Differential response-assessment track
Frequency of different CPS service outcomes following reporting
This analysis has gone far afield, but now we bring it back to the situation of individuals reporting child maltreatment. What can they expect? Our review of outcomes of reporting suggests several conclusions we can draw that would interest reporters, child welfare professionals, and indeed the public at large.
Most Cases Receive a Modest Response
An individual contemplating reporting child maltreatment might imagine that their report might result in a vigorous child protective service response. However, in majorities of cases, the response is limited. Over half of the reports to CPS do not lead to families receiving ongoing child protective services. Most of these cases without services were screened out; but even some cases that are investigated and substantiated do not lead to services. Nor do all cases referred to the assessment track in differential response systems lead to services—contributing to this is the fact that participation is voluntary and some families decline services. The results on investigation are similarly modest—over half of the reports do not result in an investigation; the bulk of these because of screen outs and others because they are placed on an assessment track. Altogether, substantiation of child maltreatment occurs in about one quarter of reports. A caveat to our point about the modesty of the child protective response is that an intervention may have an effect even if the suspicions of maltreatment are not substantiated, as investigation can sometimes lead to service delivery even in unsubstantiated cases, and interventions undertaken during the investigation phase may in themselves have a positive effect.
We have no judgment about these results, as we cannot ascertain how often less vigorous and more vigorous responses are genuinely warranted. Our main point is that potential reporters may be surprised by the modesty of response in most cases, given that research suggests that many people who choose not to report are concerned about the negative impact of a vigorous child protective response. Sege et al. (2011) found that primary health-care providers who did not report certain cases indicated that, in addition to clinical factors, they were concerned about the impact on their relationships with the involved families and their “perceptions of expected outcomes of filing” (p. 464). In a review of the literature on mandated reporting, Alvarez and colleagues (Alvarez et al. 2004) list some of the more common reasons professionals fail to report their suspicions of maltreatment: they believe it is not in the best interest of the child to report; they fear that the report will result in further harm to the family/child; and they are concerned that the report will create further instability for a family, particularly if criminal charges result or a child is removed. Lee et al. (2013) include a direct quote from one investigator expressing her frustration with mandated reporters who fail to report: “I asked the (hospital) social worker, why didn’t you guys call it in? Her exact word was, and my supervisor had me document it in my report, that the doctors do not want to call in because they don’t want to testify in court” (p. 638). While it is true that the child protective response can be invasive to protect children’s safety, in a large proportion of cases it is not—would those who choose to not report suspicions be more open to reporting if they knew the overall modesty of the response? Conversely, many people who do report hope that children and family receive services as an effect of their contact with CPS. They might be disappointed at the modest levels at which reported cases receive child welfare services—although mitigating this is the finding that children in investigated but unsubstantiated cases are as likely to receive formal assessments for emotional or behavioral problems—and referrals to mental health and special education services. To what extent is the modest response by CPS discouraging reporting? The modest response is not a reflection of modest need among families involved with CPS, as voluminous data point to substantial need in the entire child welfare population, in both cases that are substantiated and unsubstantiated and cases in which children are placed outside the home and remain at home (see, e.g., Casanueva et al. 2011; Ringeisen et al. 2011; US Department of Health and Human Services 2005, 2007). Perhaps the modesty of the response could be cited in calls for increasing resources for child protective services.
Information Plays an Important Role
Outcomes following reporting stem from decisions, mostly by CPS, based on information obtained through various forms of information gathering: screening, investigation (which ideally includes an assessment of children’s well-being), and assessment in differential response. What decisions are made will depend on what information is available, but it can often be difficult to obtain information. The literature on screening reveals frequent challenges due to limited information. Information is similarly a key to the substantiation decision, since the amount of evidence of maltreatment is the most important predictor of whether a case is substantiated, and child protective service agencies will often complete investigations by their deadlines with insufficient information to make a judgment about whether or not maltreatment occurred. Likewise, information is central to making good child placement decisions, which depends on so many child, family, and environmental factors. It is also critical in differential response, since the decision to refer and keep families in an assessment pathway does not introduce the same level of scrutiny and social control that the investigation pathway entails. We do not know whether decreased information is likely to lead to increased or decreased rates of child placement and referral to differential response; it is likely, however, that decreased information is likely to lead to a higher rate of poor decisions.
In their examination of the decision-making process related to mandated reporting and child protection, Hughes and Rycus (2007) suggest that it is an iterative process, requiring skilled assessments throughout the life of the case. Further, it is their contention that decisions at each point can only be accurate and discerning when the information gathered is reliable and solid—clearly a concern, given the literature that indicates the numerous problems from the vantage points of reporter and intake worker. As discussed above, many reporters of child abuse and neglect provide only fragmentary or unclear information. Our attempt to examine these different outcomes of reporting underscores the need for clarification about “how much is enough” to make a report and to screen in a report for investigation. Unfortunately, quantification is an elusive concept in mandated reporting, and though no one would argue against additional training for mandated reporters, we recognize a paradox in this search for more prescriptive guidelines. To train mandated reporters to collect more detailed information may have an unintended consequence—absent their understanding of “how much is enough”; mandated reporters, already fearful that their suspicions are not enough, could fail to make reports, believing their information falls short of the threshold for reporting. Training of mandated reporters could reduce this risk by instructing reporters on which information is valuable and which is superfluous.
States and Communities Differ
Outcomes of reporting vary dramatically between states and communities. NCANDS reports significant differences between states on rates of screening in cases, substantiating allegations, providing child protective services, and placing children outside of the home. States also vary in whether they have a differential response system, and when they do, states differ dramatically in how often they use the assessment track. Even within state, agencies vary on screen in rates, substantiation, and child placement, and the New York State evaluation of differential response showed differences in the use of the assessment track by county (Ruppel et al. 2011). Several factors contribute to state and community differences, including differences in legislation, philosophy, training, and resources for information gathering and providing services. Thus it is somewhat misleading to talk about what a reporter might expect without knowing where that reporter lives.
Almost as astonishing as the variation between states on rates of these outcomes is the fact that this variation has mainly gone unstudied. Research is needed to assess the causes of this variation, as well as the variation between communities and agencies within a state, and understand the implications for policy and practice. One key question is the degree to which this variation stems from actual differences in state practice versus differences between states in measurement systems. Better standardization of measurement in NCANDS would help. In our view, it seems unlikely that the fact that Iowa reports a 100 % rate of delivering services in in-home cases and the District of Columbia a 0.21 % rate means that Iowans’ hearts are full and Washingtonians’ are made of stone. We are just speculating, but perhaps D. C. is effecting service delivery through outside agencies in a way that does not get recorded in NCANDS, or Iowa’s service delivery includes some limited intervention that is not even counted in other states’ statistics. They may also differ substantially in resource availability—see below for a discussion of resources. Better standardization of state data could help eliminate statistical anomalies and confusion.
Actual differences between states and communities on outcomes following reporting (above and beyond differences in measurement) raise questions about equity and may be of interest to advocates. The substantial variation suggests the value of communities developing their own statistical profiles of what happens following child maltreatment reports and comparing these to other communities within their state. We recommend that community children’s service coalitions build such statistical profiles into their needs assessment and/or program evaluation efforts. Given a community statistical profile, our hypothetical reporter would have a better understanding of what will happen following reporting and may feel more ownership and more commitment to doing their part to maximizing the quality of the process. Moreover, local studies shared among multiple stakeholders of outcomes of reporting could inform community policy around the decision points reviewed here, helping to empower communities to achieve the outcomes of reporting that best match their values.
Outcomes Vary by Case Characteristics
Research has identified a number of case characteristics that predict outcomes following reporting. Variables such as type of maltreatment, age of child, and family’s previous protective service history can have a major impact on what decisions are made in the child protective response. Thus what happens following reporting very much depends on the nature of the particular case. Differences in the probability of outcomes given reporting are magnified if a given case characteristic affects multiple decisions in the response process. Consider child age. Cases with children under the age of 2 are more likely to be screened in and also substantially more likely to be placed in out-of-home care. Thus, these children are more likely to have a more substantial child protective service response. Prior history with child protective services similarly may have a dramatic effect in increasing the magnitude of the response, because it increases the odds of screening in, substantiating, and placing children outside the home. Reporters who have a modicum of knowledge about influential case factors will be better able to anticipate what outcomes may result from reporting.
Not only do outcomes of reporting differ, but who the reporter is tends to differ depending on the characteristics of the case. Kesner (2008) compared the characteristics of cases reported by four different types of reporters: legal, medical, social service, and educational. Medical personnel report maltreatment for children who are almost 2 years younger on average than in every other group, an average of 5.2 years old. Younger age means more screening in and more child placement, so medical personnel may be more likely to encounter a more vigorous CPS response, and they accordingly may have greater concerns about family disruption from reporting. Educational personnel reported the oldest children, an average of 9.1 years, who have lower screening, service, and placement rates. These reporters’ concerns may focus more on CPS inaction. Reports from legal and medical personnel were more likely than other reporters to identify neglect, while school personnel were more likely to report physical abuse than other reporter groups; again, these patterns can lead different outcomes. More work needs to be done on identifying profiles of outcomes by case characteristics and reporter types and considering whether procedures and training need to be adapted for these differences.
Resources May Affect Outcomes
This review also suggests that the resources that states and communities have for different response options are likely to affect outcomes of reporting. Although the empirical evidence is limited, several sources suggest that substantiation rates are lower for a given level of suspicion of maltreatment when resources are less available, and the likelihood of service delivery and child placement are lower for states and communities with fewer resources. Moreover, limited resources likely means less agency cohesiveness and support for workers, less compensation and training for workers, and more turnover. Agency stress, worker inexperience, and lack of education may add more unpredictability to outcomes, and the research cited above suggests it may also change outcomes by increasing substantiation rates, perhaps because substantiating an allegation is a safer call when a worker is stressed, unsupported, or uncertain. A call for more resources is a frequent cry by child advocates. The analysis of the outcomes of reporting and their relationship to resources could help provide persuasive evidence of the need for more resources.