Trends in local public child welfare agencies 1999–2009
Introduction
Among child-serving organizations, local public child welfare agencies are unique in their legal responsibility and authority to respond to all maltreatment reports made within their service area, determine which merit investigations or assessments, identify which children need either preventive or out of home child protective services (CPS), and subsequently determine when these services are no longer needed. Recent decades have presented public child welfare agencies with significant challenges, including increasingly complex family needs (Testa & Poertner, 2010), an economic recession that undermined the well-being of millions of families (Sell, Zlotnik, Noonan, & Rubin, 2010), and an increasing emphasis on evidence-based practice despite a limited base of relevant evidence (Barth, 2008). The purpose of this article is to identify some of the environmental factors affecting child welfare between 1999 and 2009, examine how local public child welfare agencies evolved during this time, and consider potential implications for children and families. In so doing, we focus largely on the distinctive attributes of these agencies, including their structure within state and local human services; their approaches to decision-making; and how they facilitate additional needed services.
As a vital part of the safety net, local public child welfare agencies are both supported and scrutinized by a range of stakeholders. These include other local public agencies; state and federal child welfare agencies; legislators; advocacy groups; and courts (Benson, 1975, Testa and Poertner, 2010). Collectively, these other actors shape child welfare's regulative and normative contexts (Scott, 2001). Each of these actors may also mediate the effects of economic trends on resources available to child welfare agencies and their latitude in use thereof.
Even among human services, child welfare agencies are affected to an unusual extent by legal decisions. One common means that advocates have used to improve child welfare performance has been class action lawsuits in which agencies are cited as having harmed a group of children due to failure to provide services. Most successful cases seeking broad reform result in consent decrees, through which agencies commit to remediating actions. Courts then oversee implementation of these plans (Oppenheim, Lee, Lichtenstein, Bledsoe, & Fisher, 2012). Between 1979 and 2005, over 25 state child welfare agencies were sued or placed under federal court order (Kosanovich & Joseph, 2005).
Other ways of improving child welfare agency performance have included accreditation, federal reviews, and federal and foundation demonstration programs. The entity now known as the Council on Accreditation has accredited private agencies since 1977. Increasingly over time, public agencies have followed suit, albeit without clear evidence of impact on quality (Mays, 2004, OIG, 1994). In addition, a growing number of states have either encouraged or required local agencies to become accredited (Stoparic, 2005). Since the passage of the Adoption and Safe Families Act in 1997, all state child welfare systems have been required to undergo federal Child and Family Service Reviews (CFSRs), with financial penalties possible for deficiencies. Some public child welfare agencies have also responded to stakeholder pressure by conducting outcome evaluations such as those funded through Social Security Act federal Title IV-E block grants (Solomon, 2002).
The array of mechanisms for maintaining child welfare agency accountability attests to the salience of market and evidence-based institutional logics in US human services. The shift from a previous “logic of confidence and good faith” (Meyer & Rowan, 1977, p. 357) to that of new public management included the landmark Government Performance and Results Act of 1993 (GPRA), which required state agencies receiving federal funding to track goals and objectives for their major programs (Patti, 2008). Since then, human service agencies have been increasingly expected to use data for demonstrating effectiveness as well as efficiency. Even before GPRA, however, states were required to report data on child maltreatment reports and outcomes, with the National Data Archive on Child Abuse and Neglect serving as a repository for these and other national child welfare data since 1988 (Waldfogel, 2000).
Two major recent economic trends have also shaped child welfare services. First, public children's services have become increasingly reliant on state and federal funding, including Medicaid (Scarcella, 2006). The federal match for state Medicaid spending makes Medicaid-reimbursed services less expensive for child welfare agencies than those funded exclusively from their own budgets. One consequence of increasing child welfare agency referrals to Medicaid-reimbursed services is that eligible families can at least in theory select any Medicaid participating provider for those services, most of which are private. This may not only increase the range of options available to families and buffer service access from vicissitudes in local funding, but can also complicate child welfare coordination challenges.
A second major economic factor was the “Great Recession” beginning in 2007. As tax revenues dropped, many states cut funding for human services (Smith et al., 2009). At the same time, increasing numbers of families experienced poverty (DeNavas-Walt, Proctor, & Smith, 2010), a factor which has previously been found to increase risk of child maltreatment (Shook, 1999). Even when the recession officially ended, its repercussions continued for the millions of un- or under-employed Americans and the agencies struggling to meet their needs (NACCHO, 2012). A GAO report based on four states identified significant gaps in services for families involved in child welfare, most notably in substance abuse treatment and material support such as housing (GAO, 2013).
Local public child welfare agencies have adapted to recent pressures in part through supplementing Title IV-B funds allocated for child welfare services with additional federal funding from Temporary Assistance for Needy Families (TANF), the Social Services Block Grant Program (SSBG), and Medicaid to support services and activities covered by Title IV-B, a part of Title IV focused on child welfare services (GAO, 2013). Other strategies used by public agencies include an increased use of performance-based contracting with private child welfare agencies (Collins-Camargo, McBeath, & Ensign, 2011).
The Children's Bureau has recently outlined its vision for the future of child welfare services as “comprehensive evidence-based and evidence-informed community-based services… available to families through their local child welfare agencies and other key public and private partners” (Mitchell et al., 2012, p.551). Although these authors advocate looking “beyond existing organizational boundaries”, (p. 552) we believed it would be useful to begin our inquiry by identifying which other health and human services are situated within the same larger agencies as local public CPS and whether these organizational arrangements have changed over time. State and local elected officials have sometimes reorganized human services into “umbrella” agencies in attempts to improve coordination of related services and gain efficiencies. At the state level, most states have departments of social or human services, many of which also include mental health, public health, and other services. We saw any trends toward integration with such services within common umbrella agencies as potential opportunities for improved service access and outcomes through both direct connections and possible help in improving cooperation with other local public and private providers.
Assessing risk of future maltreatment is a fundamental part of child welfare services, a high stake calculation that despite continuing research remains fraught with uncertainty. Even among families in which children are clearly at risk, child welfare agencies must direct their limited resources toward those in immediate danger. Another reason to provide child protection judiciously is its inherently intrusive nature. Most states use structured decision-making tools to inform these decisions, with the intent of thus focusing on children with the most need and improving predictability of decisions across staff members (D'Andrade, Austin, & Benton, 2008). In turn, such consistency can help to ensure that child welfare makes decisions based on risks rather than on family race, ethnicity, or socioeconomic status (Gambrill and Shlonsky, 2000, Rycus et al., 2008). Of the two predominant approaches to risk assessment, consensus-based guidelines take a comprehensive approach, often incorporating expert opinion, and generally using the same instrument to predict all types of maltreatment. Actuarial models use weighted combinations of factors noted by caseworkers on checklists to generate points indicating level of risk, and use different factors to predict physical abuse versus neglect. Overall, actuarial models have demonstrated better predictive validity than consensus-based guidelines (D'Andrade et al., 2008); hence, a trend toward their use could improve alignment between CPS and family needs.
Throughout the US public sector, private agency provision of government-funded services was “perhaps the most significant development in the latter part of the 20th century” (Ginsberg, Gibelman, & Patti, 2009, p. 93). Privatization of public services has been a prominent feature of US social welfare beginning with the Nixon administration's New Federalism initiative, and has in recent decades increasingly progressed from such relatively simple functions as garbage disposal to complex human services (Gronbjerg, 2009, Salamon, 2012). In essence, privatization was built on the assumption that competition would prompt providers to offer services at lower cost and higher quality (Sclar, 2001). The reduced cost was expected from both efficiencies that private providers would achieve in order to win contracts and the flexibility to terminate contracts when any given services were not needed (Milward & Provan, 2000). Similarly, private providers were expected to be more motivated than previously monopolistic public agencies to earn contracts through improved quality. In addition, a more diverse range of non-governmental providers was expected to be more innovative and responsive than public agencies to local needs (Suleimann, 2003).
There is, at present, greater evidence concerning the growth of privatization in child welfare systems than on its fiscal and service delivery consequences for child welfare-involved children and families (Collins-Camargo et al., 2011). In the mid-1990s, some states privatized family preservation, foster care, and adoption services either regionally or state-wide (Blackstone, Buck, & Hakim, 2004). Quality outcomes appeared more positive than cost savings: although both states and private contractors sometimes incurred higher than anticipated costs (Unruh & Hodgkin, 2004), adoption rates improved in Kansas and in Cook County, Illinois after privatization (Blackstone et al., 2004, Unruh and Hodgkin, 2004). A comparison of Florida counties where child welfare was privatized to otherwise comparable counties found generally similar outcomes in child safety, maltreatment recurrence, and permanency (Yampolskaya, Paulson, Armstrong, Jordan, & Vargo, 2004). Nonetheless, social service stakeholders have raised a range of concerns, including increased reliance on private providers that may actually attenuate accountability for complex service processes (Van Slyke, 2003). Given the potentially competing pressures for efficiency, government accountability for child protection, and family autonomy, as well as substantial if still ambiguous implications for cost and quality, we sought to identify whether local public child welfare agencies were using private providers for an increasing range of services.
Child welfare agencies have long depended on other public systems and public and private providers to address families' complex needs. The police, juvenile justice, mental health and substance abuse treatment, and schools fulfill such complementary functions as reducing potential violence in the short term and addressing behaviors that place children at risk over the long term (Bardach, 1998). In addition, such partners can help child welfare workers make sense of complex and ambiguous cues about inter-related and dynamic facets of families' needs. At the same time, professionals in other systems often face competing demands and bring different beliefs about how to interact with families. To improve cooperation and thus family outcomes, child welfare agencies have often developed inter-agency agreements, cross-trained staff, and pooled resources with other local public agencies as well as with both public and private service providers (Casanueva, Horne, Smith, Dolan, & Ringeisen, 2011). Thus, the final focus of our study was on how public child welfare agency cooperation with other local agencies had changed between 1999 and 2009.
The current study uses data from both cohorts of the National Survey of Child and Adolescent Well-being (NSCAW I and II) to depict trends in local public child welfare agency structure and practice. The service area for these agencies was typically the county, although some served multiple counties or only part of a county. NSCAW is the only national, longitudinal study of families subject to child abuse or neglect investigations or assessments. Although best known for its focus on children and caregivers, NSCAW also included in-depth interviews with local public child welfare agency directors about their policy context, structure, services, and relationships with other local child-serving systems.
Section snippets
Sample
Data were drawn from the National Survey of Child and Adolescent Well-Being (NSCAW). NSCAW was funded by the Administration for Children and Families within the US Department of Health and Human Services, with field data collection carried out by the Research Triangle Institute (RTI) International. This survey has now included two cohorts, with baseline years 1999 and 2009, respectively.
Each NSCAW cohort was sampled to represent all children reported to CPS in that year, excluding those in
Trends in local public child welfare agencies' regulative and normative environments
Table 1 shows the percentages of agencies reporting each practice in 1999 and 2009, as well as the statistical significance of the GEE coefficients assessing the association between cohort and each practice. As of 2009, a third of all participating child welfare agencies were operating under active consent decrees, making this court-monitored form of service improvement as common as accreditation. The majority of agencies in the study sample participated in federal IV-E waiver demonstration
Discussion
It appears from these findings that the regulative and normative environments surrounding public child welfare agencies remained largely unchanged in the first decade of this century. Participants in child welfare systems have cited litigation as substantially improving focal aspects of agency capacity, such as workforce development, but have also have raised concerns about its adversarial nature and potential focus on measurable indicators rather than deeper change (Farber & Munson, 2010).
Conclusions
Local public child welfare agencies discharge a vital mission within a complex web of environmental and organizational resources and obligations. Data from the only longitudinal national survey of families engaged with child welfare reveal that some key regulative and normative pressures on local child welfare agencies were largely stable between 1999 and 2009. However, some aspects of local agencies' administrative contexts and service delivery structures changed significantly during this
Acknowledgments
This paper was supported in part through K01 MH076175-01A2, from the National Institute of Mental Health, How Child Welfare Agency Management Affects Children's Outcomes.
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