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10. Well-Being and Services Through a Developmental Lens
A developmental perspective can enhance the understanding of the findings presented earlier in this report. In this chapter, we tie our conclusions about the well-being of children in this study to other sources of evidence to help explain developmental outcomes. We make some predictions about how these children will fare, given their experiences of maltreatment, their current environments, and their current developmental status. This is a difficult challenge compounded by the relatively few studies that help to make sense of standardized scores on developmental measures for poor and very poor children, the preponderance of children involved with CWS. The modicum of comparative investigations that included developmental measures on maltreated children further limits understanding of how well these measures predict subsequent development for this population of children.
This chapter approaches findings related to children’s development based on several theories in the developmental literature. Most developmental scholars believe that children proceed through a series of age-related developmental transitions (Lerner, 2002). In our analyses we distinguish four developmental periods through which children traverse, which roughly coincide with birth through 2 years (infancy), 3 to 5 years (early childhood), 6 to 11 years (middle childhood), and more than 11 years and beyond (adolescence) (see Berk, 2001). Our observations are categorized by these developmental periods.
In addition, we examine the “whole child,” including the physical, cognitive, and social-emotional domains (Cicchetti, Toth, & Maugham, 2000) of child functioning. Developmental scholars have advanced a transactional conceptualization of development in which biological and environmental (ecological) factors interact over time to determine children’s developmental progression in these domains (Bronfenbrenner & Ceci, 1993; Sameroff & Fiese, 2000). Such an approach is particularly useful when considering maltreated and foster children, given their significant exposure to biological and environmental risk factors.
By including children from infancy through adolescence, addressing development in multiple domains, and examining multiple influences on development, the NSCAW study offers a unique view of the developmental functioning of children involved with CWS. Overall, development appears to be significantly compromised for these children when compared with normative samples, particularly in the social-emotional domain. The evidence also indicates that their environmental experiences are problematic in a number of areas, including compromised caregiver functioning, parent-child relationship difficulty (e.g., maltreatment), impoverished socioeconomic status, and inadequate receipt of child welfare and other services. The following are descriptions of the developmental and environmental data organized by developmental period.
10.1 Children Aged Birth to 2 Years
Children investigated for maltreatment at this young age provide CWS the opportunity to intervene early in children’s lives, potentially providing lasting benefits including child safety and permanency, as well as successful child development. However, the timing and intensity of such interventions can seriously disrupt the development of the parent-child relationship. Because children are rapidly changing developmentally in the first few years of life, the environmental circumstances that can affect child development are crucial during this time.
Following the current incident, infants are significantly more likely to be placed in out-of-home care than children just a year or two older, suggesting that CWS interventions for infants are more broadly delivered and intensive than for children aged 3 to 5 years. This youngest group of children (aged 0 to 2) is over twice as likely to be placed in out-of-home care than to remain at home compared with older children. An additional 24% of this youngest group remained in the home but were determined to need services to address family problems related to current maltreatment or risk for future maltreatment.
Children who become involved with CPS between the ages of 0 and 5 years most frequently experience neglect—failure to provide or failure to supervise. Children from birth to age 2 most frequently experience failure to supervise as the most serious type of maltreatment (36%), followed by a substantial proportion for whom failure to provide (31%) is the most serious maltreatment type. A sizable proportion (27%) of children aged 0 to 2 have experienced physical maltreatment for the current episode of child welfare involvement, and an additional 6% experienced sexual maltreatment as the most serious maltreatment type for the current service episode. More severe levels of failure to supervise are reported among the youngest children in the study compared with children in the next cohort (3- to 5-year-olds). Infants in the NSCAW population most frequently experience placement into both foster care and kinship care settings because of neglect (failure to provide).
10.1.1 Functioning of Children Birth to 2 Years Old
Children experience the most rapid and complex developmental changes during infancy, which already show substantial variability in rate and result (Siegler, 2002). Advances in ambulation, verbal communication, and social interaction are particularly salient during this period. Additionally, the human infant experiences exponential growth in body size as well as in the size of the brain. Much of the brain’s growth occurs during the first few years after birth, and by age 3, a baby’s brain has reached a substantial proportion of its adult size (Perry, 2000). This exponential growth indicates that complex processes have occurred in the development of the brain during this period, with corresponding and profound implications for the physical growth and maturation of the brain and body and for the development of the young child. Early experience, including cognitive stimulation and emotional nurturance, has been found to affect not only the growth of the brain but the capacity of the brain to perform specific functions, such as cognitive problem-solving and affective regulation (e.g., Perry, 2000). Infants who are physically small for their age appear to be at higher risk for neurological and intellectual dysfunction (Lundgren et al., 2001).
Findings from NSCAW indicate that children in their first year of life and involved with CWS have below-average head circumference. Infants’ head circumference is below average across all child settings, with the largest differences for children remaining in the home without child welfare services. Although the exact implications of small head circumference for children is not known, there does not appear to be an all-determining link to learning capacity. There are those (e.g., Perry, 2000; Lundgren et al., 2001), however, who argue that small head size is a marker for subsequent developmental problems.
Differences in infant height exist by child setting. Infants remaining in-home and receiving child welfare services and infants living in foster care are below average in height. Whereas infants in the NSCAW population are generally comparable to children in the general population in height and weight, 1-year-old children involved with CWS are below average height compared with children in the general population, a difference that is most distinct among 1-year-olds in kinship foster care.
Differences in physical development for the children living in kinship foster care compared with children in the general population, and with children living in other service settings at intake, continue for the 2-year-olds in the NSCAW study. Children aged 2 and living in kinship foster care have low body mass index (BMI) scores compared with children in the general population and compared with children in other service settings, suggesting that young children in kinship care settings may be at risk for delays in physical development compared with children in the general population. Also of concern is the variability of BMIs for these children; younger children are below average height, and many are either at risk for or were underweight or overweight at the time of the baseline assessment. This suggests that these children continued to have nutritional needs that are not fully addressed. The need for nutritional expertise on behalf of children involved with CWS can be added to other concerns regarding these children, such as the need for educational interventions, dental care, health services, and eye care (Gorski et al., 2002; Takayama, Wolfe, & Coulter, 1998).
Perhaps the most consistent finding across children in the youngest age group in the NSCAW population is delay in cognitive and language development. Among children aged 3 years and younger in NSCAW, 30% are falling significantly behind in cognitive and language skills. Older preschoolers are clearly falling behind—farther behind than the infants in the study. Considering that the acquisition of skilled reading has its roots in the development of early oral language (Rescorla, 2002), these early cognitive and language delays are a concern. Measures of children’s auditory and expressive language development, using the PLS-3 subscales, show no meaningful differences between auditory and expressive scores.
Additional evidence of cognitive delay among young children in the NSCAW population is apparent in children’s BINS scores. More than half (53%) of all children aged 3 to 24 months whose families were investigated for maltreatment were classified by the BINS as at high risk for developmental delay or neurological impairment. Because the BINS is a screening instrument and by definition is overinclusive in terms of the number of children at risk of developmental delay, not all of these children are certain to have developmental problems. The proportion of children at risk is still extraordinarily high. Although some researchers (e.g., Meisels & Atkins-Burnett, 1999) have questioned the strength of the relationship between early developmental functioning and later intellectual performance, there is general consensus that children who fall behind the academic curve risk remaining behind (Alexander, Entwistle, & Kabani, 2001). Considering that competent cognitive functioning is a protective factor for children (Dodge & Pettit, 2003), deficits in this area among children in the NSCAW study add to the risk that young maltreated children face in their transition to school and thereafter.
While it is too soon to tell whether new environments that some children were experiencing at baseline will change their performance on standardized measures of cognitive development, there is no need to wait for additional data to observe whether delays in cognitive development across young children in all child settings are apparent. The proportion of children with scores two standard deviations below the mean on the BDI, a measure of four areas of cognitive development, ranged from 25% for Conceptual Development to 47% for Reasoning and Academic Skills.
High levels of developmental problems were also detected in the behavioral domain. The proportion of young children aged 2 to 3 years reported by their caregivers as having clinical/borderline problem behaviors was almost 27%, compared with 17% of children of the same age in the general population. These findings were also consistent across children at home and children placed into foster care.
10.1.2 Home Environment of Children Birth to 2 Years Old
A nurturing environment is important for a child at any age. This is particularly important, however, when children are in the first years of life because their cognitive and affective capacity is at risk (Perry, 2000). Many studies have pointed to the contribution of parental drug and alcohol use to compromised family environments and to the negative developmental sequelae for children living with substance-abusing parents (e.g., Beckwith et al., 1999; Mayes & Cicchetti, 1995). Parental mental health difficulties can also be damaging to the development of the very young child and may adversely affect cognitive and language development and physical growth (Seifer et al., 2001). Children aged 0 to 2 years in this population are exposed to a substantial range of adverse conditions. More than half of the households in which the youngest NSCAW children reside fall below 100% of the poverty level, which is slightly more than the proportion of children in other age groups living below the poverty level. Child welfare workers reported that 19% of the caregivers of children aged 0 to 2 were experiencing substance abuse at the time of the investigation—significantly higher than for any other age group or for the average (14%) across all age groups.
The likelihood of serious mental health problems among the mothers of very young children (19%) is also significantly greater among children aged birth to 2 than for any other child age group and the overall average (15%). Among all the age groups, children in the birth to 2 group are the most likely to have a caregiver who had experienced at least one of the adverse caregiving conditions described above (living at less than 100% of the poverty level, history of domestic violence, parental substance abuse, or serious parental mental illness). The parents of infants experienced such conditions at the highest rate of all children entering CWS.
Younger caregivers appear to experience more difficulty with emotional nurturing of their infants than do older caregivers. Emotional support scores on the HOME-SF for infants living with caregivers less than 30 years old are lower than emotional support scores for home environments with caregivers between 30 and 45 years old. In addition, about two-thirds of the caregivers of children less than 3 years old displayed some punitive parenting behavior during the field observation. Studies on mother-child interaction suggest that warmth, nurturance, and emotional availability are crucial during the infancy years (e.g., Lyons-Ruth & Zeanah, 1993). Attention to the factors associated with physical neglect and lack of emotional nurturing among caregivers of infants is needed.
As we should expect, children aged birth to 2 years living out of the home (including children living in foster or kinship care) are more likely to reside in a home environment with a higher total HOME-SF score than children living at home. According to child welfare worker reports of the home environment using the HOME-SF, children aged 0 to 2 living out of the home receive more physical affection and are less likely to be restricted from exploring by their caregivers. In addition, children aged birth to 2 living out of the home are more likely to have caregivers who kept the child in close view during the interview, who spoke with a distinct and audible voice, and who conversed freely with the interviewer compared with children living at home. Finally, children aged birth to 2 years in out-of-home care are more likely to have a safe play environment than children living at home.
These findings do not indicate that these in-home scores are unacceptable or unsafe, but they do show a strong association between low HOME-SF scores, other measures of child clinical risk, and the likelihood of the substantiation of maltreatment for children this age. This suggests that the out-of-home care environments are likely to meet some of the developmental goals of foster care. Having an open child welfare case does not appear to have a rapid impact on the total home environment and emotional support scores—the home environments of children who live at home and receive services are less emotionally supportive than the home environments of children who live at home and did not receive services. Only longitudinal data will tell if this changes over time.
10.1.3 Services for Children Birth to 2 Years Old and Their Families
One of the most central needs that young children have is for stable and safe parenting. Without such stability, the likelihood of developing difficulties in relationships and in other cognitive and behavioral realms is substantial (Berlin & Cassidy, 2001; Ackerman et al., 2002). Yet the young children in this study are not always experiencing this stability as, for example, some very young children are residing in group care despite the inconsistent caregiving and poor developmental provisions that characterize group care environments (Berrick et al., 1998; Harden, 2002).
The experience of serious maltreatment among younger children has been associated with lasting difficulty in a variety of social and emotional realms (Perry, 2000; Teicher et al., 2002). The magnitude and character of victimization in this developmental period may have an impact unlike that in any subsequent period (Rutter & Rutter, 1993). Our developmental measures indicate that very young children are clearly functioning at the margins, although we do not know the proportion of NSCAW cases with permanent developmental deficits. Parenting classes are a frequent service recommended or mandated by CPS to improve children’s care. There is evidence in this study to support the need for effective parent training—caregivers of young children more frequently employ punitive methods of caregiving and appear to provide less cognitive stimulation and emotional responsiveness than other caregivers. Although the provision of parent training was a very common intervention provided to NSCAW families, few models have been shown to be effective in improving parenting among CWS-involved parents of young children (c.f., Chaffin et al., 2003; Urquiza & McNeil, 1996). These methods, and those shown to be generally effective with young children at high risk of behavior problems (e.g., Hartman, Stage, & Webster-Stratton, 2003; Sanders & McFarland, 2000), appear to deserve much greater use in child welfare services.
The service needs of children at this age are substantial because of the likelihood that many young children enter CWS after having been exposed to prenatal risks from trauma, tobacco, alcohol, substances, and inherited genetic vulnerabilities (Semidei, Feig-Radel, & Nolan, 2001; Lester et al., 2002; Teicher et al., 2002). Even when such children are provided with protective postnatal social environments such as foster care or adoption, they may still have subsequent developmental abnormalities (Moe, 2002), although such changes in custody can facilitate some improvements in outcomes (Delaney-Black et al., 2000). Those children who continue to be exposed to substances may be more likely to show such developmental problems as aggressive behavior (Delaney-Black et al., 2000). The limited amount of substance abuse treatment for parents and the lower likelihood of young children receiving mental health or special education services renders these children more vulnerable to compromised development. These negative effects of early disadvantage may be greatest on the subsequent school performance of young African-American children (V. McLoyd, personal communication, November 18, 2002). In the NSCAW data, these children also have the lowest participation rates in services, according to information provided in the intake interviews.
Intensive, early interventions may be key to minimizing the long-term effects of early trauma on children’s brain development, and children who become involved with CWS should have access to early intervention programs. Most models of early intervention programs for young children involved with CWS involve a home-based component. Health-oriented, professionally provided, home-based interventions for mothers with infants have shown program effectiveness (Kitzman et al., 2000). Although the clientele served in that study are not as disadvantaged as the child welfare clientele, there is some evidence that other home-based interventions aimed at improving mother-infant interaction show positive results influencing the relationship between mothers’ drug use and lack of maternal responsiveness (Schuler et al., 2000).
Although NSCAW children aged birth to 2 years show physical and cognitive needs and experience relationships with their caregivers that lack sufficient physical affection, verbal attention, and safe play environments, very few are assessed and treated for developmental difficulties. Children in this age category are the least likely to receive special education services, despite having at least one clinical score. About one in eight caregivers with children in this age group reported that their child had been tested for special education services since the investigation. A small proportion (4%) of birth to 2-year-olds reportedly had an individualized education program (IEP) and individualized family service plan (IFSP), and 3% of children in this age group were receiving special education services at the time of the baseline interview.
Children in this age group are also unlikely to be receiving mental health services. Just 3% of children aged birth to 2 were receiving early intervention services, and an even smaller proportion was receiving mental health care (1%) at intake to CWS. These figures do not support other research concluding that younger children (under age 4) receive more child welfare services overall and greater caseworker activity than older children (Freeman, Levine, & Doueck, 1996).
10.2 Children Aged 3 to 5 Years
There is increasing awareness of the significant developmental needs of children younger than 5, as shown by the dramatic growth in early intervention programs and pre-kindergarten transition programs for special needs and disadvantaged children (e.g., Buell, Hallam, & Beck, 2001; Troup & Malone, 2002). Many researchers (e.g., Ramey, Campbell, & Ramey, 1999) suggest that the skills that promote later academic learning and positive interpersonal relationships are achieved in the first 5 years of life. Children of this age have received less attention in CWS discussions than infants, despite evidence that they have poor outcomes with regard to the likelihood of leaving out-of-home care once they have entered and are less likely to stay at home once reunified (Berrick, Barth, & Gilbert, 1996).
NSCAW children aged 3 to 5 years investigated by CPS are most frequently experiencing neglect as the most serious type of maltreatment, but also show high rates of sexual maltreatment compared with children in other age groups. Twice as many 3- to 5-year-olds experienced sexual maltreatment as the most serious type of maltreatment compared with younger children and those aged 6 to 10 years. Only children aged 11 years and older have a higher proportion of sexual maltreatment. The severity of the sexual maltreatment experienced by children aged 3 to 5 years is also comparable to the severity of sexual maltreatment experienced by children aged 11 and older. The magnitude of these findings was unanticipated. Clinical research with sexually abused children, however, shows promise in helping children and nonoffending parents cope with the event(s). With proper parental engagement and mental health services, sexually abused children can make substantial progress in addressing the sizable adversity often associated with this type of maltreatment (Cohen & Mannarino, 1998).
In addition to experiencing higher rates of sexual abuse, children aged 3 to 5 years experience rates of physical maltreatment that are a concern. Severity levels of physical abuse among children in this age group are comparable to physical abuse severity scores among children aged 11 years and older. Yet, of all the children, these preschool children receive the least intervention by CWS on their behalf.
Children in this age group are the least likely, by a significant amount, of all NSCAW children to be placed in out-of-home care. This finding is difficult to interpret, given the significant vulnerability of preschool children. One explanation for decreased placement in foster care for children in this age group is that the availability of day care programs may be greater for children this age than for infants. Another complementary hypothesis is that the behavior of these young children is more manageable than the behavior of older children. Parenting classes may be available for, or more oriented toward, parents with children of this age than for parents with older children, leading to decreased need for out-of-home placement. Regardless of speculation as to why children this age have the lowest level of CWS intervention on their behalf, researchers (e.g., Campbell, 1995) have documented that behavior problems during the preschool period portend later behavior problems of a more intense nature. Even if these children do not need CWS intervention, many need special compensatory or early intervention services. Yet few of the children remaining in their own homes are receiving them.
In contrast to the receipt of out-of-home care, children aged 3 to 5 years are no less likely than other children to receive in-home child welfare services. Nonetheless, almost 5% of all children placed in group care following a child maltreatment investigation are preschoolers, despite the developmental inappropriateness of having children this age exposed to shift workers, which necessarily limits their opportunities to interact with a consistent and loving parent figure (Berrick et al., 1997).
Prior child welfare experiences were judged to be significant factors in child welfare workers’ decisions about how to proceed at this juncture in the lives of children aged 3 to 5. Child welfare worker decision-making in cases involving children aged 3 to 5 appears to center on children’s (and their families’) history of prior investigations, as well as children’s inability to self-protect, to a greater extent than was reported among other age groups. Using children’s history of prior investigations as a critical factor in decision-making is complicated, however, by the fact that these children are the most likely to have ever had an investigation with no finding of substantiation. Perhaps this partially explains why children in this age group more often remain at home following the report that led to their inclusion in NSCAW.
10.2.1 Functioning of Children 3 to 5 Years Old
Preschool children are transitioning from a phase of life in which they are wholly dependent on the care of adults to a phase in which they are more capable of caring for and monitoring themselves. They become more adept at gross and fine motor activities and display more individualized growth patterns. Their thinking and verbal communication skills become more complex because of their increased capacity for abstraction (i.e., mental representation). Because of their capacity to internalize adult standards and directives, they are more emotionally regulated and display fewer behavioral challenges than younger children (Kochanska, Coy, & Murray, 2001). Preschool children in the NSCAW study are challenged in many of these areas.
Children’s development begins with their health and safety. NSCAW children aged 2 to 3 years vary from the norm in substantial numbers on BMI scores. This is particularly true for children in kinship care: 3-year-olds in kinship foster care are at the 38(th) percentile on BMI. Only 41% of children aged 2 to 3 years involved with CWS are at an expected weight for their height.
The remaining 59% are almost evenly split between being at risk for or overweight and being at risk for or underweight—about twice the expected rate in the general population. In general, head circumferences for children aged 3 years and younger in the population of children involved with CWS is somewhat below the 50(th) percentile. A reverse trend for NSCAW children aged 2 to 3 existed by child setting: children in kinship foster care had larger head circumference than children in nonkinship foster care and children remaining in the home.
NSCAW preschoolers have language skills that are somewhat below average. Older preschoolers appear to have a gap in language skills when compared with their peers, and the gap is larger than that found between younger preschoolers and their peers. This suggests that these older preschoolers, many of whom had previously been involved with CWS, are already losing ground; such a finding would be consistent with previous research on maltreated children (Fox, Long, & Langlois, 1988). This assumes that the measures are well calibrated across age groups and are, therefore, comparable. It should also be noted that language skills diminish among other at-risk groups as well, including children from low-income backgrounds, perhaps due to the complex language skills that are demanded during the preschool period (Hoff-Ginsburg, 1998) coupled with a high-risk home environment. Interventions to bolster acceptable language skills appear to be needed early on with this group of children, yet they are underserved in special education services.
The youngest children entering CWS are at a disadvantage compared with older children in regard to special services’ assessment and provision. This is an important finding, considering that children aged 2 to 5 years in NSCAW score high on problem behaviors as measured by the CBCL. In addition, with increasing evidence that exposure to violence negatively impacts children’s emotional and behavioral well-being (e.g., Cicchetti & Lynch, 1993), greater attention to the early signs of children’s behavioral difficulties, such as those measured by the CBCL, is warranted. Overall, these 2- to 3-year-olds were reported as having over 50% more problem behaviors than the norm (27% vs. 17%). As reported by caregivers, 37% of children aged 4 to 5 years who are involved with CWS exhibit borderline or clinical levels of problem behaviors. At the same time, 3- to 5-year-olds in NSCAW are rated by caregivers as having fewer problem behaviors than children aged 11 years and older. Again, it is important to consider these high rates of behavior problems in the context of the evidence that the trajectory for later conduct problems begins during the preschool period (Campbell & Ramey, 1994). Thus, high rates of problem behavior are not insignificant for younger children.
10.2.2 Home Environment of Children 3 to 5 Years Old
Caregivers’ struggles with poverty, substance abuse, mental illness, and domestic violence may erode their abilities to be successful parents. Overall, the proportion of children aged 3 to 5 years living below the poverty line, having a caretaker with substance abuse or mental health problems, or having a caretaker with a history of domestic violence victimization does not differ significantly from the proportions of children in other age groups experiencing these circumstances. Nonetheless, some slight differences between children aged 3 to 5 and children in other age groups are worth noting.
While approximately one-half of children in all age groups were living below the poverty line at intake, a higher proportion of younger children (including children aged 3 to 5) were living in poverty at intake compared with older children. Income may be a proxy for a range of problems associated with disadvantage, such as poorer prenatal care, poorer medical services, greater social stressors, and more toxic physical home environments, such as lead exposure (Linver, Brooks-Gunn, & Kohen, 2002). Poverty can affect children’s development through its impact on parental mental health, which then influences parenting practices, which in turn are associated with child outcomes (Conger et al., 1992). Income effects appear to be strongest during the preschool and early school years, when low income is persistent and when poverty is deep (Brooks-Gunn & Duncan, 1997). In the general developmental literature, a cognitively stimulating home environment and parenting practices were both found to mediate the effects of income on children’s development.
Substance abuse also appears more prevalent among caregivers of children in younger age groups. Almost 15% of caregivers of children aged 3 to 5 years have problems with substance abuse, as reported by their caseworker at intake, compared with approximately 12% of caregivers with older children. Children aged 3 to 5 are also not substantially different from children in other age groups with regard to having a caregiver with serious mental health problems, yet about one in six caregivers of 3- to 5-year-olds who become involved with CWS suffer from a serious mental health problem. Children aged 3 to 5 also do not appear to have noticeably elevated or lower rates of caregivers with a history of domestic violence victimization.
Both in-home and out-of-home environments for younger children in NSCAW have higher HOME-SF scores than both environments for older children. This is consistent with the findings that positive in-home living environments for preschoolers appear to be more similar to the levels provided in foster care than they did for other age groups. Also assessed through the HOME-SF is the presence of punitive caregiving in the home environments of children younger than 6 years. The items in the scale included observations of whether the mother/guardian shouted, expressed annoyance or hostility, criticized, slapped or spanked, and restricted the child multiple times during the interviewer’s home visit. A slightly lower proportion of children aged 3 to 5 (49%) experience punitive caregiving compared with infants and younger children (67%).
Perhaps the most striking finding among NSCAW children is the amount of violence in their lives. Somewhat unexpectedly because of their young age, children aged 5 years report the highest lifetime exposure to both mild and severe violence. Perhaps one reason is that older children are better able to run away, to use verbal and intellectual skills to placate, and to fight back (Finkelhor, 1995). Violent partners may also feel less worried that a young child will become involved in the altercation. Another hypothesis relates to the “magical thinking” that is characteristic of the preschool period (Rosengren & Hickling, 2000; Woolley et al., 1999). These young children may have difficulty responding validly to a violence exposure questionnaire.
10.2.3 Services for Children 3 to 5 Years Old and Their Families
Children aged 3 to 5 years, despite showing cognitive, physical, and psychosocial difficulties similar to children in other age groups, are unlikely to receive services and to be assessed for special needs, such as special education. Just 4% of 3- to 5-year-olds were receiving outpatient mental health treatment, such as counseling at school or at a mental health clinic. The proportion of children this age receiving specialty mental health services, in particular, is very low (2%). The proportion of children receiving special education services is higher for those who had at least one score in the clinical range (12%), but overall, children in this age group do not receive services at a rate comparable with children in other age groups, with one exception. Sexually abused children between ages 3 and 5 are approximately four times more likely to have received mental health services than similarly aged children who had experienced neglect.
Perhaps as a function of less assessment, younger children in NSCAW have lower rates of disabilities (emotional disturbance, learning disability, and “other”) than older children. Although there is evidence that involvement with CWS helps children to get expedited access to special education (Goerge et al., 1992), this had apparently not occurred for children of this age in the first few months of involvement with CWS. The children in the 3- to 5-year-old group who did receive special education were less likely than older children to have disruptive behaviors and specific learning disabilities but more likely than older or younger children to be classified as speech- or language-impaired. The developmental literature suggests that there is a strong association between language difficulties, academic functioning, and behavior problems, particularly for preschool children (Campbell et al., 2001). Several longitudinal studies have shown that early interventions can make a substantial difference in language and social development (Ramey et al., 2000; Reynolds, 2001); these methods might be adapted to serve children becoming involved with CWS. Given these clear risks, these findings call for consideration of a substantial reorientation of child welfare services and the development of routine linkages between CWS agencies and supplementary educational programs.
10.3 Children Aged 6 to 10 Years
Children aged 6 to 10 years make up a substantial portion of children involved with CWS; over one-third of children are in this age group. Children in this elementary school age group are considerably more likely than 3- to 5-year-olds to be living in out-of-home placement. Physical maltreatment appears to be a more common problem for children aged 6 to 10 compared with younger children. Approximately one-third of 6- to 10-year-olds experienced physical maltreatment for the current episode of CWS involvement. A fair proportion of children in this age group are also inadequately supervised (26%), although this is the lowest rate of failure to supervise as a primary maltreatment type compared with children in all other age groups experiencing this type of maltreatment. The severity of the current maltreatment among 6- to 10-year-olds remaining in the home is moderate across maltreatment types, but the severity ratings of children aged 6 to 10 in out-of-home care who have experienced sexual maltreatment, in particular, is high.
10.3.1 Functioning of Children 6 to 10 Years Old
During middle childhood, children experience increased cognitive demands from the adults in their environment and through the advent of formal schooling. They are exposed to ever-widening social worlds and begin to have enduring relationships with peers (Hastings et al., 2000). The capacity for emotional and behavioral regulation becomes even more important as adults spend less time with them and expect them to monitor and direct themselves (Wassef et al., 1995). Additionally, many mental health problems are thought to commence during this period (e.g., oppositional defiant disorder). The evidence from NSCAW suggests that maltreated school-aged children are compromised in each of these developmental areas.
Academic-related deficits, while not experienced by all youths in CWS, are evidently serious in a small portion of youths and appear to become more serious for youths who enter CWS after ages 6 to 10. Overall, 6- to 10-year-olds in this study are near the mean for intelligence and reading and math achievement. Yet a substantially greater-than-expected proportion of children in this age group scored more than two standard deviations below the mean for verbal and nonverbal intelligence and for math and reading achievement. Reading scores tend to be higher (100.2) than math scores (94.3) for children in this age group and also tend to be higher for children aged 6 to 10 years than for children aged 11 and older (96.9 and 90.6, respectively). KBIT composite and verbal subtest scores are also higher for the 6- to 10-year-olds (95.5 and 93.3, respectively) than for the oldest children in the study (92.7 and 89.8, respectively). Children in this age group reported fewer school problems than did children over age 10. Some evidence does exist for an association between maltreatment and academic achievement: maltreated children tend to have lower grades (Kinard, 1999) and repeat grades more frequently than nonmaltreated peers (Kendall-Tackett & Eckenrode, 1996). Research also indicates that higher academic achievement functions as a protective factor against problem behaviors (Leathers, 2002; Vance et al., 2002), which is significant for this group of children, because they have an average reading score right at the test mean.
The NSCAW elementary-school-age children exhibit high rates of depression, which, although similar to the older age group, still exceed levels for the normative population. Over one-third of 6- to 10-year-old children in the study were reported by their caregivers as having low social skills. Low social skills are not unusual in maltreated children, who have been found to be less attentive to relevant social cues, more biased toward attributing hostile intent, and less likely to generate competent solutions to interpersonal problems than nonmaltreated peers (Dodge, Bates, & Pettit, 1990; Fantuzzo et al., 1998). Such skill deficits can have a substantially adverse impact on children and are associated with aggression and peer rejection—markers for a variety of disorders that disrupt development (Dodge, 2000).
NSCAW data provide encouraging evidence that 8- to 10-year-old children (data were not collected for younger children) generally report good peer relations at school, little loneliness, and satisfaction with their school friends. Good peer relations are one indication that although many children do have low social skills, they are successfully maintaining friendships. Caregivers also indicated that 6- to 10-year-olds have higher daily living skills than 3- to 5-year-olds, even after controlling for differences based on age.
Children aged 6 to 10 years were generally reported by caregivers as having fewer clinical or borderline problem behaviors than older youths, but were reported to have more problem behaviors than younger children and than normative samples of children the same age. Problem behaviors among 6- to 10-year-olds are well above the norms—40% and 36% of children this age were reported by caregivers and teachers, respectively, to have problems in the clinical or borderline range. Almost all 6- to 10-year-olds living in group care (96%) were reported by caregivers as having clinical or borderline problem behaviors—a substantially higher rate than for the older children. We do not know if this is because children of this age placed in group care are selected into group care because of their behavior problems, or whether caregivers in group care are far more likely to observe clinical problems. We expect that both effects contribute to these high ratings.
10.3.2 Home Environments of Children 6 to 10 Years Old
Children aged 6 to 10 years remaining at home lived in households with more members and more children than children aged birth to 2 years who remained in the home following the child maltreatment investigation. Yet, across all settings, children aged 6 to 10 were living with fewer adults than were children aged birth to 2. The care of many young children by single caregivers may have substantial implications, including greater risk for inadequate parenting (Burchinal et al., 2000; Needell & Barth, 1998; Sedlak & Broadhurst, 1996), although less is known about the influences of large family size and single parenthood for elementary-aged children. Although such family configurations do not preclude excellent parenting, children involved with CWS and struggling with the multiple problems shown in this study may not receive the individual attention they need to thrive in such environments. Responsibility for multiple children and/or other individuals may reduce the capacity of caregivers to provide adequate monitoring of children’s whereabouts and peer group and increase the odds that children may become involved with delinquent peers (Patterson & Dishion, 1985)—especially in the after-school hours, when most juvenile violence occurs (Snyder, 2000).
Compared with younger children in NSCAW, 6- to 10-year-olds live in less positive home environments overall, especially related to cognitive stimulation and emotional support. The physical environment of the home is poorer for children in this age group living with caregivers aged 30 and younger—parents who were likely to have given birth to them at a young age—compared with the physical environment of children in this age group living with caregivers aged 30 to 45. Future analyses may find utility in the classification of parents according to the difference in their ages and the ages of the children in their care (Lee & Goerge, 1999). Conclusions must necessarily be tentative because different, age-dependent versions of the HOME-SF were administered. The home environment may be particularly salient for children this age, as the data show strong associations between HOME-SF scores and the proportion of children this age with behavioral problem scores in the clinical range.
Children aged 6 to 10 years in NSCAW witness more violence than children over 10. Among children five and older, the 6- to 10-year-olds appear to be the most at-risk for witnessing adult-to-adult violence and police actions against adults. Although the literature on the impact of exposure to violence is somewhat unsettled, there is growing recognition that the combination of exposure to violence and maternal distress heightens the adverse impact on children’s behavior (Linares et al., 2001). Since the caregivers in this study have high levels of maternal depression and mental health problems, we can expect that the deleterious impact would be significant.
Overall, approximately one-third of 6- to 10-year-olds in the sample remaining in the home have parents with a history of arrest, usually two or more instances. Parental arrest is a risk factor for children’s own problem behavior and placement disruptions during foster care (Leathers, 2002). Among all children this age, 13% score above the clinical cutting score on the delinquency subscale of the CBCL, over six times greater than the normative sample. Of the 11% of 6- to 10-year-olds remaining in the home with a clinical/borderline delinquent behavior, 37% have parents with a history of arrest. While many youths end such problem behaviors, early initiation of delinquency is a good predictor of continued criminal behavior, particularly for more aggressive types of behavior (Loeber, 1990).
Children aged 6 to 11 years are exposed to rates of poverty that are lower than the poverty rates of infants in the study but that are consistent with other age groups. Caregivers of 6- to 10-year-old children have significantly lower rates of substance abuse (12%) and mental illness (13%) than caregivers of infants or toddlers but that are comparable to rates among caregivers of the oldest children. Across all age categories, caregivers of children aged 6 to 10 have the lowest proportion, with at least one adverse parenting condition (being very poor, having serious mental illness, experiencing substance abuse, or having a history of domestic violence). Seventy percent of children this age have experienced at least one of these, compared with 80% of children birth to 2 years old, 73% of 3- to 5-year-olds, and 76% of children 11 years of age or older.
10.3.3 Services to Children 6 to 10 Years Old
The proportion of children living in foster care following a child maltreatment investigation is the highest for children aged 6 to 10 years (32%) compared with children in all other age groups. Children aged 6 to 10 experience placement into group-home settings at a much greater level than children in the 3 to 5 age group: children aged 6 to 10 constitute almost one-quarter of the children living in group care.
Child welfare workers indicate that the three most critical factors in determining whether to proceed with cases for 6- to 10-year-olds are a reasonable level of caregiver cooperation, children’s inability to protect themselves, and a high level of stress in the family. (“High family stress” contributors include no other supportive caregiver, low social support, and trouble paying for basic necessities.) The last factor is not one of the top contributors to child welfare worker decision-making regarding children in any other age group. We have not been able to provide further exploration of these factors but believe that they may help us understand how to provide developmentally sensitive child welfare services to this group of children and their parents.
Child maltreatment may represent the greatest failure of the expectable environment that children need in order to develop successfully (Cicchetti & Lynch, 1995). The experience of child maltreatment places them at risk of a number of untoward outcomes, especially if no protective or compensatory services or experiences are provided (Jonson-Reid & Barth, 2000a). Early onset of problem behaviors may be associated with maltreatment and is a substantial risk factor for transitions into antisocial behavior (Champion, Goodall, & Rutter, 1995). Yet there is considerable evidence that children can recover from high levels of problem behavior—over half of children identified early on as having significant behavior problems do recover (Campbell, 1995). This recovery appears to rely on a confluence of personal, familial, and community protective influences (Buchanan & Flouri, 2001; Fraser, in press) that are difficult to achieve but certainly not beyond the reach of coordinated and evidence-based interventions.
10.4 Children Aged 11 to 14 Years34
Although children aged 11 to 14 years are in less need of protection from serious physical harm at the hands of their caregivers than are younger children, they still enter foster care in substantial numbers—numbers that rival the entry rates of infants (Wulczyn, Hislop, & Goerge, 2000). These children have substantially more behavior problems and are more likely to experience physical and sexual abuse than their younger counterparts. The oldest children also have the highest rates of prior psychiatric hospitalizations, which is apparently a direct and indirect contributor to their high rates of placement into CWS-supervised placements (U.S. GAO, 2003).
The needs of older children in the NSCAW study are reflected in the types and frequency of services they receive. The primary service that CWS provides for children aged 11 and older is a change to a safe living environment. Whereas most of these early adolescent children continue to live at home, they are the only group of children, other than newborns, to constitute a larger proportion of out-of-home care receipt than they constitute in the total NSCAW sample (early adolescents are 25% of the sample but represent 29% of the children in out-of-home care). Although the majority of these youths in out-of-home care live in kinship care or foster care and only about 5% live in group care, this age group represents approximately 75% of all the children living in group care. Children in group care are apparently clustered there because they have the most behavioral problems. Unfortunately, there is little evidence that such settings help to mitigate these behavioral problems (Barth, 2002) and some evidence that behavior may worsen in group-care settings (Dishion, McCord, & Poulin, 1999).
Children aged 11 and older and living in group care did not all work their way up to group care through failed foster care or kinship care placements for the current maltreatment episode. Given the timing of the interviews, they arrived in group care soon after entering placement. Many of them entered group care as their first placement in this episode of involvement with CWS. This is consistent with other data on the transition to group care (Webster, Barth, & Needell, 2000). Although the proportion of children aged 11 and older placed in group care is not meaningfully higher than the proportion of children this age who are in foster care at baseline (38%), it is far greater than the proportion of children entering kinship care (8%). Because of the possibility that group care is particularly prone to result in the contagious exposure to negative behavior by other troubled youths (Chamberlain & Reid, 1998), the significant use of group care for these early adolescents should be more carefully considered and understood.
10.4.1 Functioning of Children 11 Years and Older
Adolescence is the developmental period when children forge their own identities and begin to prepare for an independent future. Although most adolescent children tend to adhere to social standards as they experience this developmental process, a substantial proportion of children demonstrate high-risk behaviors during this period. Children with few protective factors (e.g., academic success, close family ties, and involvement with prosocial peers) are likely to continue on to develop high-risk habits (Jessor et al., 1995).
Early adolescents (i.e., youths 11 years and older) who are involved in CWS are most distinguishable from younger children primarily in terms of exhibiting greater problem behaviors. But problem behaviors in adolescence are not necessarily indicative of problems that will carry over into adulthood. Most adolescents grow into adults with successful social and academic functioning (Steinberg & Morris, 2001). The risks of developing substantial problems with lifelong consequences become increasingly significant during early adolescence because these are the years in which forming positive family and school relationships must prosper if these youths are to withstand the developmental tensions of adolescence. Problem behaviors during early adolescence are associated with various other negative outcomes, such as low academic achievement (Vance et al., 2002) and keeping associations with other peers who also have substantial behavior problems (Gorman-Smith et al., 1998).
NSCAW children aged 11 years and older tended to exhibit considerably more problem behaviors as reported by caregivers than younger children. This difference held true when all placements were combined, as well as with children remaining in the home. Youths this age were asked to describe their own behavior; the findings show that females had greater odds of reporting behavior problems than males, and that the adolescents living in out-of-home care, particularly group homes, had the greatest level of behavior problems, even by their own accounts. Early adolescents in group care had greater odds of having committed a violent act in the 6 months prior to their interview.
Children aged 11 years and older involved with CWS also reported approximately twice as much depression (measured via the CDI and YSR Depression subscales) as normative samples, with youths living in group care at the greatest odds of reporting depression. Early onset depression may have serious and significant consequences, even after controlling for life circumstances, including greater risk for later substance use and abuse (Costello et al., 1999; Glied & Pine, 2002). We did not assess the presence of major depressive disorder, which has far stronger predictive properties (Kasen et al., 2001).
Recognizing the signs of developmental problems in maltreated children is a challenge. Assessment for trauma-related difficulties, in particular, may not normally be included as part of CWS intervention. Even when children are assessed for stress-related symptoms from trauma, this may not result in trauma-focused services because symptoms may be delayed (Putnam, 2000). Future analyses should include attention to traumatic stress symptoms of children in the NSCAW study.
NSCAW data confirm previous investigations indicating that maltreated children have poorer social skills than children in general (Fantuzzo et al., 1998; Manly et al., 1994). This was especially true for older children; approximately one-third of the oldest children had below-average social skills, over twice as many as in normative samples. Rates were comparable between the younger children and their counterparts in the general population. A still greater proportion of youths in group care had low social skills, almost three times the norm.
The predelinquent behavior of the early adolescents in this sample is worrisome, with nearly 30% reporting a clinically significant level on the CBCL delinquency subscale. Although the pathways to serious problems with the law and society are varied, general delinquent behavior often does begin during these years (Thornberrry, Huizinga, & Loeber, 1995). More serious delinquent behavior generally begins after this period, for those who do not develop more prosocial alternatives (Williams, Ayers, & Arthur, 1997). Although a variety of protective factors may intercede to break this transition from general delinquent behaviors to more serious delinquency, the chain of events to generate more serious delinquency is clearly in place. The finding that youths with higher delinquency scores were getting more services may presage this result, as some prior research identifies CWS as a protective factor in reducing subsequent incarceration (Jonson-Reid & Barth, 2000a).
Information on sexual behavior was collected only for youths 11 years and older. Approximately 25% of youths report having had sexual intercourse. An experience of sexual intercourse was reported by twice as many youths who had sexual abuse as the most severe abuse type, when compared with youths who experienced other abuse types. This is consistent with previous findings (e.g., Boyer & Fine, 1992; Stock et al., 1997) that sexually abused adolescents are at elevated risk for early initiation of sexual intercourse. Overall, youths 11 and older involved with CWS are approximately four times as likely to have been pregnant or gotten someone pregnant as youths in the general population. This dovetails with data from the National Survey of Family Growth (Carpenter et al., 2001). Such early initiation of sexual intercourse also increases the risk for sexually transmitted diseases and teen pregnancy and, ultimately, a range of untoward outcomes (Kahn et al., 2002; Stanton et al., 2001). We did not query youth about their receipt of services designed to help prevent adolescent pregnancy, although previous research indicates that these services have not been consistently provided to youths in foster care (Becker & Barth, 2000).
Information on substance use was collected only for youths 11 and older, as well. Approximately half of these youths report using illegal substances in the 30 days prior to the interview, ranging from tobacco to hard drugs such as cocaine, crack, and heroin. Children living in out-of-home care were more likely to report having used hard drugs in their lifetime, but not recently; thus, placement into out-of-home care does appear to be a temporary circuit breaker regarding the use of substances. Early substance use has a strong association with other negative outcomes, especially educational failure (McCluskey et al., 2002) and psychopathology (Costello et al., 1999).
Marginal academic achievement of early adolescents in NSCAW is consistent with younger children, with all age groups slightly below average. However, these oldest children did report significantly more school problems, including increased difficulty of work, incomplete homework, and behavior problems, than did 6- to 10-year-olds. Whereas poor academic achievement for youths in 4th grade is a solid predictor of later behavior problems (Yoshikawa, 1994), the risk of subsequent problems appears to grow with age and continued school failure. By age 13, boys with low achievement have three times the odds of serious conduct problems in the form of delinquency (Gorman-Smith et al., 1998). Youths with lower academic performance also tend to commit serious and violent crimes and persist in offending more frequently than youths with higher academic performance (Maguin & Loeber, 1996).
Children in the study did report on some protective factors that may help divert them to more positive developmental paths. When asked about their caregivers, these early adolescents reported basically positive relationships, expressing a high sense of relatedness and closeness to their caregivers. They also reported positive relationships with peers at school. The literature on resilience suggests that positive relationships with adults can compensate for the adversities that children experience (e.g., Masten, 1994). In addition, positive peer relationships have been found to predict later adjustment (Stanton et al., 2001).
10.4.2 Home Environment for Children 11 Years and Older
Although we do not have direct measures of the home environment for children aged 11 years and older, we do have some information about the conditions under which they reside. Children aged 11 and older experienced poverty at high rates, but these rates are consistent with rates for children from other age groups. At the time of the investigation, child welfare worker assessments of caregiver substance abuse were slightly lower for children in this age group compared with children overall; with 12% of caregivers of older children reportedly using substances compared with 14% of caregivers overall. A history of exposure to domestic violence is also elevated for caregivers in this age group; almost one in three have such a history, as reported by child welfare workers. About one in six of the caregivers were reported to have serious mental illness, a rate consistent with that of caregivers of children in all age groups. A substantial proportion of children aged 11 and older report receiving physical discipline from their caregivers across their lifetime. Almost one-third of older children report experiences of severe physical assault, and approximately one-fifth report experiences of very severe physical assault at the hands of a parent or caregiver. On average, children 11 and older report one very severe maltreatment incident in their lifetime (i.e., beaten; choked; burned or scalded on purpose; or threatened with a gun or knife). Children aged 11 and older and living in out-of-home care are more likely to have experienced three such incidents in their lifetime. In fact, children in out-of-home care are more likely to have experienced all types of assault in their lifetime than children remaining in the home. Such a history of maltreatment can disrupt the development of problem-solving and communication skills (Price & Landsverk, 1998; Dodge, Bates, & Pettit, 1990) and increase the likelihood of aggressive behavior (Nelson & Crick, 1999) and peer rejection (Fantuzzo et al., 1998; Manly, Cicchetti, & Barnett, 1994).
According to child reports of exposure to domestic violence, older child age does not appear to result in greater exposure to domestic violence; younger children report more exposure to domestic violence. Parents of young children may be more likely to engage in domestic violence compared with parents of older children. Another hypothesis to explain why smaller proportions of older children report exposure to domestic violence compared with younger children is that having older children in the home may suppress some domestic violence. Alternatively, younger children may be more likely to report exposure to domestic violence compared with older children.
10.4.3 Services for Children 11 Years and Older
The early adolescents involved with CWS are more likely than the younger children (5 years and under) to be receiving mental health or specialty mental health services. Yet only 14% of them were receiving specialty mental health services at intake to CWS—a far smaller group than the 34% of children this age who have a borderline or clinical score on the CBCL, the YSR, or the CDI.
In terms of academics, approximately one-third of these youths are classified as needing special education services, and these older children are also more likely than children 5 years and younger to be classified into a special education category, such as being emotionally disturbed or learning disabled. Adolescents in CWS are more likely than children aged 5 and younger to have been tested for educational difficulties, to have an IEP/IFSP, and to be receiving special education services. The ratio of need exhibited by children aged 11 and older to their receipt of special education services is balanced; comparable levels of youths 11 and older have an IEP/IFSP and are receiving special education services. Among those who were getting special education services at intake, the largest groups were receiving special education for specific learning disabilities and emotional disturbance.
The oldest children, in many cases, may have suffered the greatest harm in terms of longer-term exposure to maltreatment and harsh disciplinary practices over the years. This may be one explanation for the many behavioral problems reported. Rates of behavioral problems among children aged 11 years and older are far greater compared with children in other age groups, as well as compared with children in the general population. Harsh discipline (Koenig et al., 2002; Palmer & Hollin, 2001) and maltreatment (Lynch & Cicchetti, 1998) have both been associated with significant increases in problem behaviors in adolescents. At the same time, because we do not have population-based comparison groups that are very similar to the children in the NSCAW study, we cannot ascertain how comparable this level of problem behavior actually is compared with other children who are similarly situated, except that they have not been exposed to maltreatment.
10.5 Summary
The circumstances of children’s involvement with CWS are interdependent with their age. Although there are common and overlapping reasons why any child will become involved with CWS, the types of case characteristics vary considerably by children’s age. This chapter provides substantial support for continuing to examine ways that a developmental perspective can help to shape CWS and the allied service systems that are involved in addressing the needs of these vulnerable children and families.
From a developmental perspective, the majority of children involved with CWS are functioning below national norms in at least one area of functioning. Given the many risk factors that these children are likely to experience (e.g., poverty, maltreatment, substance exposure), this is not surprising (c.f., Sameroff & Fiese, 2000). Generally, the most extreme scores are on mental health measures and the less extreme deficiencies are in the areas of intelligence and academic functioning, although there is variation in these child characteristics across age groups. The difference in the magnitude of outcomes relative to these two domains is interesting, given that the preponderance of evidence from longitudinal studies of the development of maltreated children suggests that both the cognitive and social-emotional trajectories are extensively compromised (Erickson, Egeland, & Pianta, 1989). It may be that the experience of maltreatment and potential instability of subsequent caregiving environments may affect core social-emotional processes that are particularly central to mental health outcomes.
With regard to services, younger children tend to be most vulnerable to harm and are most likely to receive in-home and out-of-home services in contrast to having their cases closed at intake. Our analyses of risk assessment items (see Chapter 4) indicate that a child’s inability to “self-protect” is a major consideration of child welfare workers when making decisions about cases involving younger children. Evidence of differential decision-making according to children’s age is apparent in high-risk assessment scores among older children, who are less likely to result in out-of-home placements. For older children, other considerations appear to intervene. For example, older children tend to exhibit more behavioral problems, and this factor, along with other special needs, is reported by child welfare workers to be a major consideration in deciding how to proceed with cases involving older children. Generally, older children do not receive as many services compared with younger children or the same mixture of services that younger children receive; when older children do receive child welfare services, they are much more likely than younger children to receive supportive services, such as special education and specialty mental health services.
Although CWS is primarily designed to provide protection of children who would otherwise be parentless or who have parents who are putting their children’s safety at serious and unmitigated risk, contributing to the developmental well-being of children certainly is not outside the scope of CWS’s goals and functions. Many children are offered child protection even though they have parents and their physical safety is not endangered. The many children who have been sexually abused or emotionally maltreated are among those who warrant protection under the law because of the expectation that such protection is necessary to avert unacceptable levels of harm to their developmental welfare. Children whose behavior represents a problem also appear to be entering into CWS, despite not having recent reports of maltreatment (Barth, Wildfire, & Green, 2003; U.S. GAO, 2003).
Although there is no general agreement on the levels of developmental well-being that CWS or allied child and family service institutions are expected to achieve, there is implicit agreement that such achievement is a proper goal of CWS (Children’s Bureau, n.d.). In the child and family well-being component of federal CWS reviews, states are expected to show evidence that they are meeting children’s educational, health, and mental health needs. CWS is a gateway to services for many children who would qualify for those services regardless of their involvement with CWS but might not otherwise obtain those services due to their parent’s lack of knowledge, motivation, or resources. Children who are entering CWS are clearly in need of a range of supportive activities. Yet the vast majority of these children will not receive ongoing child welfare services, and if they do, they will receive in-home services. The NSCAW findings suggest that these children are substantially less likely to receive specialized services than children who are in foster or group care, although we cannot determine whether or not their likelihood is increased over what would have occurred had there been no CWS involvement. Nor have we determined whether those children who became involved with CWS for the first time have received fewer services, all else being equal, than those who have had CWS contact before.
We do observe, nonetheless, that many children in the NSCAW sample who have come to the attention of a major child and family service system and are at substantial risk of problems with education, social relations, and justice will not end up on the path from child welfare involvement to the specialized care of professionals. We must hope, therefore, that the improvements in parenting that may result from CWS involvement are sufficient to provide children with a greater chance at success than they had prior to the investigations that are the subject of this report.
These analyses cannot answer many questions about the role of CWS in supporting positive outcomes for children. They still plead for resolution. Although the levels of child, family, and community risk factors are high, and these cumulative risks do not augur well (Deater-Deckard et al., 1998; Herrenkohl et al., 2000), other countervailing forces may help these young people to succeed. The research identified a variety of mediators that may buffer the likelihood that children with very high levels of cumulative risk will show antisocial behavior. Indeed, some evidence argues that the children with the greatest risk are those most likely to benefit from such buffering effects (i.e., Pollard, Hawkins, & Arthur, 1999). These data are not yet longitudinal and do not indicate whether involvement with CWS will contribute to these effects. This will have to wait until the next wave of data is analyzed.
The opportunity of NSCAW is to follow these youths over time and determine how much of a protective factor CWS provides in the development of the many young people who have been maltreated and who are already leaning over the edge of developmental risk. The influences on development are complex, and the outcomes for the children in NSCAW are almost certain to vary from tragic to highly successful. Yet considerable evidence indicates that maltreated children often fail to traverse the narrow path to adult health and wellness (Dube et al., 2001; Widom et al., 1999). The high levels of conduct problems at baseline, the adverse parental environment for many children, the many different services received by youths, and the longitudinal design of this study offer the basis for important advances in understanding psychopathological versus successful development. Although the primary mission of CWS is to provide safety and permanency, we cannot turn away from the developmental influences that we seek to promote through policies and practices.
Even tentative predictions about long-term outcomes for children who have been observed at one point in time, as they have in this study, have become increasingly dicey as developmental science accumulates a “multiplying number of documented influences on development” (Sameroff & Fiese, 2000, p. 36). The developmental context for children in this study includes, at minimum, alleged harms and very often includes a history of repeated events indicating exposure to an unsafe and compromised environment. This would seem to predict futures beset with significant health and mental health problems. Such long-term results of the kinds of adverse childhood events that are experienced by these children have been documented (e.g., Felitti et al., 1998; Perez & Widom, 1994). However, our growing knowledge of the physical, cognitive, and social-emotional results of child maltreatment is accompanied by unprecedented efforts to reduce the untoward results of child abuse and neglect through formal child welfare services. Previous longitudinal analyses have generally not tested the mitigating and protecting influences of these services. This study will provide unique information about the effectiveness of efforts to intervene in the poor developmental trajectories of children involved with CWS.
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