Time for Reform: Investing In Prevention
Keeping Children Safe at Home
Approximately 36 million children were reported to child protection authorities as possible victims of abuse and neglect in 2005. Unfortunately, few data exist about services provided to these children, but it is estimated only 25 percent of these children receive any kind of preventive services. We do know that, of the 899,000 confirmed cases of maltreatment, our child welfare system provides services or supports to approximately 60 percent of the children. Approximately 359,000 children with confirmed cases of abuse or neglect receive no services or supports. These statistics beg important questions: Why do so many children who have experienced abuse or neglect and their families receive no services after abuse or neglect occurs? Had we provided prevention services to more of the 900,000 children confirmed as victims of abuse or neglect could we have prevented further abuse or neglect or perhaps even reduced the number of children who end up entering into foster care?
Foster care provides a much-needed safety net for children and youth when they have experienced abuse or neglect and cannot remain safely at home. However, a growing body of evidence and real-life experiences in Nashville, Milwaukee and Allegheny County Pennsylvania, among others, suggest that providing families with a broader array of services and supports can effectively prevent child abuse and neglect from occurring in the first place.1 When abuse or neglect occurs, providing vulnerable families with a full continuum of services can help more children safely stay with or return to their families from foster care.2 However, to provide alternative services to foster care—including family counseling, emergency housing support, referrals for drug treatment programs, and parenting classes, among others—states and localities need federal support to help ensure children live safely with permanent families.
Unfortunately, the majority of dedicated federal funding for child welfare is currently reserved for foster care services and cannot be used for prevention or reunification services or supports. States may access dollars under Title IV-E, the principal source of federal child welfare funding, only after children have been removed from their home and enter foster care. Of the $7.2 billion in federal funds dedicated for child welfare in 2007, approximately 90 percent supported children in foster care placements ($4.5 billion) and children adopted from foster care ($2.0 billion). States can use about 10 percent of federal dedicated child welfare funds flexibly for family services and supports, including prevention or reunification services, in accordance with local and regional decisions about what is most needed.3
Failure to invest in the broad range of services needed by vulnerable children and families, and in particular, prevention and reunification services, is costly to society. A recent analysis estimated that in 2007, the total annual cost of child abuse in the United States was nearly $104 billion.4 This total represents more than $33 billion in direct costs of child maltreatment, including judicial, foster care, law enforcement and health system responses, and $70 billion in indirect costs, including long-term economic effects. The cost of providing foster care alone, including local, state and federal dollars, was $23 billion in 2004.5
Although foster care is an important and necessary safety net, equally important services for vulnerable children and families are not adequately supported by current federal financing policies. Family support, family strengthening, and family reunification services have shown great promise in ensuring the safety and well-being of children.6 In 2005, approximately 124,000 (or 54 percent) of the children leaving foster care were returned to their families, after having stayed in foster care for an average of six months.7 Diversifying the kinds of effective services that can be supported with federal child welfare funding can produce better results for children and families. A stronger array of front-end services could:
- Decrease the incidence of abuse and neglect. An evaluation of the Nurse-Family Partnership program (which provides nurse home visits to low-income first time parents) found a 48 percent lower level of abuse and neglect for children served through the program than children in the control group.8
- Reduce short and long term trauma to children. Childhood experiences of abuse and neglect are linked with serious lifelong problems, including depression, suicide, alcoholism and drug abuse, as well as major medical problems such as heart disease, cancer and diabetes.9 Renewal House in Nashville, Tennessee provides a residential program for mothers who have an addiction and allows children to accompany their mothers into treatment. Studies show that children served by the program double their developmental assets and that fewer infants born while mothers are in the program require neonatal intensive care, sparing babies severe medical complications and lifelong disabilities.10
- Lessen the need to remove children from their families in some cases and help children safely return home from foster care more quickly and safely. In Pennsylvania's Allegheny County, as a result of increased investment in prevention services, more than 65 percent of children remain at home for the entire time they are served by the child welfare system. The length of stay for those who entered foster care before they were safely returned home dropped from 21 months in January 1997 to 14 months in August 2007.11
- Lower the costs of care per child. By pooling funding from several state and county agencies, Wraparound Milwaukee has achieved greater flexibility in meeting a range of family needs. It has succeeded in decreasing the number of children in foster care by sixty percent (from 364 daily to less than 140) and reduced the cost of care from $5,000 to less than $3,300 since the program was implemented. By reinvesting the savings into other services, the program now serves more than 650 youth with only 21 percent of the youth living in out-of-home foster care placements.12
The federal child welfare financing system should better support the full range of services needed to keep children safe and strengthen families. States could significantly improve the lives of children and families through changes at the federal level that make existing federal child welfare dollars more flexible while maintaining protections for children in need and by making targeted new federal investments in front-end services to prevent child abuse and neglect and reduce the need for foster care. These reforms would also allow states to provide services and supports for children and families so that children in foster care could leave for safe, permanent families more quickly through reunification or, when reunification is not possible, through adoption or subsidized guardianship.
The following policy options for federal child welfare financing could help keep children safe and strengthen families:
- Ensure a sufficient, flexible and reliable federal resource to help support the continuum of services needed by at-risk children and families.
- Reward states for safely reducing the number of children in foster care and achieving all forms of permanence.
- Make all children who have experienced abuse or neglect and who cannot remain safely with their families eligible for federal foster care support.