The next steps: Recommendations

Call it the $200,000 question. Failure to meet child protection federal standards will cost New Hampshire $200,000 in penalties. A Child Welfare League report estimates it will cost the state about the same to accredit its system, enabling it to meet almost every standard. Where will we spend the money – on penalties or on abused and neglected children?

Click here for printable PDF version

October 27, 2004

How can New Hampshire best continue to move toward the vision and the promise of its Child Protection Act?

Prevent child abuse
Invest in home visitation and treatment for adults and children with mental health and substance abuse issues

New Hampshire can prevent child abuse and neglect and make children's homes safer by investing more in home visit programs and effective alcohol and drug treatment.

Child protection is a classic example of "you get what you pay for." Federal and state/county governments share the cost roughly 50-50. States receive open-ended federal reimbursement for children removed from their homes, but funding for preventive and family support services is miniscule -- and capped. This is impractical.

This funding structure supports a system that reacts to child maltreatment, but does little to prevent it -- even though prevention is far more cost-effective. One-third of parents who were abused or neglected as children and who were not treated for their emotional trauma will abuse their own children.

The U.S. Centers for Disease Control says close to 40 percent of child maltreatment might be prevented by early childhood home visit programs that serve high-risk families, such as those with low birth weight infants, or with single, young, or low-income mothers. In N.H., home visiting programs are both publicly and privately funded. They are conducted by family resource centers, Visiting Nurse Associations, community health centers and other organizations.

Model programs include "training of parent(s) on prenatal and infant care, training on parenting, child abuse and neglect prevention, family planning assistance, development of problem solving and life skills for parents, and linkage with community services," according to the CDC.

One such program, a nurse home visitation program in Elmira, N.Y., reduced verified cases of abuse and neglect among poor, unmarried mothers by 79 percent.

Substance abuse by parents is a major contributor to the maltreatment of as many as two-thirds of children involved with the child welfare system. In a National Center on Child Abuse Prevention Research survey, 85 percent of states named substance abuse as one of the two major problems in families in which maltreatment was suspected.

Nearly one in 10 American children live with a parent who abuses alcohol or other drugs. Those children are more likely to experience abuse or neglect than are children in non-abusing homes. When they are removed from their homes, they are likely to stay in foster care longer.

DCYF's “Project First Step,” a demonstration project in its fifth year, is a step in the right direction. It uses federal foster care funds to provide substance abuse assessment and treatment for families in which alcohol and/or other drug abuse is a factor in suspected child abuse or neglect. First Step services start when the assessment is initiated, usually before any action is taken to remove children from the home.

DCYF reports that the project has led to better outcomes for the children and families involved, while saving more than $250,000. Officials hope to extend Project First Step to all 12 district offices.

Overall, though, New Hampshire spends less than half the national average on alcohol and other drug treatment services. According to the state Division of Alcohol and Drug Abuse Prevention and Recovery, NH needs between two and 10 times more alcohol and drug treatment capacity than currently exists.

Better management
An accredited DCYF will perform better for children, parents and communities and will meet federal child protection standards

States whose child protection systems are nationally accredited are held to best practice standards.
Accreditation means DCYF will have the "tools" -- the workforce, training, supervision and policies -- to protect children and support families. It will mean a child protection system that is more effective, efficient and, with the right approach, accountable.

The federal Child and Family Services Reviews present states with rigorous outcome standards that they must meet or risk financial penalty. The accreditation process helps them meet those standards, and helps NH avoid the financial penalty of not meeting them.

Nearly every deficiency identified in New Hampshire's CFSR is addressed by two or more COA standards (a couple require legislation or action by the courts). They include issues related to thorough assessments of abuse and neglect reports, addressing issues underlying violence in families, moving children more quickly to permanent homes or reunification, facilitating visits with siblings and parents, involving parents in case planning and placing children with relatives, to name a few.

Accreditation also presents an opportunity to make the child protection system more accountable to lawmakers and the public. A law requiring DCYF to accredit its child protection services should also make public all accreditation reports, including annual “maintenance of accreditation” reports, as well as those required in cases of serious incidents, such as deaths. These regular reports will provide for the legislature and for the public regular "report cards" from impartial, independent evaluators.

It’s the $200,000 question. Failure to meet federal standards will cost New Hampshire $200,000 in penalties. A Child Welfare League report estimates it will cost the state about $200,000 to accredit its system. Where will we spend the money – on penalties or on abused and neglected children?

More attention to youngest victims
Strengthen community services for abused infants and toddlers and their families

Child protection in New Hampshire is about very young children.

Infants and toddlers comprise 22.9 percent of known child maltreatment victims in New Hampshire, children under age 6 account for 33.7 percent. The actual number of young victims is much higher. Young children cannot verbalize what they are experiencing, and infants and toddlers are less likely to be identified as abused by the caregivers and other professionals who most frequently report abuse.

Infants and toddlers in the child protection system are among the most vulnerable children in the country. Because their brain development is at its most critical stage -- roughly 85 percent of the brain's core structure, linking social, emotional and cognitive development, is formed by age 3 -- they are the age group most damaged by abuse and neglect.

Foster families for babies and toddlers should receive special training and support so they can better understand the unique physical, mental and emotional needs of these children.

At a stage when attachment is their most important developmental need, the need to protect them from further abuse may mean separating them – sometimes permanently – from their parents. Once in out-of-home care they are likely to experience several foster care placements, which reinforces feelings of abandonment and mistrust.

DCYF works closely on infant-toddler cases with a variety of community partners, including mental health centers, developmental service area agencies, family resource centers and other programs. Every abused or neglected child under age 3 should be referred to early intervention services and receive a mental health assessment.
Whenever and wherever possible, infants and toddlers removed from their homes should enter the Permanency Plus program, to make multiple placements less likely.

Some of these effective and proven programs that address both prevention and treatment of infant-toddler abuse and neglect are themselves underfunded, or are not available in all areas of the state. They should be strengthened and expanded so all children and families, no matter where they live, have access to them.

DCYF could also consider continuing its trend toward specialization by creating infant-toddler CPSWs to coordinate the specialized care its youngest victims require.

Place children in permanent homes quicker
Increase Legislative and court attention to child permanency

New Hampshire's legislative and judicial branches can do much to improve the state's record of moving children into permanent placements.

1. The Legislature should ensure that the courts are adequately staffed to address child protection, delinquency and permanency cases within the legal timeframes for each.

2. As New Hampshire moves toward a Family Court system, courts should expedite these cases.

3. The Legislature should require that children's permanency hearings be within 12 months of entry into foster care. Currently, these hearings are required within 12 months of a child's adjudicatory hearing (a hearing to determine the truth of allegations of abuse or neglect). Because some adjudication hearings are delayed for months, the children in those cases are already in foster care longer than a year before their first permanency hearing is held.

4. Courts should consistently order permanency hearings for CHINS (Children in Need of Services) and delinquency cases to move children more quickly into permanent homes.

Resources

Child Welfare League of America

Child and Family Service Reviews
U.S. Children's Bureau

Data: "Child Maltreatment 2002: Reports from the States to the National Child Abuse and Neglect Data Systems"
U.S. Children's Bureau

Research in Brief : "An update on the 'Cycle of Violence' " (PDF)
National Institute of Justice

Report: "Blending Perspectives and Building Common Ground: A Report to Congress on Substance Abuse and Child Protection"
U.S. Dept. of Health and Human Services

Report: "Childhood Victimization and Delinquency, Adult Criminality, and Violent Criminal Behavior" (PDF)
U.S. Dept. of Justice

Report: "First Reports Evaluating the Effectiveness of Strategies for Preventing Violence: Early Childhood Home Visitation"
Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report

Report: “From Neurons to Neighborhoods: The Science of Early Childhood Development”
National Research Council, Institute of Medicine

Report: "Report Regarding The Feasibility, Costs And Outcomes Associated With The Pursuit Of Accreditation By The New Hampshire Department Of Health And Human Services, Division For Children, Youth And Families." (PDF)
Child Welfare League of America

Report: "Substance Abuse and Child Maltreatment"
National Clearinghouse on Child Abuse and Neglect Information

Report: "The ABCs of early childhood: Trends, information and evidence for use in developing an early childhood system of care and education"
Iowa Kids Count and Iowa Forum for Children and Families.

Report: “What Science Is Telling Us: How neurobiology and developmental psychology are changing the way policymakers and communities should think about the developing child”
National Scientific Council on the Developing Child