Improving child protective services
How to expand and implement the consensus
By Douglas J. Besharov
This article originally appeared in Children Today, March 1992.
Over the past twenty years, enormous made in protecting children
from abuse and neglect. But major gaps in services remain. Recently, a consensus
has developed among many child protective specialists about some basic reforms
that need to be made. This report describes one way through which the broader
child welfare and human services community can be helped to understand the goals
of this consensus and how it can be mobilized to actively support the needed
Progress and Problems
Thanks to years of advocacy by concerned individuals across the
country, there now exists a basic infrastructure of laws and agencies to protect
children. All fifty states now have child abuse reporting laws. Specialized
"child protective agencies" have been established to receive reports (usually
via highly publicized hotlines) and then to investigate them. Health, social
service, education and law enforcement agencies and individual professionals
increasingly see themselves as jointly, not separately, responsible for
protecting children and, wherever possible, preserving and strengthening their
families. New resources have been identified, useful family support systems
developed, and some simplistic solutions discarded. Statistics, definitions, and
procedures are being standardized and upgraded. More concretely, the quality of
treatment services has been greatly improved.
The result has been an enormous increase in reported cases.(1) In
1987, almost 2.2 million children were reported to the authorities as suspected
victims of child abuse and neglect. This is more than fourteen times the
estimated 150,000 children reported in 1963.
Increased reporting and specialized child protective agencies have
saved many thousands of children from death and serious injury. The best
estimate is that, over the past twenty years, child abuse deaths fell from over
3,000 a year (and perhaps as many as 5,000) to about 1,500 a year.
Still, in almost every community, there are serious inadequacies,
breakdowns and gaps in the child protective process. Reports are increasing
faster than many agencies can handle them, but detection and reporting remain
haphazard and incomplete. Professionals--physicians, nurses, teachers, social
workers, child care workers, and police--fail to report many of the maltreated
children whom they see, including those with observable injuries severe enough
to require hospitalization.
Although all statistics concerning what happens in the privacy of
the home must be approached with great care, the scale of non-reporting can be
appreciated with the help of the National Study of the Incidence and Severity of
Child Abuse and Neglect (conducted for the federal government by Westat, Inc.).
It estimated that, in 1986, selected professionals saw about 300,000 physically
abused children, another 140,000 sexually abused children, and 700,000 who were
neglected or otherwise maltreated.(2) According to the study, the surveyed
professionals reported only about half of these children. (The study methodology
did not allow Westat to estimate the number of children seen by
non-professionals, let alone estimate their reporting rate.)
The professionals did not report almost 40 percent of the sexually
abused children whom they saw. They did not report nearly 30 percent of fatal or
serious physical abuse cases (defined as life-threatening or requiring
professional treatment to prevent long-term impairment) and almost 50 percent of
moderate physical abuse cases (defined by bruises, depression, emotional
distress or other symptoms lasting more than 48 hours). The situation was even
worse in neglect cases: about 70 percent of fatal or serious physical neglect
cases were not reported and about three quarters of the moderate physical
neglect cases were not reported.(3)
This means that, in 1986, at least 50,000 sexually abused children
went unreported, at least 60,000 children with observable physical injuries
severe enough to require hospitalization were not reported, and almost at least
184,000 children with moderate physical injuries were also not reported.
Many thousands of other children suffer serious injuries after
their plight becomes known to the authorities. Studies in a number of
communities indicate that 25 to 45 percent of the children who die under
circumstances suggestive of child maltreatment have previously been reported to
child protective agencies. 4 There is some reason to believe that, after many
years of decline, child fatalities attributable to child maltreatment have begun
At the same time, the nation's child protective agencies must
investigate a large number of reports that are not substantiated. Nationwide,
only about 45 percent of all reports are "substantiated" (or a similar term)
after investigation. This is in sharp contrast to 1975, when about 65 percent of
all reports were "substantiated Each year over 500,000 families are investigated
for reports that are not substantiated.
In 1988, responding to these problems, three major reports were
published by leading child protective and child welfare organizations. (See Box
#1.) Each document proposes substantial changes in reporting, intake and
screening, investigations, and case determination practices. Despite their
varied origins, remarkable agreement exists among these three documents about
what needs to be done to improve services to abused children and their families.
In essence, each recommends that a much greater effort be made to ensure that
only appropriate cases are accepted for investigation and that suitable services
are provided to families needing them. (See Box #2.)
The Three Child Protective Reform Documents(5)
Child Abuse and Neglect Reporting and Investigation: Policy
Guidelines For Decision Making (ABA/APWA/AEI, 1988), available from the American
Bar Association, (312) 988-5555 for $ 3.
Guidelines for a Model System of Protective Services for Abused
and Neglected Children and Their Families (APWA, 1988), available from the
American Public Welfare Association, (202) 682-0100 for $ 10.
Standards for Service for Abused or Neglected Children and Their
Families (CWLA, 1988), available from the Child Welfare League of America, (201)
225-1900 for $ 12.50.
Expanding the Consensus
Issuing a report and achieving the recommended changes, however,
are two very different things, as we all know. The three reports were developed
by groups largely composed of child protective and child welfare specialists.
For their recommendations to be implemented, much broader understanding and
support will be necessary. (Even among specialists, many of the recommendations
in the three reports remain controversial.)
This report describes one way in which this consensus can be
expanded and implemented. It is based on the experience of a national meeting
sponsored by the American Bar Association's National Center on Children and the
Law, in association with the American Enterprise Institute, the American Public
Welfare Association, and the Child Welfare League of America. (The meeting was
funded by the National Center on Child Abuse and Neglect.) The process has five
steps. (See Box #3.)
Steps in the Process
1. Presentation and discussion of documents to involve others in
2. Small group discussions and reporting back to the
larger group to identify needs,
3. Voting to establish priorities among identified
4. Structured discussion to plan strategy, and
5. Follow-up to encourage
Step 1: Involving Others: On December 15th and 16th, 1988,
thirty-eight individuals from almost as many organizations met in Washington,
D.C. to consider the three documents and to identify priority steps in a
strategy to implement their recommendations. The participants were from a much
broader array of disciplines, agencies, and advocacy groups than those who had
drafted the original documents. (The participants are listed in the Appendix A.)
To open the conference, each of the three reform documents was
summarized by a designated presenter. Then, the various themes and
recommendations common to each of the documents were discussed by the whole
group. This initial discussion provided an opportunity for participants to voice
their concerns about and disagree with some of the recommendations. In this
orientation process, the group as a whole worked through the most controversial
issues in the documents. Although some participants would have preferred to
rewrite certain recommendations in the documents (such as the need to screen
reports), they were reminded that, for the purpose of the process, they had to
work within the context of the documents.
There were times when it seemed as if the group would fracture in
disagreement and not be able to come together again, but the participants'
overriding desire to improve programs for these vulnerable children brought the
discussion back to how service needs could be identified and met. The group
decided that it could proceed with planning how best to seek the needed reforms
even though not all participants agreed with each and every recommendation in
the documents. The spirit that developed was: "Rather than getting mired down in
what we disagree about, let' see what we can agree to do to improve services."
We think that this open, no-holds barred discussion was essential
for the later success of the process. Indeed, it served to focus attention on
the severe shortage of long-term, family oriented treatment programs--and what
to do about it.
Step 2: Identifying Needs: To allow issues to be discussed in
greater detail and to encourage a more informal and collaborative atmosphere,
the participants were divided into small workgroups on: (1) "reporting"; (2)
"intake and screening"; (3) "investigation7; and (4) "case determination" "
These are, of course, somewhat overlapping categories, so that group discussions
tended to cross categories. In fact, this report adds new sections on
"recruitment, staffing, and training" and on "child and family services" to
cover those issues that emerged across the groups. Nevertheless, the division of
the entire conference into these smaller groups and the assignment of these
particular topics to each group helped move the discussion forward.
Michael Weber, President of the National Association of Public
Child Welfare Administrators (an affiliate of the APWA) and Director of the
Hennepin County Department of Community Services, gave the charge to the
conference. Each group was asked to identify up to ten priorities or actions in
its specific topic area. They were also encouraged to identify the organizations
that might perform these actions. (Group leaders were asked to keep the
discussion on the assigned topic but to allow the group some flexibility in
working things out and in identifying needs.)
Step 3: Establishing Priorities: The workgroups met for about two
and a half hours, after which the full conference reconvened. Each workgroup
leader presented -- and explained -- his or her group's recommendations. The
recommendations were also written on flip charts and the sheets were later
posted around the room. (These are summarized in Appendix B.) An unstructured
discussion helped the other participants to understand their colleagues'
Each participant was then asked to select the ten most important
recommendations. Each participant was given ten round stickers and told to put
one or more next to the recommendations that he or she deemed most important.
Box 4 lists the identified needs and the priority votes they received.
Step 4: Planning Strategy: The next step was to determine how best
to pursue the priorities that had been established. Participants were asked to
suggest how their particular organization, either alone or in cooperation with
others, could help. Mike Weber led the discussion, working down from the
recommendation that received the most votes. Appendix C lists the specific
strategies or implementation plans that were proposed.
Step 5: Encouraging Implementation: We did not have funds for a
second meeting, so that follow-up was limited. There was a general feeling that
this hampered efforts to work together toward common goals and that more formal
monitoring of the plans described at the meeting would have encouraged
We believe that the conference successfully helped to identify
important objectives for reform in a way that engaged and invested the
participants in the outcome. We believe that our experience can serve as a model
for similar efforts at the local, state, and regional level, but we did learn
some practical lessons about the process that should be shared with those
contemplating a similar conference.
Choose the workgroup leaders carefully and make sure that they
understand their crucial role in the process. Group leaders need to be both firm
and flexible--firm enough to keep the group on its task and flexible enough to
recognize when the group needs to work through an unexpected issue. Ours were,
and that made all the difference.
Carefully review the workgroup recommendations before they are
presented to the group as a whole, combining those that are essentially the
same. We had a number of overlapping recommendations, and there was a clear
tendency for participants to split their votes among similar priorities. For
example, if the risk assessment recommendations had been combined, as they quite
properly could have, the resulting recommendation would have scored among the
Select participants with an eye for the ultimate purpose of the
process--to get agencies and organizations to commit themselves to specific
efforts and projects. Thus, (1) they should come from organizations whose
efforts could be relevant to improving child protective and child welfare
services, and (2) although it is not necessary that they have authority to
commit their agency, at the meeting, to a specific project or activity, they
should have a reasonable voice in setting their organization's priorities.
During the session on planning strategy, be alert to the
possibility that some priority areas--even though they receive a large number of
votes--will not have action items suggested for them. It was only after the
meeting that we realized that there were no implementation ideas for two
Finally, keep your expectations for the process reasonable.
Realize that many of your pet ideas will not be recommended and be prepared for
many action items to go unimplemented. If even one in ten comes to pass, the
process will have been worthwhile.
Douglas J. Besharov is a Resident Scholar at the American
Enterprise Institute for Public Policy Research in Washington, D.C. He was the
first director of the National Center on Child Abuse and Neglect, Administration
for Children, Youth and Families.
(1) Much of the following material concerning reported cases is
derived from Child Abuse and Neglect Reporting and Investigation: Policy
Guidelines For Decision Making (ABA/APWA/AEI, 1988), reprinted in D. Besharov,
Protecting Children From Abuse and Neglect (Charles C. Thomas, 1988), Chap. 13.
(2) A. Sedlak, Study of National Incidence and Prevalence of Child Abuse and
Neglect (Westat, Inc., Bethesda, Md., December 1987). (3) Supplementary Analyses
of Data on the National Incidence of Child Abuse and Neglect, supra n. 4, at pp.
3-19. (4) J. Alfaro, "What Can We Learn from Child Abuse Fatalities: A Synthesis
of Nine Studies" found in: D. Besharov, Protecting Children From Abuse and
Neglect (Charles C. Thomas, 1988), Chap. 9. (5) The views expressed in the
documents do not necessarily represent the views or policy of the National
Center on Child Abuse and Neglect, the Administration for Children, Youth and
Families, or the Administration for Children and Families, U.S. Department of
Health and Human Services. (6) Prepared by Beverly Jones. The absence of a
notation for a particular element does not denote disagreement but, rather, the
fact that that element was not addressed by the document. (7) Some of the
recommendations have been edited for clarity and brevity. The recommendations do
not necessarily represent the views or policy of the National Center on Child
Abuse and Neglect, the Administration on Children, Youth and Families, or the
Administration for Children and Families, U.S. Department of Health and Human
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