, burnout, conflict, etc.). Most Practice Highlight
importantly, it is necessary for the
Reflective Supervision
child welfare professional and the
supervisor to find a system that works Weatherston et al. (2010) outline 3 key
for both of them. components of reflective supervision:
Child welfare professionals should
1.  Reflection: use active listening
be prepared and proactive when going
and thoughtful questions by both
to supervision. They should think
parties.
about a case or cases that they would
2.  Collaboration: share ideas and
like to discuss and obtain feedback
responsibilities to inform
about or ideas going forward. It is
decision-making.
important that child welfare profes-
3.  Regularity: meeting regularly to
sionals pay attention and listen to their
reflect and collaborate.
308 12 Supervision and Professional Development in Child Welfare

supervisors. Supervisors have been doing this work for a longer period of time and
have experience with the system, community partners, and children and families.
When an issue presents itself, child welfare professionals should be honest and tell
the whole story. Supervisors are looking out for child welfare professionals’ well-
being and want to have all the information when supporting them in difficult situa-
tions. Child welfare professionals should know agency protocol and be sure to
follow the chain of command. If they do not like the supervisor’s answer, they
should not “shop around” for other answers. However, if they believe the supervisor
is asking them to do something inappropriate or unethical, they should contact an
administrator. Child welfare professionals should ask for help when they need it.
This is sound social work practice and will help child welfare professionals get what
they need. These are good guidelines when approaching supervision as a student
intern as well as a child welfare professional employed at an agency.

Agency Responsibility for Supervision

It is the child welfare agency’s respon-

sibility to support and create a pipeline Practice Tip
of supervisory leadership. Child wel- Child Welfare Professionals’
fare agencies should prioritize the Responsibilities in Supervision
recruitment of skilled supervisors and
provide them with appropriate support • Tell the whole story as it is known.
and training in this role. This type of • Follow the chain of command.
recruitment should include cultivating • Be prepared when going to
internal child welfare professionals supervision.
who have the experience and knowl- • Be proactive.
edge of the system and whose skills • Pay attention.
align with that of the organization. In • Listen to the supervisor’s advice.
addition to selecting qualified candi-
dates as supervisors, who possess skills
such as empathy, motivation, mentoring, and leadership, supervisors should be pro-
vided with ongoing training regarding new and effective models of supervisory
practice and field work. Practice standards should also include investing in a diverse
group of supervisors that reflect the community and workforce. Child welfare
administration should clearly define what is expected of supervisors and train them
appropriately to fulfill this role. Training should also include best practices for using
data, provide tools and resources to provide clinical and administrative supervision
(e.g., education, professional development, space, and time), and provide guidance
and supervision to supervisors themselves. There are a number of toolkits and
resources available to supervisors as well as models to guide and structure their
supervisory practice. It is also important to note that not all practice models fit each
community and group of people and may often need to be modified to meet the
needs of families and children in a specific community.
Supervision Practices and Strategies 309

Supervision Practices and Strategies

The supervisory interaction may present itself like many helping relationships. For
example, good supervisory skills include listening skills, reflecting, good questions,
appropriate feedback, and follow-up. An important component of supervision is
being present and available to those being supervised – psychologically and physi-
cally. When child welfare workers need support, guidance, and assistance with mak-
ing a decision, it is important that their supervisor is available and willing to provide
that support. Supervisors should create an environment where supervisees feel safe
and able to be honest about their feelings and thoughts. Mostly, they must feel sup-
ported. Supervisors should have strong active listening skills while making eye con-
tact, providing verbal cues to indicate understanding. In supervision, supervisors
should reflect and ask questions to show understanding of what is being said.
Supervisors should ask follow-up or clarifying questions that lead to exploring
options and problem-solving. When appropriate, supervisors shod provide feed-
back, give advice, and share experiences to help caseworkers in formulating their
own plans and decisions. Supervisors should be keen on following up and providing
accountability for such interactions. This shows the supervisor’s attention to matters
and helps caseworkers ensure follow-through.

Practice Conversation
Example of Supervision Discussion
Supervisor: Hi there! I wanted to check in with you to see how the Hernandez
family1 is doing. How have you been able to engage the family in services?
Child welfare professional (CWP): I’m feeling okay. Mom has been diffi-
cult to get on board with services, but I have been checking in with her every
week to ask her how I can help.
Supervisor: Has she been receptive? In what ways has it been difficult to
engage her in services?
CWP: She is really fixated on getting her kids back, but struggles with under-
standing what services she needs to complete in order for reunification
to occur.
Supervisor: That does sound challenging, but it also sounds like you have
done a great job with staying in touch and supporting mom through this. Have
you offered services like transportation and counseling for her?
CWP: Yes. I have started using some of the motivational interviewing tech-
niques with her, too, and I think that is working.
Supervisor: That’s great! What techniques have you used, and how have they
been helpful?

(continued)
310 12 Supervision and Professional Development in Child Welfare

CWP: I think she really wants someone to listen to her concerns about the
case. So, I am using active listening and summarizing her statements. I also
work with her resistance and challenge her when she pushes back about com-
pleting tasks.
Supervisor: This is great! I think if you continue to use these skills and show
empathy, compassion, and genuineness, she will feel comfortable with you
and be more open and motivated to work through her case plan.
CWP: I agree. I will continue to check in with her, and I’ll be sure to support
her in these ways.

1
All names and other personal identifiers in cases and examples throughout this book have
been changed to protect privacy and confidentiality.

Practice Conversation
Supervision When Child Welfare Professional Is Beginning to
Feel Burnout
Supervisor: Hi Alison, how are you doing? I’ve noticed you seem a bit down
lately. Is there anything going on that I can support you with?
CWP: Actually, yeah. I am really starting to question my ability to do this
work. I feel like no matter what I do, I can’t help these kids or their parents.
Supervisor: I can understand where you’re coming from and why you might
be feeling this way. This is really hard work. We often work with families that
we are not able to reunify and families who come to us with a lot of needs. I
also know that the work you do has helped a lot of families. For example, the
Brown family – remember when you started working with them, it seemed
like everyone was having a hard time. You worked with them for a long time
and were able to get the services that the kids needed to work through some
of their challenges. You also worked really hard so that the siblings could stay
together in the foster home and stay at their school together. I also remember
how you sat down with their parents and encouraged them to get treatment for
their substance use. You show families compassion, support, and work closely
with them to empower them to understand the system and how they can com-
plete their case plan so their kids can come home safely.
CWP: Yeah, that was a tough case. But I really saw in them the ability to get
better and strengthen their family. I don’t know why I am feeling this way all
of a sudden.
Supervision Practices and Strategies 311

Supervisor: I think it’s OK for us to feel this way some time. It’s important
for us to reflect on our cases and our work and see the things we’ve done well
and recognize where we could improve. I know we’ve talked about burnout
and compassion fatigue that comes with this kind of work. What things have
you been doing to keep yourself well outside of work?
CWP: Well, maybe that is the problem. I have been working later on most
days to make sure I get all of my paperwork done and complete all of my case
visits. Then, when I get home, my partner is unhappy that I can’t spend more
time with them. I used to work out in the evenings, but I haven’t had the time
lately. So, I am feeling more tired and deflated a lot. I also feel like I have been
worrying more about the families on my caseload and questioning my
decisions.
Supervisor: Hmmm. OK. It sounds like you are overextended with your
cases. Maybe we can take a look at your caseload numbers and the demands
they have had on you. I think it’s important for you to stay healthy and happy,
so let’s review your cases and go from there. Maybe we can also map out your
time to see if we can reduce the amount of time you’re spending on cases
after-hours so you can get back to working out and spending time with your
family. Is there anything else I can do to support you right now?
CWP: No, I think this is a good start. Maybe we can talk again in a week to
see where I am. Maybe I am just in a funk right now and needed someone to
listen. Thank you.

Practice Conversation
Supervision at Key Decision Points: Investigation
Supervisor: So, how did the initial visit go? What did you determine about
the safety of the child?
CWP: Based on my assessment, if the child stayed in the home, she would be
at risk for moderate to severe abuse in the near future. The parents did not
acknowledge what happened to the child, were verbally aggressive with me
and the child during the interview. She was physically injured and we are
concerned for her safety and well-being. We are recommending that the child
be removed and placed with her aunt.
Supervisor: Ok, let’s make sure everything is documented in your notes.
What family strengths did you note?

(continued)
312 12 Supervision and Professional Development in Child Welfare

CWP: There are a lot of family members who want to help. The child is atten-
tive, kind, and clearly loved her mom. Mom said that she did well in school
and was helpful. Mom obviously cares for the child, but was and is unable to
protect her from her boyfriend.
Supervisor: Great! Do you think there were any family strengths that would
mitigate the safety concerns that you have?
CWP: No, unfortunately not. Mom’s boyfriend was abusive with the child
and he will not leave the home. I think protective custody is needed.
Supervisor: OK. Let’s talk about what services you think are appropriate for
this family.
CWP: To start, I think the family should be referred for counseling, parenting
classes, and a drug and alcohol screening. The mother should have regular
visits with the child, without mother’s boyfriend present. Information about
housing and financial resources should be offered and provided to help with
mom to take care of the family independently from the boyfriend. Further, I
would recommend counseling with someone who is familiar with intimate
partner violence to help mom advocate for her needs and that of the child.
Supervisor: Ok, that sounds like a good plan. What services need to be in
place for the child and her caregiver, her aunt?
CWP: I will make a referral for counseling for the child as well as a forensic
interview regarding the incident. I will ensure that the caregiver has the
resources to schedule an appointment with a medical provider and counselor.
I will also make sure they are enrolled to receive financial support from the
agency and know where to find support groups and education. I will also
spend time with her to talk about the system, parameters for visitation, and
so forth.
Supervisor: This is a great starting point. Keep me posted on how things are
going. Great job with this case!

Practice Conversation
Supervision at Key Decision Points: Case Closure
Supervisor: Let’s talk about the Miller family. I believe they might be at a
point where we can close the case. Is that your sense, too?
CWP: Yes, as I refer to the case plan, I believe that the father has completed
all of the requirements related to the reason the child came into care. He has
been able to access stable and safe housing, is working full time and has set
Professional Development for Child Welfare Professionals 313

up childcare while he works. He also successfully completed counseling and

parenting education and participated in all visitation with the child.
Supervisor: Great. Have you received reports from all of the providers
regarding his services and talked to them about their recommendations?
CWP: Yes, I have all of the reports and I have shared them with all the parties
in the case.
Supervisor: Have you been to the home to do a home safety assessment and
talked to the father and child?
CWP: Yes, the home is appropriate and has been deemed safe for the child. I
talked to both the father and child and believe that they are ready to move
forward. They have supports in place and family to rely on should they need
assistance.
Supervisor: OK. Do you think there are any services they could benefit from
going forward? Are there any court mandates we need to address?
CWP: There are no mandates. There was a recommendation that the father
obtain custody of the child and he has been able to do that. I told the father
that I thought he should continue the family therapy after the case closes and
he agreed with this.
Supervisor: Great work. You’ve really done an excellent job with this case. It
was challenging to get the father on board, but you were able to really
empower him to take on the role of sole provider and take advantage of all the
services provided to have the child be placed with him. Next, I would put a
call in to the attorney to make a motion to dismiss and close the case.

Professional Development for Child Welfare Professionals

The goal of professional development is to support child welfare professionals in

their work and help them hone their skills and learn policy and procedures.
Professional development must remain ongoing throughout a child welfare work-
er’s career. Child welfare professionals must engage in professional development to
ensure they have the most up-to-date skills and knowledge about policies, programs,
and procedures. The children and families whom child welfare workers serve ben-
efit from the professional development.
The field of child welfare is ever-changing as the knowledge base grows and
society changes and new trends emerge. Professional development of child welfare
professionals is important. Child welfare professionals must be thoroughly edu-
cated about the etiology and aspects of child maltreatment and the child welfare
system and profession as they enter their positions; however, their knowledge will
314 12 Supervision and Professional Development in Child Welfare

not stop there. Throughout their careers, child welfare professionals must partici-
pate in trainings and continue to network to ensure they are up to date on informa-
tion in child welfare as well as policies and procedures. As new evidence-based
practices are developed, child welfare professionals need to be trained in how to
implement the practices with high fidelity (Akin et al., 2016).
Professional development gives workers opportunities to learn about best prac-
tices while refining their skills. Opportunities for professional development can be
facilitated by experts in person at agencies or conferences, or they may be live or
previously recorded webinar. There are multiple opportunities for training virtually
through podcasts, videos, and webinars that are self-directed or hosted by the child
welfare agency. The National Child Welfare Workforce Institute is an example of a
resource for professional development. Universities may have training and research
centers that also provide trainings such as the Center for Advanced Studies in Child
Welfare at the University of Minnesota or the Pennsylvania Child Welfare Resource
Center at the University of Pittsburgh. Workers should prioritize professional devel-
opment and advocate for themselves to get professional development.

Professional Goals

Child welfare workers are the backbone of the child welfare system. They are
responsible for ensuring the safety, permanency, and well-being of children. While
the goals for the system are clearly defined, it is necessary that child welfare profes-
sionals set professional goals for themselves. Often these goals can be around pro-
fessional growth and development. These goals can be connected to promotions that
offer more responsibilities and compensation. Perhaps a worker wants to become a
mentor, supervisor, or a trainer within the unit where they work. Perhaps the promo-
tion is moving into administration at the local or state level. Many of these goals
may involve completing additional training or education.
Professional goals could also include developing expertise in a specific area of
child welfare, for example, becoming specialized in handling cases involving a spe-
cific issue or population such as child sexual abuse, older foster youth, or human
trafficking. Along with the expertise, a professional goal could be to help improve
the system and how children and families are served. As the child welfare system is
forever evolving, a professional goal could be part of shaping the future of the system.
There are a whole range of goals about job satisfaction that are professional
goals. One goal could be finding fulfillment within the work. Another goal could be
helping create a supportive work environment through connecting with colleagues.
Maybe the goal is to informally mentor recently hired workers to work as a field
supervisor for student interns. Perhaps the goal is to find work-life balance and to
have a vibrant, fulfilling life outside of working in child welfare.
Everyone’s professional goals are going to be slightly different. Regardless of
what the goals are, workers should determine what they value and create a plan to
achieve the goal. To set a professional goal, workers can ask themselves broad
Professional Development for Child Welfare Professionals 315

questions such as what they want their legacy to be and where they want to be in 5
or 10 years. These questions can help identify a professional goal. In working
towards a goal, it will be helpful to create objectives that are specific, measurable,
achievable, relevant, and timed (SMART). This will ultimately assist in evaluating
progress towards the professional goal. Additional strategies to achieving profes-
sional goals is revisiting plans and finding a way to be accountable. This could be
telling a colleague or supervisor about the goal or keeping a journal about specific
professional goals and progress.

Ethics and Legal Issues

Ethics are central to the child protection in behaviors and making decisions. Child
welfare workers must perform their work with integrity while they prioritize the
best interests of the child. Some of the key ethical issues within child welfare work
include confidentiality, conflicts of interest, client self-determination, and informed
consent. Child welfare professionals will encounter ethical dilemmas throughout
their careers and must be able to work with their supervisors and teams to make
decisions.
While there is not a single set of ethics that guide all child welfare professionals
follow, various states have codes of ethics. For example, Illinois and Florida are two
states that have a code of ethics. In Florida, employees of the Department of Children
and Families are obligated to follow the Florida Code of Ethics, CF Operating
Procedure, NO. 60-05, Chapter 05, and there are additional requirements after
becoming a certified child welfare professional that are outlined by the Florida
Certification Board. The code of ethics covers a wider range of topics outlining
professionals’ responsibilities and behaviors. Additionally, the National Association
of Social Workers (2013) has standards for social work practice in child welfare.
These standards outline expectations for child welfare practices and provide guid-
ance for child welfare social workers. Informed by the National Association of
Social Workers (NASW) Code of Ethics, the standards present expectations on top-
ics including professional development, advocacy, collaboration, confidentiality,
cultural competence, assessment, engagement, supervision, and administration.
Child welfare professionals must remain current in their knowledge about legal
statutes and policy and procedures. Each state has specific statutes regarding child
maltreatment and child welfare. These statutes align with federal regulations,
although implementation may vary across states and jurisdictions. Child welfare
professionals must maintain current knowledge about the statues as they pertain to
working with children and families. Legislation is ever-changing, which results in
changes in policies and procedures. Therefore, there is an ongoing need for training
and information. While child welfare agencies are responsible for training workers
on the legal issues and implementation of the legislation, child welfare workers
must prioritize attending trainings and mastering the materials.
316 12 Supervision and Professional Development in Child Welfare

Racial Equity and Cultural Humility

With the well-documented racial disparities and disproportionalities within child

welfare, professional development in the areas of ensuring racial equity and using a
cultural humility approach is paramount. Racial equity is when there is fairness and
justice due in regard to race. This means that the color of a person’s skin does not
limit their opportunities or predict their outcomes. Racial equity increasingly is pri-
oritized as a goal in child welfare. To achieve equity, it requires a commitment at the
organizational level where an examination of institutional policies and systematic
racism is addressed.
Child welfare professionals and other professionals who work with children and
families need to be committed to addressing racism within their work with children
and families (e.g., Madison, 2016). There are various training programs that seek to
improve the ways that child welfare professionals serve children and families from
different cultures and reduce racism. The trainings are one way to ensure that child
welfare workers have the most up-to-date information about practice skills and poli-
cies related to reducing racial and ethnic disparities and disproportionalities. While
workshops on specific topics such as working with families of various racial and
ethnic backgrounds are helpful, it is important also that child welfare professionals
have opportunities to explore their personal beliefs and biases.
Professional development regarding racial equity and cultural humility often
begins with a reflection of our own beliefs and biases as well as our behaviors. We
are a product of our environment. How we were raised has shaped our outlook in the
world, which we often tend to feel is the “normal” or “right” worldview. Being
open-minded and acknowledging that we all hold different views is central to being
able to learn about how we can work towards racial equity. It is important that we
also critically examine our behaviors in addition to our beliefs. This may be chal-
lenging and uncomfortable to do, but it is central to our challenging racism and
promoting racial equity.
One way that child welfare professionals are being trained is in cultural humility.
Cultural humility can be understood as a commitment to self-awareness about cul-
tural differences where someone accepts and connects with a person from a differ-
ent culture while valuing their culture and seeking to minimize power imbalances.
Rather than trying to learn how best to work with people from different cultures and
learn the beliefs, values, and norms of specific cultures, which is sometimes referred
to as cultural competence (e.g., “In Mexican cultures, people often believe….”), a
cultural humility approach posits there is a need to reflect upon personal biases and
beliefs and seeing how these may perpetuate power structures, especially in the
helping relationship (Tervalon & Murray-Garcia, 1998). The cultural humility
approach, as the name suggests, is based in professionals adopting a humility mind-
set, whereas they suspend beliefs of superiority and they honor others’ cultures.
There is an openness to differences without the judgment that another culture
is flawed.
Professional Development for Child Welfare Professionals 317

Much of cultural humility in child welfare is parallel to general social work prac-
tice. For example, it includes meeting the client where they are, having empathy,
identifying the family strengths, and acknowledging historical injustices, system-
atic barriers, and power imbalances (Ortega & Coulborn, 2011). Using cultural
humility in child welfare practice can help child welfare professionals engage chil-
dren and families. Skills relevant to cultural humility in child welfare practice
include active listening, reflecting, reserving judgment, and entering the client’s
world (Ortega & Coulborn, 2011). Cultural humility in child welfare can be seen to
compliment the cultural competence practices where child welfare professionals are
provided information about different cultures (Ortega & Coulborn, 2011).
There are also trainings for child welfare professionals focused on implicit bias
and how this impacts decision-making in child welfare. Implicit bias is our uncon-
scious beliefs about groups of people that are shaped by our life experiences includ-
ing what we see in the media. These internalized messages may influence our
behaviors. The implicit biases of child welfare professionals are seen as important
as if they can negatively impact children and families of racial and ethnic groups
that have historically been discriminated against as well as other groups of people.
For example, a child protective investigator who holds an implicit bias against Black
single mothers may be more likely to remove a child from a Black single mother
than removing a child from a married White couple even when there are identical
assessments of risk and safety. Being aware of implicit bias can assist child welfare
professionals in understanding how their own decision-making and actions can be
impacted by their beliefs. An assessment tool, the Implicit Association Test, can
measure someone’s positive or negative attitudes towards different groups of people
(Greenwald et al., 1998). Additionally, self-examination about our thoughts and
behaviors can be useful in determining the extent to which implicit biases are pres-
ent and may impact our work in child welfare.

Licensing and Certification

The purpose of licensure and certification is to ensure the worker has a set of stan-
dards of skills and training to demonstrate competence in child welfare practice.
States have different licensing standards and certification processes. In general,
states that have licensing for child welfare workers require that the workers com-
plete specific training, pass an exam, and/or complete a required number of supervi-
sion hours. The supervision may include both direct individual one-on-one
supervision and supervisor’s observations of the worker interacting with children
and families. There are typically other conditions including passing a criminal back-
ground check and agreeing to follow professional guidelines. Once someone is
licensed or certified, ongoing continuing education credits are required. Additionally,
there may be a renewal process every few years to ensure that the workers are cur-
rent on their knowledge and skills. With certification and licensure, there is often a
state board that is made up of individuals who review applications and complaints
318 12 Supervision and Professional Development in Child Welfare

for professional misconduct and works with the Office of the Inspector General to
conduct hearings, write reports, and determine punitive measures and license/certi-
fication suspensions and revocations.

Practice Highlight
Child Welfare Licensing in Illinois
In most states and jurisdictions, a degree, experience, and training are required
to assume the role of child welfare practitioners. As described in earlier chap-
ters, there are a number of roles in child welfare work; however, practitioners
working directly with children and families often require more experience
and training. In some states, like Illinois these practitioners are required to
obtain Child Welfare Employee Licensure (CWEL) to assume direct practice
roles. In order to qualify, individuals must have a degree (bachelor’s, prefer-
ably a master’s); complete classroom and/or virtual training related to special
populations, policies and practices, and basic social work skills (e.g., engage-
ment); and complete and pass a series of exams (risk and safety assessment,
placement specialty, and CWEL). Applicants must not be in default of an
educational loan and not be subject of a child abuse/neglect investigation or
conviction, and they must have a valid driver’s license and fingerprint clear-
ance. CWEL licenses are monitored by an office within the Illinois Department
of Children and Family Services and work closely with the Illinois Office of
the Inspector General (OIG) to monitor any complaints, infractions, and over-
sight. Many schools of social work in Illinois offer training and exams to
students enrolled in their programs to prepare them for licensure upon
graduation.

Child Welfare Professional Safety

Safety rightfully is a concern for child welfare workers. A national study reported
that approximately 70% of child welfare workers in the United States have been
victims of violence or threat of violence in the workplace (American Federation of
State, County, and Municipal Employees, 2011). A statewide study of child protec-
tive services workers found within the first 6 months of employment 75% experi-
enced nonphysical violence, 37% experienced threats, and 2.3% experienced
physical violence (Radey & Wilke, 2018). According to Occupational Safety and
Health Administration (OSHA) standards, child welfare workers are at risk to expe-
rience violence in the workplace. The OSHA standards highlight 10 different risk
factors for workplace violence. Eight can be considered elements of child welfare
workers’ job responsibilities: contact with the public; delivery of passengers, goods,
or services; having a mobile workplace such as a taxicab or police cruiser; working
with unstable or volatile persons in healthcare, social service, or criminal justice
settings; working alone or in small numbers; working late at night or during early
Child Welfare Professional Safety 319

morning hours; working in high-crime areas; and working in community-based set-

tings (NIOSH, 2016). Child welfare workers often work alone during various hours
of the day in the homes of families where there is a perceived adversary and conflict
related to allegations of child maltreatment and in neighborhoods that are dispro-
portionately of lower socioeconomic levels and may have high levels of crime.
Training for child welfare professionals should include information on safety.
The goal of the trainings should be to increase worker safety through familiarizing
workers with risk factors for violence and agency policies and resources related to
safety. Workers must master techniques to handle potential violence such as de-­
escalation. It is important to recognize that empathy and engagement skills proac-
tively contribute to keeping workers safe. (See Chap. 6 for information about
engagement.)
Worker safety begins with the commitment to safety and open communication.
Agency leaders and workers alike must prioritize creating an environment where
child welfare professionals can work free from violence and threats of violence.
Safety concerns must be taken seriously. Efforts should be proactive; rather than
waiting to respond to violence, violence can be avoided. Awareness of the situation
as well as environment is key. Workers should have the available information about
the families they are serving. They should know if there is a history of violence and
any concerning issues that could escalate violence. Many agencies have the ability
to conduct background checks which can provide relevant information. Within the
work environment, there should be easy access to exiting a workspace and a system
to alert others to immediate safety concerns. This could be predetermined code
words or a silent panic button. There can be policies of workers meeting with poten-
tially volatile or violent people with a colleague present. Within office spaces,
objects that could be used to hurt someone (e.g., scissors, staplers) should not be in
the space where meeting with clients. If possible, child welfare workers should
avoid meeting in spaces where objects could easily become weapons (e.g., knives,
tools). While most home visits are conducted individually, workers typically can
request a colleague to accompany them, and in some instances law enforcement can
be present.
In addition to training workers, child welfare agencies are responsible for creat-
ing a culture of safety to assist with prevention of client-perpetrated violence. The
NASW (2013) Guidelines for Social Work Safety in the workplace emphasizes that
agencies must “establish and maintain an organizational culture that promotes
safety and security for their staff” and “create a culture of safety that adopts a proac-
tive preventative approach to violence management and risk.” (p. 9). While having
policies and procedures that focus on safety are important, it is also crucial that
agencies respond appropriately when an incident of violence occurs. A response
begins with supporting the worker who experienced the violence. Also important in
the response includes proper documentation and a debriefing where agencies can
process how to learn from the incident to hopefully minimize the likelihood of
future incidents. The Capacity Building Center for States’ Child Welfare Worker
Safety Guide (2017) comprehensively explores the key issues about worker safety
and provides direction for how agencies can increase safety in the workplace.
320 12 Supervision and Professional Development in Child Welfare

Retention and Job Satisfaction

The average length of child welfare employment is less than 2 years (US GAO,
2003). Studies have reported the worker turnover in child welfare workers within
the first few years of hire ranging from 20% to 50%, with highest rates during the
first 3 years of starting the position (Chenot et al., 2009; Smith, 2005). Worker turn-
over is a concern for multiple reasons. Changes in child welfare professionals
assigned to a case are related to poorer outcomes for children and families (US
GAO, 2003). Reducing turnover increases timely investigations and more client
contact, both key elements of quality service delivery and can contribute to increas-
ing child safety, permanency, and well-being. In addition to worker retention being
important due to its connection with outcomes for children and families, worker
turnover costs a lot. Training new workers is both time-consuming and expensive.
When workers do not stay long, the investment of training them is not recuperated.
Worker turnover also has a negative impact within the work environment and col-
leagues. When people leave, especially those who leave with little notice, colleagues
must take over their cases and their work burden increases.
The importance of child welfare workers’ satisfaction with their job extends
beyond avoiding burnout and secondary trauma. Helping families and seeing posi-
tive changes are important aspects contributing to job satisfaction (McGowan et al.,
2010; Johnco et al., 2014). A study of recently hired frontline child welfare profes-
sionals reported their satisfaction with the work largely was due to helping and
making a difference (Schelbe et al., 2017). Additionally, the autonomy of the posi-
tion and variety in the work was cited as contributing to their job satisfaction.
There are multiple stressors that workers experience that can erode their satisfac-
tion with the job. Excessive workload and large caseloads are especially concerning
in contributing to dissatisfaction (US GAO, 2003). Aspects of the work that create
tension and dissatisfaction have been found to include administrative requirements,
workload, unsupportive colleagues, and working with challenging parents and hurt
children (Schelbe et al., 2017). Additionally, working in a trauma-filled environ-
ment can be stressful. (See Chap. 5 for information about trauma-informed practice.)

Burnout and Secondary Traumatic Stress

Child welfare workers are at risk for burnout, secondary traumatic stress, and vicari-
ous traumatization. One study found almost a third of child welfare workers in their
sample experienced high levels of burnout (30%) and secondary trauma (29%;
Salloum et al., 2015). This finding has been replicated elsewhere where approxi-
mately a third of child welfare workers experience vicarious traumatization
(Middleton & Potter, 2015). Burnout, caused by administrative stress or burden, is
one of the main reasons that child welfare professionals cite for leaving their posi-
tions. Burnout develops over time. Factors that contribute to burnout include high
Self-care 321

caseloads, immense amount paperwork and documentation, demanding work envi-

ronment, rigid procedures, communication problems, and inadequate training
(Barak et al., 2006). An unsupportive environment where supervisor and peer sup-
port are limited or the unit does not function as a team can contribute to burnout.
When workers perceive unfairness or have few opportunities to influence their work
and policies, they may experience burnout. Symptoms of burnout include a wide
range of negative reactions such as physical and emotional exhaustion; chronic
fatigue; feeling hopeless and helpless; feeling disillusioned; feeling negative about
self and holding a negative outlook towards others and life; high absenteeism and
tardiness; inability to cope; experiencing depersonalization; not performing work to
meet the needs of clients; and not completing assigned work responsibilities (Barak
et al., 2006).
Related to burnout are secondary traumatic stress and vicarious traumatization.
Secondary traumatic stress is when someone experiences trauma indirection through
hearing about another person’s firsthand experience of trauma. Unlike burnout, sec-
ondary trauma can occur from one event, although it can also be the accumulation
of the impact of the work. The symptoms mirror those of posttraumatic stress disor-
der. Vicarious trauma occurs when someone works with people who have experi-
enced trauma and through their repeated exposure to other people’s trauma their
worldview is impacted and behaviors change.
Secondary traumatic stress and vicarious trauma have a range of outcomes for
workers including impaired judgment, low motivation, decreased productivity,
poorer quality of work, decreased compliance with agency requirements, absentee-
ism, and quitting (Barak et al., 2006). These outcomes result in problems for agen-
cies in terms of issues with quality of services provided, staff friction, and higher
staff turnover (Barak et al., 2006). All of which can have negative impacts on chil-
dren and families served by child welfare professionals.
Prevention of burnout, secondary trauma stress, and vicarious trauma may seem
to rest on the shoulders of child welfare professionals and their need to better man-
age stress and trauma. However, in actuality, child welfare agencies have the respon-
sibility and ability to reduce the likelihood of burnout and secondary traumatic
stress in child welfare workers. There are multiple strategies to do so including
effective recruitment, training, increasing knowledge, developing coping skills,
quality supervision, social support, addressing workplace culture and climate, and
recognizing diversity of workforce.

Self-care

Self-care is the activities and practices that someone regularly engages in to main-
tain and enhance their current and future health and well-being. Child welfare pro-
fessionals have been found to engage only in modest amounts of self-care although
it is promising to maintain well-being and retention within child welfare (Miller
et al., 2019). Self-care is multidimensional and consists of various components:
322 12 Supervision and Professional Development in Child Welfare

body, mind, and spirit. The caring for the body is attending to physical health at a
basic level including ensuring proper nutrition and hydration as well as adequate
sleep. Self-care includes seeing healthcare providers for routine checkups and
timely appointments should health concerns arise. It includes getting exercise and
staying active. Some people get massages or acupuncture as part of their physical
healthcare. Taking a bath or soaking in a hot tub could also be self-care.
The mind aspect of self-care focuses on attending to someone’s mental and emo-
tional state. In many regards, it starts with the noticing of feelings. Self-care involv-
ing the mind is ensuring that negative feelings and thoughts do not become all
consuming. It includes addressing and decreasing stressors. Maintaining a positive
outlook is one of the goals of self-care. To do so, some people talk to others or jour-
nal. They spend time proactively looking for the positive aspects of life and focus-
ing on being aware of their feelings. To address negative feelings, self-care can
include spending time relaxing and doing activities that are fun or restorative. This
could include reading a book, putting together a puzzle, knitting, crafting, or other
hobbies. It can also include spending time with friends and family.
The spirit component of self-care can be understood as taking care of the soul
and connecting to something larger than oneself. For some, this could be in the form
of religion and being active in a church, synagogue, or mosque. Others may embrace
spirituality outside of an organized religion. Spending time in nature and admiring
the beauty of the world can be components of self-care related to the spirit. Likewise,
reading poems or books that inspire can also be considered self-care. Some consider
their creative outlets, including art, music, and dance to be elements of spiritual
self-care.
Self-care includes practices in and outside the workplace. Within the workplace,
self-care practices include setting healthy boundaries with clients and colleagues,
creating a strategy to address the different work tasks, and finding time to eat lunch
and take breaks during the day. A support system within the workplace with col-
leagues and supervisors can be central to self-care and can be fostered through regu-
larly scheduled supervision or routine check-ins with colleagues. As the paperwork
demands can be great and require extensive time at a computer, workers should
explore ways to be active at work. For example, standing up during a phone call or
having a “walking meeting” with a colleague instead of sitting at their desks.
Outside the workplace, self-care mirrors the workplace. Ensuring that work does
not “splash over” outside working hours. While arguably child welfare workers
working hours may be different from a 9-to-5 job, setting boundaries and not engag-
ing in work activities (i.e., phone calls, paperwork, consultations) during nonwork
hours is an important part of self-preservation and self-care. While it may be diffi-
cult, trying not to think about work responsibilities and cases when “off the clock”
is important. To establish a delineation between professional and personal lives,
some workers practice a ritual to establish the transition between the two. This
could be as simple as listening to a playlist on the drive home or coming home,
changing clothes, feeding a pet, and opening the mail.
Self-care 323

Developing a Self-care Plan

The adage “if you fail to plan, you plan to fail” is apropos in regards to child welfare
professionals developing a self-care plan. Self-care does not happen accidentally; it
must be intentionally planned and tailored to the need of individual workers. Child
welfare professionals need to develop a plan for their self-care. A good plan goes
beyond identifying activities that can help relax and unwind after a stressful inci-
dent. It should include details about being proactive in securing support and manag-
ing the ongoing demands of the work. The development of a plan for self-care
should be intentional. It should be specific for the person, based on individual pref-
erences and life circumstances. For some people, the physical aspects of a self-care
plan mean running multiple times a week, whereas for others it may be yoga classes
or playing in an adult kickball league. People need to determine what will work best
for themselves, although they may wish to try something that they have not
tried before.
There are many resources that can also be used to develop a plan for self-care.
The State University of New York at Buffalo (2019) has online materials to guide
the creation of plans starting with an assessment of current “negative” and “posi-
tive” coping strategies. In addition to creating a plan to use to address typical daily
stressors, it also includes a plan for self-care in a crisis. Another resource for self-­
care is The A-to-Z Self-Care Handbook for Social Workers and Other Helping
Professionals (Grise-Owens et al., 2016). The book highlights 26 different aspects
of self-care, encouraging readers to find balance in their professional lives. Other
websites and books seek to assist with
the similar message: self-care cannot
Reflection
be optional or accidental. To be an
effective child welfare professional, it Assessing Boundaries: Personal
is necessary to plan self-care. The Boundary Vulnerabilities
importance of child welfare profes-
1. What are influences of your past
sionals practicing self-care cannot be
and current experiences?
overstated.
2.  Think about influencing factors
Developing a plan for self-care
and how they impacted your
early is helpful when done thought-
boundaries (e.g., family, gender,
fully and early in one’s career. The
culture, religion, and generation.)
self-care plan is meant to evolve
3. What are your personal tenden-
depending on work responsibilities,
cies as a result?
family responsibilities, and interests.
4. What types of clients and scenar-
The plan should be individualized to
ios might cause you to be entan-
meet all of those areas and should
gled or to become rigid?
address psychological, emotional,
5.  Think about professional experi-
physical, spiritual, and professional
ences, what are two to three most
needs. Trying to find a balance in work
influential events that mark devel-
and personal life is often challenging,
opmental boundaries development?
but not impossible. As a child welfare
324 12 Supervision and Professional Development in Child Welfare

professional, it can be easy to work extra hours and begin to give up areas of per-
sonal development (e.g., exercise, healthy diet, relationships); however, recognizing
when these behaviors begin is important in order to intervene and correct.
Establishing boundaries with co-­workers, clients, and in personal relationships is
important in self-care. As individuals, we all have levels of comfort around the
physical, emotional, professional, and personal boundaries. We choose who we
spend time with, when we answer the phone, and the number of hours we work. As
professionals who may hold a significant amount of trust and power with our clients
and their families, it is important to be aware of this and ensure balance.

Boundaries

Professional relationship boundaries can be understood within a continuum as it

ranges from entangled boundaries to rigid boundaries. Entangled boundaries refer
to a consistent over-involvement, where a worker may be investing more of their
time, emotional energy, or favor in his relationship than in others, in a manner that
is unhelpful for the client. A worker with entangled boundaries meets their own
emotional, social, or physical needs through the relationship with their client, at the
expense of the client. Rigid professional boundaries refer to those who go forward
with their own agenda, inflexibly, condescendingly, and without attending to the
unique and multifaceted needs of the client. Their lack of authenticity and sensitiv-
ity while attending to the client’s needs contravenes their ethical responsibility to
honor the dignity and worth of the individual. Responding rigidly exploits the cli-
ent’s vulnerabilities and is an abuse of the professional’s position of power as it
accentuates and even exaggerates the power differential between them. Equally
between rigid and entangled boundaries is a balance. Professionals with balanced
boundaries are authentic and caring while maintaining clear boundaries. They use
their authority appropriately; remaining aware of their position of power, they take
care to neither exploit their client’s vulnerabilities nor infringe on their rights. Those
functioning in a balanced manner use professional judgment and self-reflection
skills in their assessments and make decisions that are professionally despoiled and
accountable to other professionals.

Conclusion

In child welfare, clinical and administrative supervision are critical to ensure client,
worker, and agency standards, as well as personal well-being and safety. There are
many ways one can engage in supervision, whether it be individual, group, clinical,
and/or administrative. In general, a strengths-based, solution-focused, and trauma-­
informed approach to supervision is optimal for the supervisor and child welfare
professional and for ideal case outcomes. Both supervisor and child welfare
Conclusion 325

professional must be invested and committed to consistent, organized supervision to

ensure best outcomes and satisfaction. To continue to develop professional skills
and practices, child welfare professionals should engage in continuing education
and training and continue to set and work towards goals of improving knowledge
and skills. Supervision and professional development include developing a plan for
self-care and setting boundaries that can help with reducing the incidence of burn-
out and secondary traumatic stress, which, in turn, could improve longevity in child
welfare practice and improve individual well-being.

Acknowledgments The authors thank Cynthia A. Lietz, PhD, LCSW, and Lisa Garcia, MSW, for
their contributions to Chap. 12.

Discussion Questions
1. What are two reasons that supervision in so critical in child welfare practice?
2. What are the child welfare professional’s responsibilities and role in supervision?
3. What are two ways that child welfare professionals can engage in professional
development?
4. How can child welfare systems promote child welfare professional retention and
job satisfaction?
5. What are two ways child welfare professionals can engage in self-care and avoid
burnout?

Suggested Activities
1. Complete the self-care assessment at https://socialwork.buffalo.edu/content/
dam/socialwork/home/self-­care-­kit/self-­care-­assessment.pdf, and come up with
two strategies for each domain to improve your personal and professional
self-care.
2. Join a professional group (e.g., NASW, CSWE, APSAC, etc.), and find local and
national opportunities for professional development.
3. Interview a child welfare professional, and ask about how they engage in profes-
sional development and self-care.
4. Find an article or a podcast about self-care in child welfare, and consider new
ways to engage in your own self-care.
5. Research the licensure and certification requirements for the state you live in or
a state you might want to live in. What steps would you have to take to become
licensed or certified to be a child welfare professional?
6. Participate in an online training designed to reduce racism and implicit bias (e.g.,
https://kirwaninstitute.osu.edu/implicit-­bias-­101).
7. Complete the Implicit Association Test (IAT), which measures if there are posi-
tive or negative attitudes towards a concept or social group. (Available: https://
implicit.harvard.edu/).
Reflect on your results. How has your life experience shaped your results?
How could your results impact the way that you serve children and families
involved in the child welfare system?
326 12 Supervision and Professional Development in Child Welfare

8. Read Akin et al. (2016), and write a reflection paper about ideas to improve train-
ing for frontline child welfare professionals.
Akin, B. A., Brook, J., Byers, K. D., & Lloyd, M. H. (2016). Worker perspec-
tives from the front line: Implementation of evidence-based interventions in
child welfare settings. Journal of Child and Family Studies, 25(3), 870–882.
(Available https://rdcu.be/ccaNs).

Additional Resources
American Professional Society on the Abuse of Children: Forensic Interviewing
training clinics and institutes: https://www.apsac.org/forensicinterviewing
Child Welfare Information Gateway, Ethics: https://www.childwelfare.gov/topics/
management/ethical/
Child Welfare Information Gateway, Worker safety: https://www.childwelfare.gov/
topics/management/workforce/workforcewellbeing/safety/
Kirwan Institute, Exploring Implicit Bias in Child Protection training: https://kirwa-
ninstitute.osu.edu/implicit-­bias-­101
State University of New York at Buffalo School of Social Work Self Care
Information: http://socialwork.buffalo.edu/resources/self-­care-­starter-­kit/
introduction-­to-­self-­care.html
National Child Welfare Workforce Institute: https://www.ncwwi.org/
National Child Welfare Workforce Institute, Racial Equity Resources:
https://ncwwi.org/index.php/resourcemenu/racial-­equity

References

Akin, B. A., Brook, J., Byers, K. D., & Lloyd, M. H. (2016). Worker perspectives from the front
line: Implementation of evidence-based interventions in child welfare settings. Journal of
Child and Family Studies, 25(3), 870–882. https://doi.org/10.1007/s10826-­015-­0283-­7
American Federation of State, County and Municipal Employees. (2011).
Double jeopardy: Caseworkers at risk helping at-risk kids. Retrieved from
h t t p : / / w w w. a f s c m e . o r g / n e w s / p u b l i c a t i o n s / w o r k p l a c e -­h e a l t h -­a n d -­s a f e t y /
double-­jeopardy-­caseworkers-­at-­risk-­helping-­at-­risk-­kids
Barak, M. E. M., Levin, A., Nissly, J. A., & Lane, C. J. (2006). Why do they leave? Modeling child
welfare workers’ turnover intentions. Children and Youth Services Review, 28(5), 548–577.
https://doi.org/10.1016/j.childyouth.2005.06.003
Capacity Building Center for States. (2017). The child welfare work safety guide. Retrieved from
https://library.childwelfare.gov/cwig/ws/library/docs/capacity/Blob/115592.pdf?r=1&rpp=10
&upp=0&w=+NATIVE(%27recno=115592%27)&m=1
Cearley, S. (2004, October). The power of supervision in child welfare services. In Child and Youth
Care Forum (Vol. 33, No. 5, pp. 313–327). Kluwer Academic Publishers-Plenum Publishers.
Chenot, D., Benton, A. D., & Kim, H. (2009). The influence of supervisor support, peer support,
and Organizational culture among early career social workers in Child Welfare Services. Child
Welfare, 88(5), 29–148.
Collins-Camargo, C., & Millar, K. (2010). The potential for a more clinical approach to child wel-
fare supervision to promote practice and case outcomes: A qualitative study in four states. The
Clinical Supervisor, 29(2), 164–187. https://doi.org/10.1080/07325223.2010.517491
References 327

Collins-Camargo, C., & Royse, D. (2010). A study of the relationships among effective
supervision, organizational culture promoting evidence-based practice, and worker self-­
efficacy in public child welfare. Journal of Public Child Welfare, 4(1), 1–24. https://doi.
org/10.1080/15548730903563053
DePanfilis, D., & Zlotnik, J. L. (2008). Retention of front-line staff in child welfare: A system-
atic review of research. Children and Youth Services Review, 30(9), 995–1008. https://doi.
org/10.1016/j.childyouth.2007.12.017
Faller, K. C., Grabarek, M., & Ortega, R. M. (2010). Commitment to child welfare work: What
predicts leaving and staying? Children and Youth Services Review, 32(6), 840–846. https://doi.
org/10.1016/j.childyouth.2010.02.003
Frey, L., LeBeau, M., Kindler, D., Behan, C., Morales, I. M., & Freundlich, M. (2012). The pivotal
role of child welfare supervisors in implementing an agency's practice model. Children and
Youth Services Review, 34(7), 1273–1282. https://doi.org/10.1016/j.childyouth.2012.02.019
Greenwald, A. G., McGhee, D. E., & Schwartz, J. L. (1998). Measuring individual differences in
implicit cognition: The implicit association test. Journal of Personality and Social Psychology,
74(6), 1464. https://doi.org/10.1037/0022-­3514.74.6.1464
Grise-Owens, E., Miller, J., & Eaves, M. (2016). Self-care handbook. White Hat Communications.
Hanna, M. D., & Potter, C. C. (2012). The effective child welfare unit supervisor. Administration
in Social Work, 36(4), 409–425. https://doi.org/10.1080/03643107.2011.604403
Johnco, C., Salloum, A., Olson, K. R., & Edwards, L. M. (2014). Child welfare workers' perspectives
on contributing factors to retention and turnover: Recommendations for improvement. Children
and Youth Services Review, 47, 397–407. https://doi.org/10.1016/j.childyouth.2014.10.016
Kadushin, A., & Harkness, D. (2002). Supervision in social work. Columbia University Press.
Kruzich, J. M., Mienko, J. A., & Courtney, M. E. (2014). Individual and work group influences
on turnover intention among public child welfare workers: The effects of work group psy-
chological safety. Children and Youth Services Review, 42, 20–27. https://doi.org/10.1016/j.
childyouth.2014.03.005
Landsman, M. (2007). Supporting child welfare supervisors to improve worker retention. Child
Welfare, 86(2), 105. https://doi.org/10.1037/e522532014-­205
Lietz, C. A. (2009). Critical thinking in child welfare supervision. Administration in Social Work,
34(1), 68–78. https://doi.org/10.1080/03643100903432966
Lietz, C. A. (2013). Strengths-based supervision: Supporting implementation of family-centered
practice through supervisory processes. Journal of Family Strengths, 13(1), 6.
Lietz, C. A., Hayes, M. J., Cronin, T. W., & Julien-Chinn, F. (2014). Supporting family-centered
practice through supervision: An evaluation of strengths-based supervision. Families in Society,
95(4), 227–235. https://doi.org/10.1606/1044-­3894.2014.95.29
Lietz, C. A., & Julien-Chinn, F. J. (2017). Do the components of strengths-based supervision
enhance child welfare workers' satisfaction with supervision? Families in Society, 98(2),
146–155. https://doi.org/10.1606/1044-­3894.2017.98.20
Madison, M. (2016). Dear ECE, we need to talk about racism. Available https://ecepolicyworks.
com/dear-­ece-­we-­need-­to-­talk-­about-­racism/
McGowan, B. G., Auerbach, C., Conroy, K., Augsberger, A., & Schudrich, W. (2010). Workforce
retention issues in voluntary child welfare. Child Welfare, 89(6), 83.
Middleton, J. S., & Potter, C. C. (2015). Relationship between vicarious traumatization and
turnover among child welfare professionals. Journal of Public Child Welfare, 9(2), 195–216.
https://doi.org/10.1080/15548732.2015.1021987
Miller, J. J., Donohue-Dioh, J., Niu, C., Grise-Owens, E., & Poklembova, Z. (2019). Examining
the self-care practices of child welfare workers: A national perspective. Children and Youth
Services Review, 99, 240–245. https://doi.org/10.1016/j.childyouth.2019.02.009
Mor Barak, M. E., Nissly, J. A., & Levin, A. (2001). Antecedents to retention and turnover among
child welfare, social work, and other human service employees: What can we learn from
past research? A review and metanalysis. Social Service Review, 75(4), 625–661. https://doi.
org/10.1086/323166
328 12 Supervision and Professional Development in Child Welfare

National Association of Social Workers. (2013). NASW standards for social work practice in child
welfare. NASW Press.
National Child Traumatic Stress Network. (2020). Creating trauma-informed systems. Retrieved
from: https://www.nctsn.org/trauma-­informed-­care/creating-­trauma-­informed-­systems
NIOSH. (2016). https://www.cdc.gov/niosh/docs/96-­100/risk.html
Ortega, R. M., & Coulborn, K. (2011). Training child welfare workers from an intersectional cul-
tural humility perspective: A paradigm shift. Child Welfare, 90(5), 27–49.
Radey, M., & Schelbe, L. (2020). Gender support disparities in a majority-female profession.
Social Work Research, 44(2), 123–135. https://doi.org/10.1093/swr/svaa004
Radey, M., & Wilke, D. J. (2018). Client-perpetrated violence among frontline child welfare work-
ers. Journal of Interpersonal Violence. https://doi.org/10.1177/0886260518812792
Rzepnicki, T., & Johnston, P. (2005). Examining decision errors in child protection: A new appli-
cation of root cause analysis. Children and Youth Services Review, 27, 393–407. https://doi.
org/10.1016/j.childyouth.2004.11.015
Salloum, A., Kondrat, D. C., Johnco, C., & Olson, K. R. (2015). The role of self-care on compas-
sion satisfaction, burnout and secondary trauma among child welfare workers. Children and
Youth Services Review, 49, 54–61. https://doi.org/10.1016/j.childyouth.2014.12.023
Schelbe, L., Radey, M., & Panish, L. (2017). Satisfactions and stressors experienced by recently-­
hired frontline child welfare workers. Children and Youth Services Review, 78, 56–63. https://
doi.org/10.1016/j.childyouth.2017.05.007
Smith, B. D. (2005). Job retention in child welfare: Effects of perceived organizational sup-
port, supervisor support, and intrinsic job value. Children and Youth Services Review, 27(2),
153–169. https://doi.org/10.1016/j.childyouth.2004.08.013
State University of New York at Buffalo. (2019). http://socialwork.buffalo.edu/resources/self-­care-­
starter-­kit/developing-­your-­self-­care-­plan.html
Tervalon, M., & Murray-Garcia, J. (1998). Cultural humility versus cultural competence: A criti-
cal distinction in defining physician training outcomes in multicultural education. Journal of
Health Care for the Poor and Underserved, 9, 117–125. https://doi.org/10.1353/hpu.2010.0233
United States. General Accounting Office. (2003). Child welfare: HHS could play a greater role
in helping child welfare agencies recruit and retain staff: Report to congressional requesters.
US General Accounting Office.
Weatherston, D., Weigand, R. F., & Weigand, B. (2010). Reflective supervision: Supporting reflec-
tion as a cornerstone for competency. Zero to Three, 31(2), 22–30.
Index

A B
Abandonment, 92 Battered-Child Syndrome, 5
Abuse Black Lives Matter Protest, 10
indicators mistaken for, 86 Boundaries
Active listening, 150 professional development, 324
Actuarial-based approaches Brief Trauma Questionnaire (BTQ), 128
child welfare practice, Burnout
assessment, 200–202 professional development, 320, 321
Administration for Children and Families
(ACF), 178, 184
Administration on Children, Youth and C
Families (ACYF), 14 CDC Essentials for Childhood, 181, 183
Adoption Center for the Study of Social Policy
child welfare practice, permanency, (CSSP), 178
256, 257 Center for the Study of Social Policy (CSSP)
Adoption and Foster Care Analysis and strengthening families, 179, 180
Reporting System Certification
(AFCARS), 1, 249 professional development, 317, 318
Adoption and Safe Families Act (ASFA), 6, 7, Child abuse, 23, 32, 33, 191
189, 233, 252 Child Abuse Prevention and Treatment Act
Adoption Assistance and Child Welfare Act (CAPTA), 5, 83, 177
(AACWA), 6, 189, 233 Child advocacy centers (CACs), 34
Adverse childhood experiences (ACEs), 122, Child and Adolescent Needs and Strengths
124, 132 (CANS), 128, 208
Affective sharing, 19 Child and Family Services Reviews
Aging out of care, 262 (CFSR), 13
American Academy of Pediatrics (AAP), 188 Child assessments, 208, 209
Another Planned Permanent Living Child behavior, 73
Arrangement (APPLA), 254, Child development
255, 262 attachment disorders, 69, 70
Attachment theory, 66, 67 attachment theory, 66, 67
Authoritarian parents, 71 child behavior, 73
Authoritative parenting, 71 child discipline, 72

© Springer Nature Switzerland AG 2021 329

J. M. Geiger, L. Schelbe, The Handbook on Child Welfare Practice,
https://doi.org/10.1007/978-3-030-73912-6
330 Index

Child development (cont.) policies

cognitive development, 55 family preservation, 188, 189
dental examination, 65 prevention strategies, 179
difficult developmental phases, 73–75 CDC Essentials for Childhood,
early intervention programs, 64 181, 183
emotional development, 55 Center for the Study of Social Policy
eye examination, 66 strengthening families, 179, 180
family roles, 70 primary prevention approaches, 175, 176
impede/delay normative development, 59 secondary prevention approaches, 176
medical examination, 65 tertiary prevention approaches, 176
normative observations, 56–58 Child Maltreatment Prevention Programs, 184
parent-child bonding, 69 Child Post-Traumatic Symptom Scale
parent-child relationships, 76, 77 (CPSS), 128
parenting styles, 70 Child protection, 30
physical development, 55 child welfare system, 40, 42, 43
prenatal drug exposure and development Child protection services process, 31
impact, 59–63 Child Protection Teams, 30
sexual development, 55 Child PTSD Symptom Scale (CPSS), 128
Child discipline, 72 Child Report of Post-Traumatic Symptoms
Child fatalities, 2 (CROPS), 128
Child fatality rates, 1 Child sexual abuse, 87
Child maltreatment, 1, 2, 75, 83, 155 familial consequences After, 103
child welfare, ongoing debates in, 108, 109 Child Trauma Screening Questionnaire
consequences of, 101, 102 (CTSQ), 128
emotional abuse, 103, 104 Child traumatic stress, 116
neglect, 104–106 Child welfare, 13
physical abuse, 102 child and family teams, 167, 168
sexual abuse, 103 child maltreatment prevention, 15
cultural considerations, 107, 108 child welfare professional, 146, 147
elements of, 83 collaborative practice in, 157
emotional abuse, 88–89 culturally grounded engagement, 146
signs and symptoms of, 89 educators and school system, 165, 167
neglect, 90–93 empathy in, 20
signs and symptoms of, 93, 94 engaging parents, 139–141, 143
physical abuse, 84 family-centered practice in, 141
signs and symptoms of, 85, 86 implementation science for, 95, 96
polyvictimization, 94, 95 individuals and families, 151, 152
risk factors, 96–99 intimate partner violence (IPV), 154, 155
protective factors, 99–101 and Juvenile Justice Dual System
sexual abuse, 86, 87 Involvement, 231, 232
disclosure, 87 kinship placements, 159
signs and symptoms of, 88 law enforcement officers, 161
short- and long-term consequences, 83 medical and behavioral health providers,
societal consequences, 106, 107 163, 164
systems’ historical response to, 3–5 mental illness, 155, 156
Child maltreatment prevention, 15, 24, motivational interview, 149, 150
107, 175–177 ongoing debates in, 108, 109
history of, 177, 178 permanency, 13
models as profession
community-level empathy in, 19–21
interventions, 185–187 managing bias and navigating
Home Visiting Programs, 183, 184 professional identity, 21, 22
parent education programs, 185 trauma, 20, 21
Index 331

protective factors, 16 clinical supervision, 301, 302

residential or group home staff, 160 group supervision, 306
safety, 13 maximizing supervision, 307, 308
skills in, 19 practices and strategies, 309, 310
solution-focused approach, 148 research, 300
strength-based approach, 139 solution-focused supervision, 305
substance abuse, 153, 154 strengths-based supervision, 302–304
substitute caregivers, 157–159 trauma-informed supervision, 304, 305
well-being, 14 youth aging, 283
Child welfare agencies, 2, 11, 29 youth aging out/transition-age
Child Welfare Employee Licensure youth, 277–280
(CWEL), 318 Child welfare practice, assessment
Child welfare licensing, 318 actuarial and clinical-based
Child welfare practice approaches, 200–202
assessment and intake in, 24 case notes, 211–213
child and family engagement in, 24 conducting family and home
adolescents, 283 assessments, 207
disabilities and special needs, 272, 273 child assessments and, 208, 209
educational and vocational dynamics and patterns, 208
opportunities, 282 nuclear and extended families, 208
employment opportunities, 282 documentation, 210, 211
human and sex trafficking, 288–291 forensic interviewing, 209, 210
immigrant and refugee children and safety and risk, 195–197
families, 285–287 goals, 197, 198
LGBTQ youth, 274, 275 service need, identifying families, 203
permanency in, 249 by abuse type, 203, 204
achieving permanency, 259–261 in different contexts, 205
adoption, 255–257 skills for, 205, 206
best interests, 258 tools, 199, 200
concurrent permanency Child welfare practitioner safety
planning, 258–260 professional development, 318, 319
factors, 261 Child welfare professionals (CWP), 17, 18,
family-centered practice, 264, 265 44, 46, 47, 309
foster care re-entry, 265, 266 professional development for, 313, 314
guardianship, 257 burnout and secondary traumatic stress,
older youth, permanency planning 320, 321
for, 261–264 child welfare practitioner safety,
planning, 249, 250 318, 319
policies and laws, 252, 253 ethics and legal issues, 315
principles guiding permanency goals, 314, 315
planning, 251, 252 licensure and certification, 317, 318
reunification with biological parents/ racial equity and cultural humility,
caregivers, 253 316, 317
as profession, 16 retention and job satisfaction, 320
characteristics of, 16 self-care, 322
ethics, 18 Child welfare system, 2, 3, 23, 25, 29, 30
mandates, 17, 18 case management, 33, 34
professional responsibilities, 16, 17 child maltreatment, systems’ historical
safe and affordable housing, 283 response to, 3–5
sibling relationships, 288 child protection and foster care, 40, 42, 43
supervision in, 300 child welfare position and
agency responsibility for, 308 responsibilities, 41–42
best interest, 301 children’s rights, 50
332 Index

Child welfare system (cont.) Emotional development, 55

court, preparing for and testifying Empathy, 144
in, 48, 49 child welfare, 19–21
dependency court system, Engagement
navigating, 44, 45 family engagement, 137, 138, 144
intake, 33 Ethics
law enforcement investigations, 34, 35 child welfare practice as profession, 18
parents’ rights, 49, 50 professional development, 315
privatization, 38 Every Student Succeeds Act (ESSA), 36, 166
professional partners, 35, 36 Evidence-based programs, 184
services, 37, 38 Evidence-based protocols, 210
Child Welfare Worker Safety Guide, 319
Children’s rights
child welfare system, 50 F
Clinical-based approaches Family and home assessments
child welfare practice, child welfare practice assessment, 207
assessment, 200–202 child assessments and, 208, 209
Clinical supervision, 25, 301, 302 dynamics and patterns, 208
Cognitive development, 55 nuclear and extended families, 208
Coining, 107 Family-centered practice, 141
Commercial sexual exploitation of children child welfare practice, permanency,
(CSEC), 86–87 264, 265
Community Child maltreatment Family engagement, 137, 138
prevention, 185–187 in interviewing, 206
Concurrent permanency planning Family Finding, 264
child welfare practice, Family First Act, 187
permanency, 258–260 Family First legislation, 7
Congregate care, 228 Family First Prevention Services Act (FFPSA),
Council on Social Work Education 7, 8, 253, 262
(CSWE), 43 Family Group Decision-Making (FGDM), 142
Court Appointed Special Advocate (CASA), Family preservation
39, 40, 44 child maltreatment prevention policies,
Crimes Against Children Research Center 188, 189
(CCRC), 94 Family Preservation and Support Services
Cultural competence, 316 Program Act, 178
Cultural humility, 316, 317 Family reunification, 250
Cupping, 86, 107 Federal child welfare policies
addressing racial and ethnic disparities, 8
and disproportionalities, 8–10
D Indian Children Welfare Act of
Dependency court hearings 1978, 10, 11
caseworkers in, 45, 49 Multiethnic Placement Act of 1994 and
Documentation Interethnic Placement Act of
child welfare practice, assessment, 1996, 12
210, 211 Adoption and Safe Families Act of
1997, 6, 7
Adoption Assistance and Child Welfare Act
E of 1980, 6
ECE programs, 76 Family First Prevention Services Act, 7, 8
Education and training vouchers (ETV), 281 Forensic interviewing
Emergency foster care, 230 child welfare practice, assessment,
Emotional abuse, 88–89, 204 209, 210
consequences of, 103, 104 Foster Care Independence Act (FCIA), 281
signs and symptoms of, 89 Foster care placement
Index 333

children’s needs and circumstances, 219 traumatic stress, 116

congregate care, 228 Interethnic Placement Act (IEPA), 12, 233
culturally appropriate settings, 225 Interstate placement of children (ICPC), 253
emergency foster care, 230 Interviewing
family/kin, 222, 223 family engagement in, 206
Foster Care Awareness Month, 233 Intimate partner violence (IPV), 154, 155
in-home services and family preservation
services, 240
kinship care providers, 235 J
least restrictive environments, 221 Job satisfaction
nonrelative family placement, 228 professional development, 320
normalcy, 222 Judicial system, 36
placement trends, 230, 231
pre-adoptive placement, 229
proximity, 226 K
relative/kinship, 227 Kinship care, 227
services for children, 234
services for parents, 238, 239
siblings, 224, 225 L
supervised independent living (SIL), 229 Landmark legislation Family First Prevention
therapeutic foster care, 228 Services Act, 234
trauma of removal, 220, 221 Law enforcement investigations
Foster care re-entry, 265, 266 child welfare system, 34, 35
Fostering Connections Act, 262 Least restrictive environments, 221
Fostering Connections to Success and Legal permanency, 263
Increasing Adoptions Act, 233, Lesbian, gay, bisexual, transgender, queer, or
253, 281 questioning (LGBTQ) youth,
Fractures 274, 275
abuse for, 84 Licensure
professional development, 317, 318
Life Events Checklist (LEC), 128
G
Group supervision, 306, 307
Guardian ad litem (GAL), 44 M
Guardianship Maltreatment, 94
child welfare practice, permanency, Mandatory reporting, 36, 37
257, 258 Maternal, Infant, and Early Childhood Home
Visiting Program (MIECHV), 183
Medication evaluation and management, 238
H Mental illness, 155, 156
Hearings Mirroring, 19
types of, 46, 47 Multidisciplinary teams, 30
Home environment, 207 Multi-Ethnic Placement Act (MEPA), 12, 233
Home visitation
as game changer, 182
Home Visiting Programs, 183, 184 N
Human trafficking, 288–291 National Association of Social Workers
(NASW), 43, 315
National Child Abuse Prevention Month, 186
I National Child Traumatic Stress Network
Immigrant, 285–287 (NCTSN), 132
Implicit Association Test, 317 Neglect, 23, 32, 33, 191, 204
Indian Child Welfare Act of 1978 (ICWA), child maltreatment, 90–93
10, 11, 232 consequences of, 104–106
Infants and toddlers signs and symptoms of, 93, 94
334 Index

O Predictive analytics, 203

Occupational Safety and Health Pregnancy Risk Assessment Monitoring
Administration (OSHA) System (PRAMS), 188
standards, 318 Pre-service training, 242
Prevent Child Abuse America (PCA), 186
Preventing Sex Trafficking and Strengthening
P Families Act (PSTSFA), 262
Parent cafes, 143 Privatization
Parent education programs, 185 child welfare system, 38
Parent engagement, 139–141, 143 Professional development
Parent-child Interactions, 207 boundaries, 324
Parents’ behavior, 252 for child welfare professionals, 313, 314
Parents’ Resources for Information, burnout and secondary traumatic stress,
Development, and Education, 241 320, 321
Parents’ rights child welfare practitioner safety,
child welfare system, 49, 50 318, 319
Permanency ethics and legal issues, 315
child welfare, 13 goals, 314, 315
in child welfare practice, 249 licensure and certification, 317, 318
achieving permanency, 259–261 racial equity and cultural humility,
adoption, 255–257 316, 317
adoption with a Kinship caregiver, 254 retention and job satisfaction, 320
another planned permanent living self-care, 322
arrangement, 254, 255 self-care, 321, 322
best interests, 258 plan development, 323, 324
concurrent permanency Professional partners
planning, 258–260 child welfare system, 35, 36
factors, 261 Professional responsibilities
family-centered practice, 264, 265 child welfare practice as profession, 16, 17
foster care re-entry, 265, 266 Protective factors
guardianship, 257 child maltreatment, 99–101
older youth, permanency planning child welfare, 16
for, 261–264 PTSD Checklist (PCL), 129
planning, 249, 250
policies and laws, 252, 253
principles guiding permanency Q
planning, 251, 252 Qualified residential treatment programs, 8
reunification with biological parents/
caregivers, 253
Permanency Among Older Youth, 262 R
Permissive parents, 71 Racial disproportionality, 9, 10
Physical abuse, 84 Racial equity
consequences of, 102 professional development, 316, 317
signs and symptoms of, 85, 86 Reflective supervision, 307
Physical development, 55 Refugee families, 285–287
Polyvictimization Retention
child maltreatment, 94, 95 professional development, 320
Positive childhood experiences (PCEs), 132 Reunification, 251, 256
Post-traumatic Stress Disorder Semi-­
Structured Interview and
Observational Record, 129 S
Post-Traumatic Symptom Inventory for Safe sleep practices, 188
Children (PT-SIC), 129 Safe, stable, and nurturing relationships
Poverty, 90, 99 (SSNRs), 181
Pre-adoptive placement, 229 Safety
Index 335

child welfare, 13 Therapeutic foster care, 228

Child welfare practice, 195–197 Title IV-E plan, 187
goals, 197, 198 Transition planning, 280
Safety plan, 204 Trauma
Secondary traumatic stress, 321 child welfare as profession, 20, 21
professional development, 320, 321 Trauma and Attachment Belief Scale
Self-care, 321, 322 (TABS), 129
plan development, 323, 324 Trauma Assessment Pathway Model
Sex trafficking, 288–291 (TAP), 128
Sexual abuse, 86, 87 Trauma-informed approach, 21
consequences of, 103 adverse childhood experiences, 122, 124
disclosure, 87 assessment tools and strategies, 124–126
signs and symptoms of, 88 CDC’s Guiding Principles, 131
Sexual battery, 86 child investigation, 127
Sexual development, 55 evidence-informed interventions, 129
Sexual exploitation, 86 impact of, 119–122
Sexual molestation, 86 screening process, 126
Sibling relationships, 288 Trauma-Informed Child Welfare
Siblings, 224, 225 System, 131
Skills traumatic event, 115
for child welfare practice assessment, treatment of, 128
205, 206 triggers and trauma reminders, 117–119
Social norms, 181 Trauma-Informed Child Welfare System, 131
in community, to prevent child Trauma-informed practice, 23
maltreatment, 187 Trauma-informed supervision, 304, 305
Solution-focused brief therapy (SFBT), Trauma Symptom Checklist for Children
148, 305 (TSCC), 129
Solution-focused supervision, 305 Trauma Symptom Checklist for Young
Specific, measurable, achievable, relevant, and Children (TSCYC), 129
timed (SMART), 315 Traumatic Life Events Questionnaire
Spurning, 88 (TLEQ), 129
Strengthening Families approach, 100, 180 Traumatic stress
Substance abuse, 153, 154 infants and toddlers, 116
Sudden Infant Death Syndrome (SIDS), 188 middle school- and high school-age
Supervised independent living (SIL), 229 children, 117
Supervision preschool and elementary school-age
in child welfare practice, 300 children, 117
agency responsibility for, 308
best interest, 301
clinical supervision, 301, 302 U
group supervision, 306 UCLA Reaction Index, 129
maximizing supervision, 307, 308 Uninvolved parenting style, 71
practices and strategies, 309, 310 United Nations Children’s Fund, 2
research, 300 Upsetting Events Survey, 129
solution-focused supervision, 305
strengths-based supervision, 302–304
trauma-informed supervision, 304, 305 V
Surveillance bias, 98 Vermont Department for Children and
Families, 16

T
Termination of parental rights (TPR), 253 W
Testifying Well-being
in court, 45, 48, 49 child welfare, 14