Chronically Referring Families: Patterns, Dynamics

and Interventions

(Originally published January 2011)

L. Anthony Loman’s Families Frequently Encountered Families: A Report on Chronic Child Abuse and Neglect (2006) is one of the most discerning analyses of families with multiple CPS reports ever written. Loman discusses findings from two samples of families with CPS reports:

 

(a) 33,395 families in Missouri with at least one CPS report between July 1997 and June 1998; families were followed for five years from the date of the initial report (i.e., the initial report in this time frame) and,

 

(b) 797 families in Minnesota with a CPS report during 2001- 2; these families were tracked for 27 months from the date of the initial report (i.e., the first report in this time frame). Families with at least four additional reports were classified as “frequently encountered families” (FE) and compared to families (non - FE) with fewer than four additional reports during the study period. Twenty one per cent of the Missouri families and 19 per cent of the Minnesota families had at least 5 CPS reports during the years of the studies and constituted ‘frequently encountered families’ as defined by Loman. 

 

Loman is highly skeptical of substantiation as an accurate indicator of either child maltreatment or risk of child maltreatment because he discovered in studies conducted in the early 1990s that CPS caseworkers were aware of a great deal of abuse and neglect on open cases that they did not report, much less substantiate; and because he found that CPS reports in and of themselves are indicators of risk as measured by future substantiations. For example, Loman describes a Missouri study of 227 cases (Loman and Siegel, 1994) opened for investigation prior to Missouri’s implementation of a differential response system; in more than a third of unsubstantiated cases referred for voluntary preventive services there was an violent act directed at a child while the case was open, and in almost 17% of families children were verbally abused as determined by case record reviews and interviews with caseworkers.  

 

One of Loman’s most important findings in his large Missouri sample was that the type of allegations in initial reports did not necessarily predict the types of allegations in subsequent reports. Loman uses the metaphor of the family as a film to describe this phenomenon. He states, “A particular abuse and neglect report is like one frame of a film. It is unlikely that a single frame will be representative of the entire film.” For example, 6,048 Missouri families were initially reported to CPS for lack of supervision/ proper care; 55.4% of these families had at least one additional CPS report. Types of subsequent reports included 839 reports of sexual abuse, 1,313 reports of minor physical abuse, 1456 reports of parent – child relationship problems, 1195 reports of unmet basic needs along with 2550 additional reports alleging lack of supervision. There were 53,509 new reports on the 33,395 families with initial reports; only 28.5% of new reports matched the abuse or neglect alleged in the initial report.

 

Loman found that in FE families, neglect reports predominated, and some of these families could be accurately described as chronically neglecting, a description Loman objects to because of its allegedly pejorative connotations. Other FE families might be more accurately described as chronically maltreating because of the combination of various forms of neglect with physical abuse and/ or sexual abuse. In a recently published study of chronically reported families (Jonson- Reid, Emery, Drake and Stahlschmidt, 2010) comment that “The underlying dynamics that bring families back to the attention of child welfare multiple times are probably not captured well by a specific type of maltreating behavior,” even chronic neglect. In my view, the dynamic that explains multiple CPS reports for neglect and/ or physical abuse, sexual abuse or emotional abuse is the erosion or collapse of social norms around parenting under the pressure of extreme poverty, substance abuse, mental health problems and/ or family violence. The erosion of parenting standards may be minor as when a single parent leaves a  sleeping infant in a crib for a few minutes while she runs to a grocery store to highly risky behavior such as leaving young children alone overnight or allowing unsupervised pre – school children to bathe infants and toddlers; or even criminal behavior such as sexual exploitation of children or socializing children to steal. Restoring parenting standards in FE families is often something quite different than teaching new parenting skills.

 

In his Minnesota sample, Loman found that almost twice as many FE families (20.8%) were considered to be in severe financial difficulty as non- FE families (11.6%); almost half of FE families (46%) had 3 or more children in the home vs. 30% of non – FE families; more than a third of FE families (34%) had a primary caretaker in a relationship that involved DV compared to 18% of non – FE families. FE families were more likely than non –FE families (24% vs. 13%) to have an emotionally disturbed or mentally ill child and more likely than non –FE families to have a disabled or developmentally disabled child (24% vs. 13%). FE families were more likely than non – FE families to have a mentally ill adult (7% vs. 2%) or a substance abusing adult in the home (41% vs. 21%). This is a formidable set of challenges that often lead to hopeless / helpless parental attitudes that are indicators of demoralization.

 

 It is not unusual to find caseworkers and service providers who are almost as discouraged as parents regarding their potential to make positive changes.  It is a reduced sense of self efficacy that makes FE families so difficult to help. Effective engagement strategies must engender hope that life can be better in families accustomed to moral condemnation and widespread social disapproval even in their extended families.  An insistence on small steps that lead to the renewed belief of parents that their actions can make a positive difference for themselves and their children is how therapeutic interventions should begin.

 

Loman found that single parent, mother- only families had lower rates of parental employment and higher rates of neglect reports; and that a male presence in the family reduced financial stress but led to an aggregate increase in abuse reports, especially when the male caregivers had no biological relationship to the children. As children aged in FE families, neglect reports decreased and reports of parent – child conflict increased. He states that “The primary finding of interest is that as younger children age in FE families certain problems of child abuse and neglect, more characteristic of younger children, give way to interactions within the family that would be better described as conflicts, fights, locking children out of homes, rejection, and the like.” What Loman does not say is that the main harms children suffer in FE families are emotional and developmental; and that these harms occur gradually and are cumulative rather than immediate. Loman found that after Minnesota implemented its differential response system, “Based on the initial report, exactly the same proportions of FE and non- FE families were screened for investigation. This finding suggests that chronic CA/N (child abuse and neglect) is not distinguished by threats to child safety associated with single reports.”

 

Loman is a strong proponent of differential response systems in which 50-70% of families with accepted CPS reports receive a family assessment focused on the needs of the family rather than a CPS investigation, one goal of which is to substantiate or not substantiate that alleged abuse or neglect has occurred. Loman and some of his colleagues at the Institute of Applied Research have conducted experimental evaluations of differential response implementation in Minnesota and more recently in Ohio. These studies found that even a few hundred dollars of poverty related services had a small but statistically significant effect in reducing re-referral rates and rates of out - of- home placements among families receiving voluntary services in DR tracks compared to families receiving the usual CPS investigation.  

 

Loman sums up the implications of his findings regarding FE families in a few recommendations:

 

       1. Target families early; shift CPS in the direction of prevention.

       2. Use CPS reports as occasions of assistance.

       3. Engage families to participate voluntarily.

       4. Focus on root causes such as extreme poverty, depression, substance abuse and family violence.

       5. Become more available to FE families.

       6. Enlist the community in prevention and early intervention initiatives.

 

Loman recommends identifying potential FE families the first or second time they come to CPS attention by targeting chronically impoverished parents with little or no social support who struggle with depression, loneliness and/ or a sense of hopelessness and one or more of the following:

     

  • Domestic violence with the violent partner still in the family;

  • Substance abuse by a parent not in treatment;

  • Diagnosed mental illness;

  • Child with severe emotional problems or mentally ill child;

  • Child developmental disabilities; and/or

  • Child behavior problems and a parent unable to cope with the child’s behavior

 

Loman found that the average cost of services per FE family was about $13,000 over 5 years. The cost of services for families with only a single CPS report was $1500; families with 2-4 reports received services costing about $5300. The public agencies that served the FE families In Loman’s samples invested heavily but not wisely in services for FE families. Most of these expenditures were for the cost of foster care and residential care for children from the 37% of FE families that had at least one child removed from the home during the 5 years of the study.

According to Loman, half of all expenditures for services were spent on FE families. Twenty per cent of families with CPS reports used half of total agency resources available for families and children with open child welfare cases with limited results on subsequent CPS reports. Loman comments: “Imagine if some portion of the $13,000 expended over five years for each FE family were available to help families early on.”

 

During the 26 years I worked for Washington State’s Children’s Administration (CA) in various capacities, I often encountered skepticism that any set of agency funded and/ or community services would be effective with chronically neglecting families. CA has large numbers of FE families with double digit referrals, and almost every local office has a small number of families with 20, 30, 40 or even 50 referrals. It is common for services to begin interventions in earnest only after extensive referral histories, i.e., multiple case openings and closings, a formula for delivering ineffective services. Furthermore, agency funded or commonly available community mental health services may not target depression, co – occurring substance abuse and mental health disorders, family violence, children’s oppositional behavior or a parent’s capacity to provide emotionally responsive parenting to young children, much less extreme and long term poverty. For services to be more effective with potentially FE families, they must be delivered in the initial stages of CPS involvement – or prior to the first CPS report – and they must target conditions that lead to child maltreatment.

 

Jonson – Reid, et al (2010) report the findings of a longitudinal study of 6,412 children, 0-9 at the time of their first report of maltreatment.  Children were followed from 1993- 94 through 2006 or until age 18; 12.7 per cent of these children had four or more CPS reports during the years of the study. Parents with less than a high school education were far more likely to be re-reported at each stage, i.e., first report to second report, second report to third report, etc.  Parents with a record of treatment for substance abuse or mental health problems prior to the first report were more likely to be reported a second time. Less than a quarter of these families received services after investigation at each stage, that is after 1-2 reports, 2-3 reports, 3-4 reports, or 4 plus reports. Family support services at any stage markedly reduced the risk of a subsequent CPS report. For example, family centered services delivered after the first CPS report or after the fourth report reduced the risk of an additional report by half. These authors comment, “Any thought that chronic families should not receive services because “we’ve tried before and it didn’t work” should be abandoned.” Jonson- Reid, et al, assert that “understanding how the broader social service and support system is helping these families is key to understanding recurrence over time.”

 

The hopeless / helpless attitudes of some child welfare practitioners and service providers in regard to helping FE families are self perpetuating. These attitudes are an obstacle to experimentation and careful evaluation of services and programs and to a re – examination of agency practices (such as prioritizing services to families in which there are immediate safety threats) that lead to futile and expensive recycling of families through child welfare systems. CPS programs need to be redesigned and re-tooled to meet the needs of potentially FE children and families who are taking such a large percentage of agency time and resources with largely poor results.

 

References

 

Jonson – Reid, Melissa, Emery, Clifton R., Drake, Brett, Stahlschmidt, Mary Jo, “Understanding Chronically Reported Families, Child Maltreatment, Volume 15, No. 10, November 2010.

 

Loman, L. Anthony, Families Frequently Encountered by Child Protection Services: A Report on Chronic Child Abuse and Neglect , Institute for Applied Research, St. Louis, Missouri, 2006. Available at http://www.iarstl.org

 

Loman, L. Anthony, Siegel, G., Missouri child welfare decision – making study, Center for the Study of Social Policy, Washington, D.C.,1994.

  

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