Work With FamiliesFamily and Child Welfare

Step Six of the Decision Tree

Chapter 15

Family Welfare and Protective ServicesAs A Method of Family Practice

• When family welfare or protective services are indicated (step six) competent practice requires familiarity with both services.

• The goals of service delivery to families are: (1)Model One: to prevent or mitigate the effects of poverty, (2) Model Two: to protect family members from abuse and neglect.

• Social work is distinguished as a profession by its history of service to impoverished individuals and families through policy and program initiatives & direct, face–to-face, service delivery.

The Helping RelationshipFamily Economic Welfare

• The helping relationship between worker and family is circumscribed by the worker’s fiduciary responsibilities.

• A specific set of skills, different from the skills needed to enact family therapy (chapter 14), are needed to work with children and families receiving social welfare services.

• The desired end-goal of economic welfare is the distribution of resources to meet basic human needs consistent with a just and humane society.

The Helping RelationshipFamily Economic Welfare

• When distributing resources to families, social workers also exercise social control by regulating access e.g. determining eligibility and monitoring compliance.

Theories & ApproachesWelfare Service Delivery

Sociological theories and approaches used to inform the delivery of family and child welfare services are: (1) structure-functional theory, (2) role theory, (3) critical theory, (4) afro-centric theory (5) empowerment theory, (6) crisis intervention theory (leading to foster care, kinship care, reunification, or family preservation),

(7) strengths perspective and (8) post modern principles

Family as a Sociological Construct

• In the context of family and child welfare, the family is recognized as a sociological construct.

• Society has a stake in the family as a societal institution.

• As a societal institution, the family is responsible for meeting the instrumental and expressive needs of its members e.g. procreation, protection, education, and socialization.

The Family As a Sociological Construct Structure-Functional Theory: Parsons

• The application of General Systems theory to society and its institutions is referred to as Structure-Functional theory.

• Parson argues that families must function in a manner that sustains the integrity of society as a system (law and order perspective).

• Families that do not fulfill their duties (or roles) as expected pose a danger to self ( their members) and others (community).

The Family As a Sociological Construct Structure-Functional Theory: Parsons

• Parson’s perspective is consistent with social conservatism and the social control (fiduciary) function of social work.

• Acting on behalf of society, social work has a fiduciary obligation to ensure that families have their basic needs for food, shelter (housing), clothing, health and education met.

• Social work has a fiduciary obligation to ensure the safety of family members (partner abuse, child neglect & abuse, and elder neglect & abuse).

The Family As a Sociological Construct Structure-Functional Theory: Geismar

• Consistent with Parson’s perspective, Family Centered Casework (50’-60’s) held that families who received economic welfare or who were referred for protective services, were not fulfilling normative roles and functions as expected by society (Geismar).

• Casework accompanied service delivery (1956-1967) based on the premise that family centered casework services could resolve problematic family functioning.

The Family As a Sociological Construct Structure-Functional Theory: Geismar

• In protective services, one family structure

(temporary foster family care) was substituted for another (parental family care) while families acquired (through casework) the skills and resources they needed to function effectively.

• In 1967 congress officially severed casework services from cash assistance programs.

The Family As a Sociological Construct Structure-Functional Theory: Merton

• Merton challenged Parson’s theory on the basis that it promoted unexamined acceptance of society as the normative system in need of maintenance; preference for the status quo.

• Merton argued that societal forces and dynamics cause family dysfunction e.g. what society as whole demands can be detrimental to individual families- low wages, two wage earners, limited paternity leave, unaffordable child care, etc.

• This school of thought is consistent with social work activism and reform.

Model OneThe Family As A Economic Unit• In contrast to the psychological depiction of

family dynamics in chapter 14, sociologists hold that socio-economic factors dictate how members of a family relate to one another.

• Family functioning is closely related to the economic and social structure of a society.

• Economics and social stratification (not transactional patterns) either helps or disrupts family structure and function.

Model One: Family WelfareSocial Stratification

• In societies, families are embedded in racial and class hierarchies.

• Consequently families have different access to resources that support families.

• Middle and upper class families are privileged in that they have access to medical coverage, expense accounts, and credit cards.

• Middle and upper class families have occupational roles that are highly valued by society and consequently earn higher incomes.

Model One: Family WelfarePoverty Statistics

• The following data comes from CWLA; National Fact Sheet 2004

• 12 million (16%) of US children live in poverty; $14,600/yr for a family of three.

• 5 million (7%) in extreme poverty (family of 4 $8,980/yr)

• 27 million (37%) live in near-poor or low-income families.

• 42% of poor children had a working parent

Model One: Family WelfareCausal Hypotheses of Poverty

(1) Family Causality :The family, as a primary economic unit, is charged with the responsibility

of meeting the basic financial needs of its members (Structure-functional theory).

(2) Personal tragedy: Poverty can result from personal tragedy; death, disability or old age of the wage earner.

(3) Social factors: Poverty is an outcome of social factors such as discrimination, oppression, and exploitation.

Model One: Family WelfareCausal Hypotheses of Poverty

(4) Economic Systems: Poverty is an outcome of

economic systems:

Communism because of economic stagnation and

irregularities in supply-demand

Capitalism because of flawed market mechanisms

and unequal distribution of opportunities and

benefits e.g results in layoffs, outsourcing,

minimum wages, part-time or seasonal work, etc.

Model One: Family WelfareSolutions: Policies and Programs• Social policies and programs attempt to ensure the

economic stability of families.• There are two types of programs: (1) Social Security Insurance: (work history). -Protects workers and their dependents from poverty due to loss of income caused by the death, disability, old age or unemployment of the primary wage earner. -Programs are universal and non-stigmatized.

Model One: Family WelfareSolutions: Policies and Programs(2) Public Assistance (no work history/wages below poverty). Programs are needs-based, means– tested and stigmatized. Programs include: -Temporary Financial Assistance to Needy Families (TANF). - Nutrition and Food Stamp programs - Housing programs - Health programs-Medicaid.

Model One: Family WelfareFunding Welfare Programs

• Social Security programs are financed through premiums paid by both workers and employers. The Federal government administers the program.

• Public Assistance programs are jointly financed by Federal Block grants and State funds from general tax revenues. State and local Departments of Health and Human Services administer the programs.

Economic WelfareHistorical Perspective

• ADC: Historically, public assistance (financial aid) was provided under the Social Security Act of of 1935 -Aid to Dependent Children (ADC). Cash aid was given to impoverished families with dependent children on behalf of each child in the family.

• AFDC: In the 1950’s the program was expanded to make the caretaker also eligible for cash assistance.; however only households without a father were eligible.

Welfare ReformHistorical Perspective

• PROWR: (1996) The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA,

P.L. 104-193); welfare reform. This act created state run programs of Temporary Assistance to Needy Families (TANF) .

• TANF: Funded by federal block grants and state revenues, this program imposes strict work registration, a training requirement, an employment requirement and time limits to receive financial assistance.

Economic WelfareHistorical Perspective

• EITC: Earned Income Tax Credit: Revenue Act of 1978 P.L. 95-600. This program is designed to support the working poor by refunding earned income through a tax credit program. Some states have followed the lead of the federal government and offer State EITC.

In-Kind BenefitsHunger: Statistics

CWLA National Fact Sheet (2004)• 1 in 25 children and 1 of 9 poor children lived in

households where adults had difficulty securing food. Members experienced moderate hunger. (1999)

• 2.3 million Americans received emergency hunger relief in 2000.

• There was an increase of 18% in requests for hunger relief in 25 major cities from 2002 to 2003.

In-Kind BenefitsHunger: Programs

• Food Stamps - Food Stamp Act 1974, P.L. 93-86 • School breakfast programs• Summer food service• Supplemental nutrition program for women,

infants, and children, (WIC)• Special milk program for children• National school lunch program; (28 million

children served in 2003)• Homeless children nutrition program

In-Kind BenefitsHousing: Statistics

• An estimated 2.3 million people experience homelessness at some point each year.

• Of this number more than 1 million are children• 2003, 40% of the homeless population in 25 major

cities, included families with children.• Almost 75% of poor households spend more than

30% of their income on rent and utilities.• The number of affordable housing units has been

declining since 1991

In-Kind BenefitsHousing: Programs

• Shelters- Emergency; day by day. Domestic Abuse Shelters- Limited Time Family Shelters – Limited time• Public Housing High-rise or Clustered Scattered• Foster Care: Family or Group Homes

In-Kind BenefitsHousing: Programs

• Residential Living- Assisted Living Supervised independent living Supervised group homes Physical and mental disabilities Senior citizens• Correctional Settings Detention Centers and Jails Correctional treatment centers Half-way houses

EvidenceDoes TANF Work?

Numerous studies of TANF leavers indicate

that the program and its policy (PRWORA) is more effective in reducing welfare caseloads than in reducing poverty.

Model TwoThe Family As Protector

• As a societal institution, the family is responsible for meeting the expressive needs of its members for protection, education, and socialization.

• Societies establish specific family policies (or not) to support the family as a valued societal institution.

• The family buffers members from the harsh realities of their physical and social environments

• The family nurtures it members by providing for their socio-emotional needs.

Model TwoFamily Violence

Factoid

Despite the romanticized view of the family held by many, individuals are more likely to be killed, physically assaulted, sexually victimized, hit, beat-up, slapped, or spanked in their own homes by other family members than by anyone else in our society

Model TwoFamily Violence: Statistics

• 1400 women are abused every day in the United States (Roberts and Roberts, 2005)

• Between 3 and 10 million children witness some form of violence in the home each year.

• In 2001, an estimated 903,000 children were victims of abuse and neglect.

Model TwoDefinition of Child Maltreatment• Child maltreatment is defined as a

heterogeneous group of acts (commission or omission) that place children at risk.

• Child maltreatment- 4 types(1) physical abuse(2) child neglect(3) sexual abuse(4) emotional abuse

Model TwoPhysical Abuse

• Physical Abuse is the infliction of physical injury by various methods, even if the perpetrator does not intend harm.

• In the United States, physical punishment is regarded as a form of physical abuse.

• In Canada, the use of physical punishment is allowed as a parental form of correction. Workers must distinguish physical punishment from physical abuse.

Model TwoChild Neglect

• Child neglect is the failure to provide for the child’s basic physical, educational, medical, or emotional needs.

• The inability of parents to adequately supervise their child(ren) is a form of child neglect e.g. children in need of supervision

Model TwoSexual Abuse

• Sexual abuse is the involvement of a child in any kind of sexual action including incest, sexual molestation by a family member, prostitution, pornography, or human trafficking.

Model TWOEmotional Abuse

• Emotional abuse is an act or omission that has caused or could cause serious cognitive, behavioral, emotional, or mental disorders.

• Some jurisdictions include exposure to domestic violence under emotional abuse.

Model TwoStructure: Children’s Bureau

• The federal government established the Children’s Bureau in 1912 because of societal concern over child labor, delinquency, and orphaned children.

• Title V of the 1935 Social Security Act directed the bureau to cooperate with states to develop child welfare services.

• In 1967, child welfare funding under title V became Title IV-B, Child Welfare Services.

Model TwoBattered Child Syndrome

• Battered child syndrome emerged (1960’s) as a public issue due to the observation of pediatric radiologist John Caffey; prior to this injuries to children were considered a private family matter.

• Between 1962-1965, every state passed legislation preventing child abuse.

• The Child Abuse Prevention and Treatment Act (CAPTA) was enacted in 1974. This act was reauthorized in 2003 as the Keeping Children and Families Safe Act. P.L. 108-36.

Model TwoMandatory Reporting

• In the 1970’s laws mandating reports of suspected child abuse were enacted in every state. See chapter two on fiduciary responsibilities.

• According to Knoke and Trocme (2005) the inclusion of exposure to domestic violence as a category of mandated reporting of child emotional abuse led to 133% increase in reported cases of suspected child abuse in Canada.

Model TwoChild Neglect & Abuse: Statistics• Rates: Child abuse rates are similar in Canada,

England, Australia, and the United States. • U.S. Reports of suspected abuse: 1970-1974 250,000 child abuse reports annually.• U.S. Reports of Suspected Abuse FY 2000

2 million reports of suspected abuse and neglect 1.8 million reports were unsubstantiated. • U.S. Substantiated Reports FY 2000 879,000 children were victims of maltreatment.

Model TwoConceptual Quagmires: Defining Harm

• The use of physical force against children is prevalent in the United States. (Gelles and Straus, 1987); Severe physical harm occurs in a minority of maltreated children (Zuravin, Orme, Heger, 1995).

• Acts (beatings, use of weapons) that have a high probability of resulting in severe physical harm requiring medical treatment occur at much lower frequencies than milder forms of abuse (bruises, scratches).

Model TwoChild Fatalities

• Some form of physical injury in 28% of the total number of reported cases in study by (Trocme, MacMillan, Fallon, Demarco, 2003)

• Minimal harm: a bruise, scratch, or sprain but no need for medical treatment.

• Severe physical harm occurred in 4% of the cases.; shaken baby syndrome accounts for the highest rate of severe harm (Trocme et al 2003)

• U.S. Child Fatalities FY 2000 –1200 child fatalities FY 2003 – 1500 child fatalities

Model Two Defining Harm: Critique 1

• Some critics charge that harm is too narrowly defined as physical injury requiring medical attention.

• Such a definition does not take into account psychological harm associated with living in an environment where one is physically assaulted even though such assaults do not require medical treatment.

• Verbal assaults leave no visible scars but can cause psychological harm.

Model TwoDefining Harm: Critique 2

• Others argue that many children and families are unnecessarily subjected to investigative intrusion that result in unsubstantiated reports.

• In FY 2000 approximately 1.8 millions reports were unsubstantiated.

• Finally, critics wonder whether families should be separated where maltreatment has been substantiated but there is no severe physical harm.

Model TwoAssessing Safety and Risk

Safety: imminent danger – short term decision; information gathered is more narrowly focused. Removal of child to protect him/her now.Risk: potential for re-abuse – long term decision

Probability of future maltreatment: safety and risk assessments categorize families on the basis of probability of imminent and future abuse

Service Intensity: Accuracy in assessing risk is crucial to ensure that appropriate intervention (type and intensity) is provided.

Model TwoAssessment Tools: Actuarial

• Structured risk assessment. Actuarial Instrument. Incorporates client characteristics shown to be statistically predictive of future maltreatment. Each risk factor is weighted in terms of its overall risk rating as determined by a formula designed to maximize accuracy.

• Example: FRANN- the Michigan Structured Decision Making Systems Family Risk Assessment of Abuse and Neglect.

Model TwoAssessment Tool: Consensus

• The other type of instrument is based on consensus. Such instruments are based on expert clinical judgment. Case files and case vignettes are used with expert panels to arrive at items thought to be predictive of future abuse.

• Examples are Washington Risk Assessment Matrix (WRM) and the California Family Assessment Factor Analysis (CFAFA).

Model TwoPredicting Future Abuse

• Prediction Accuracy: Regardless of the type of instrument used, one cannot predict with 100% accuracy which substantiated cases of child abuse or neglect will result in severe harm or death.

• Re-entries: How shall they be interpreted?

- indicative of a new problem/crisis

- indicative of chronic/untreated abusive behavior

Model TwoService Delivery: Intervention Options

• Initial determinations of safety and risk assist practitioners in deciding upon the most appropriate intervention: (1)Foster care: removal of the child from the home and placement in some form of foster care, (2) Family preservation: preventing outplacement through family preservation services.

Model TwoProtective Service Legislation

• Mandatory Reporting –State laws 1970”s• Prohibition of child abuse-State laws 1962-1965.• Federal Legislation: Child Abuse Prevention and

Treatment Act -CAPTA, 1974; Keeping Children and Families Safe Act, P.L. 108-36, 2003;

• Permanency Planning: Adoption Assistance and Child Welfare Amendments of 1980 P.L. 96-272 –Mandated permanency planning within a reasonable time; effort to counter foster care drift.

Model TwoProtective Service Legislation

• Independent Living Program: Amendment to title IV-E 1980 to assist youth who age out of foster care.

• Family Preservation: Title IV-B amended to create family preservation and family support programs, 1993.

• Multiethnic Placement Act: 1994• Interethnic Adoption Provisions 1996 • Adoption and Safe Family Act: 1997

Model TwoFour Principles/Child Protection

1. Permanency planning- timelines for moving children to permanency in their care

2. Reasonable efforts – States are required to show that reasonable efforts to keep the child in his/her family of origin were made prior to seeking a court order for substitute care.

3. Least restrictive alternative: workers should attempt to care for children in the least restrictive environment.

4. In the Child’s Best Interest:

Model Two: Determining the Child’s Best Interest

Operationally, workers often experience conflict when determining whether, in a specific case:

(1) family preservation is in the best interest of the child

(2) temporary foster care & family reunification is the child’s best interest. (3) permanency planning through adoption and kinship care is in the child’s best interest.

Model TwoFoster Care

• Definition: Foster care is defined as 24 hour substitute care for children outside their own homes.

• Settings: Foster care settings include: family foster homes, relative foster homes, group homes, emergency shelters, residential facilities, childcare institutions, and pre-adoptive homes.

Model TwoFoster Care: U.S. Statistics 2001

• Total Number: 542,000 children in foster care 260,000 in non-relative foster care

57% of foster care children were reunited with parents or a primary caretaker• Entries and Exits

290,000 entered foster care in FY 2001 263,000 exited foster care in FY 2001• Homeless Children

12% were placed in foster care

Model TwoFoster Care: U.S. Statistics 2001

• Length of stay Average length of stay 11.7 months for those entering care in 2001. Average length of stay for all those exiting foster care in FY 2001 was 22.1 months Average length of stay for all children in

foster care in 2001 was 33 months.• Average age: 10 years.

Model TwoFoster Care: Safety

• Abuse does occur in foster care. In 2001, 0.5% of perpetrators of abuse or neglect

were foster parents; this ½ percent represented 5,133 instances of child abuse and neglect.

• Fatalities Foster care: 8 reported cases 2001 Family preservation 5 yrs: 175 (10.7%) Family reunification 5 yrs: 2.8% ;

Model TwoFoster Care: Stability

Critique of Stability: • Children fare as well in stable foster care as those

left in their home.• Children who experience unstable foster care

(multiple placements) may be at-risk for long term emotional, cognitive, and social difficulties.

• The quality of foster care homes can be poor, average, or good. Homes may be approved with inadequate investigation or may be inadequately supervised after selected.

Model TwoKinship Care

• Scope: Kinship care accounts for approximately 50% of all foster care placements.

• Principles of permanency and least restrictive environment: Kinship care meets these principles and offers the option of having contact with biological parents

• Outcomes: (1) fewer placement moves, (2) greater retention of ties to the child’s biological family, (3) lower rates of reentry to care.

• Comparatively, 25% of reunified children return to care after two years.

Model Two Adoption: Statistics 2001

126,00 children (18%) were available for adoption.

67% were adopted by strangers

23% were adopted by relatives

10% went to live with relatives though not

adopted

For adoption to occur, parental rights must be

surrendered or legally terminated.

Model Two: Family PreservationPrevention Of Outplacement

• Outplacement is viewed as the option of last resort.

• Children are at-risk of outplacement due to: abuse, neglect, delinquency or need for inpatient

psychiatric care.• Objective of Adoption Assistance and Child

Welfare Act of 1980 P.L. 96-272 was to mandate that families be kept intact whenever safe and appropriate ( without risk to the children) and that children be returned home whenever possible.

Model Two: Family PreservationStructure

• Following passage of AACWA, over 30 states and their counties implemented programs that provide family preservation type services.

• In FY 2000 family preservation programs served 314,766 children

• In FY 2000, family reunification programs served 380,507 children.

Model Two: Family Preservation8 Program Policies and Procedures

1. Eligibility: those families at imminent risk of having a child removed.2. In-home service: intervention occurs in

the family’s home; not in an office.3. Response time: Workers must respond to

a request for service within 24 hours.4. Service Intensity: Service is intense (5-20

hours per week)

Model Two: Family Preservation8 Program Policies and Procedures

5. Small caseloads: 6-8 families per worker.6. Length of service: Brief – 4-6 weeks7. Worker availability: Available 24/78. Service blend: blend of “hard” services

e.g. additional funds and “soft” services such as mental health counseling or skills

training in child care,child rearing, budgeting etc.

Family PreservationService Provisions

• crisis intervention• auxiliary funding• parenting skills training• in-home emergency caretakers• child care• housing• transportation• teaching/demonstration• worker home visits

Family PreservationService Provisions

• in-home counseling

• referral for individual, family and/or group counseling.

• substance abuse treatment

• mental health treatment

Model Two: Family Preservation Determining Eligibility

• Families in Acute Crisis: Because of its short duration, family preservation programs were intended to help families in an acute crisis. The goal of the intensive intervention was to resolve the crisis after which the family would return to its pre-crisis state of adequate functioning.

• Families in Chronic Crisis: Often families with chronic dysfunction present in acute crisis. Resolving the crisis at hand does not prevent the recurrence of other crises. In such cases the length of service has been extended to 3,6, or 12 months.

Model Two: Family Collaboratives

• Frequently located within public housing communities.

• Work with protective services but tend to follow post modern principles; especially those focused on community.

• Rely on grant money.• Services are not time limited but are

constrained by funding

The Worker-Family RelationshipIn Protective Service

• Direct, face-to-face contact between the protective service worker and recipient of protective services is often tense and laden with emotions.

• As agents of the State, social workers have a fiduciary obligation to ensure child safety.

• Historically, protective service workers have relied on casework and/or case management e.g.

removal, temporary foster care, reunification. .

The Worker-Family RelationshipIn Protective Service

• Currently, protective service is conducted within the context of family preservation, post-modern principles, and a family strengths perspective

• Though child welfare is a service rather than a therapy, the DSM IV recognizes, through V-codes the need for therapy for both the victims and perpetrators of abuse and neglect.

Critique of Protective Service Models

• A conceptual quagmire exists in defining harm• At the operational level, acting in the best interest

of the child and preserving the family are often in conflict

• Traditional models of providing substitute child care have led to foster care drift.

• Family preservation and family reunification models may prevent outplacement but appear to be associated with higher rates of reentry and child fatalities.

Critique of Protective Service Models

• Post-modern principles do not always result in a shared (worker-family) narrative of what is in the best interest of the child.

• A family strengths perspective, like more traditional perspectives, sustains the social order. It does not challenge the sociological causes of family dysfunction and gives a pass to inadequate resources and service delivery.

• Therapy for victim and perpetrator, if offered, is outsourced.