Note: This article was updated on Monday, March 21
The path to curbing child fatalities is lined with a balance of predictive tools, heightened scrutiny of abuse and neglect reports, and increased family preservation services, a federal commission funded to study the issue reported today.
The Commission to Eliminate Child Abuse and Neglect Fatalities completed its nearly three years of work today with a 150-page report that admits from the very beginning that it discovered little evidence that existing programs and strategies were working in the prevention of child maltreatment fatalities.
“Unfortunately, although we found that we know a lot about what puts children at risk, there are relatively few promising or evidence-based solutions,” said Commission Chairman David Sanders, in a preface to the report. “Had we found strong evidence for certain approaches, we would have recommended expansion of these programs.”
The report’s recommendations focus on two main tracks related to child fatalities: New approaches to responding to abuse and neglect reports, and an augmentation of the services available to help address the type of family stressors that can lead to tragedy.
Risk and Reaction
The recommendations on improved investigations begin with development of a national consensus on how to actually tally child deaths related to abuse or neglect. The commission further recommends that states conduct federally approved five-year reviews of maltreatment-related deaths to better establish commonalities in those cases.
But the review would not merely be a learning exercise in the commission’s view. It recommends that states actually reassess open cases using the information from the review, and possibly reconsider decisions to keep children at home or what services are offered or required.
The price and payment of such a review and reassessment proved to be a divisive point for the commission. Some commissioners – including Every Child Matters founder Michael Petit and former Administration for Children and Families Commissioner Wade Horn – recommended a $1 billion investment in this process on the part of the Department of Health and Human Services.
Other commissioners disagreed with that amount, or disagreed with the commission recommending spending at all. But there is no disagreement that the proposed changes would carry a significant price tag.
“The feasibility of it is significantly tied to finance,” said Tom Morton, who was the lead staff on practice issues for the commission. “If there’s specific federal funding, states would probably do it. I think it will be very expensive.”
“It will require a much stronger investment in funds by both the state and the federal governments, otherwise it will not happen in many states,” said John Sciamanna, vice president of public policy for the Child Welfare League of America.
Another commissioner – Patricia Martin, the presiding family court judge in Cook County, Ill. – opposed the idea of the study and review, and did not vote to approve the final report.
From a dissent published by Martin this week:
Not one witness recommended nor intimated such an approach to eliminate fatalities. Instead, Commission leadership unilaterally decided to include it as a “signature recommendation.” More troubling is that this recommendation encourages foster care placements despite expertise and research that demonstrates that the better path for our children is providing services in home.
An additional recommendation that would increase workload at the state and county level: No call regarding a child under the age of three, for whom a call or referral had already been made, could be screened out. This recommendation would have CPS respond to any report about a child under three, even if the reported activity did not amount to maltreatment.
Addressing Family Risk Factors
The commission endorsed the Family First Act, a bipartisan bill in development by the Senate Finance Committee, which would enable states to draw federal entitlement money formerly earmarked for foster care to offer family preservation and reunification services.
The legislation is in line with several of the individual recommendations made by the commission that involved increasing the offer of better assistance to families deemed to be in crisis, especially for African American and Native American households.
In addition to that legislation, the commission recommended extending HHS’ authority to issue IV-E waivers. Since the late 1990s, waivers have enabled local systems to use the federal entitlement for foster care on other programs and services.
Without a legislative renewal, the waiver authority will expire on September 30, 2019.
The only service program explicitly endorsed by the commission is the Nurse-Family Partnership (NFP), a model under which professional nurses are paired with first-time, low-income moms to support them from pregnancy through the child’s second birthday.
There was a dramatic expansion of NFP after passage of the Affordable Care Act, which carved out several hundred million in federal funds each year for home visitation programs. NFP’s national office in Denver is also in line for a potential $200 million investment from Blue Meridian, a capital aggregation group created this year by the Edna McConnell Clark Foundation.
“We were able to identify only one practice with research evidence showing a reduction in fatalities: Nurse-Family Partnership,” Sanders remarked in his preface.
Among the commission’s other services-oriented recommendations:
- A Medicaid waiver that would allow states to address mental health and substance abuse needs of parents through Medicaid’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. This would be the first time that EPSDT was permitted as a precursor to serving adults; it is now only available to children under age 21.
- Incentivizing “intact family courts” in communities with “disproportionate numbers of African-American child fatalities.” These courts would attempt to intervene with family services before a formal dependency hearing became necessary; parents could voluntarily seek help through them, and mandated reporters could make referrals directly to the courts.
The commission was created in 2013 as part of the Protect Our Kids Act, and was provided with a $4 million budget through funding for the Temporary Assistance for Needy Families program. Most of that was spent on the committee’s staff of 20, and public hearings held in 12 U.S. cities.
