Child welfare
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In the United States, the term "child welfare" is used to describe a set of government services designed to protect children and encourage family stability. These typically include investigation of alleged child abuse and neglect ("child protective services"), foster care, adoption services, and services aimed at supporting at-risk families so they can remain intact ("prevention services" or "family preservation services"). Though the federal government sets rules which all U.S. states must follow and provides significant funding, the states themselves have primary responsibility for establishing and operating their child welfare systems.
Most children who come to the attention of child welfare social workers do so because of any of the following situations, which are often collectively termed child maltreatment or child abuse:
- Neglect (including the failure to take adequate measures to protect a child from harm)
- Emotional abuse
- Sexual abuse
- Physical abuse
The Federal government's Administration for Children and Families reports that in 2004, approximately 3.5 million children were involved in investigations of alleged abuse or neglect, and an estimated 872,000 children were determined to have been abused or neglected. An estimated 1,490 children died that year because of abuse or neglect. As of September 30, 2004, there were 517,000 children in the United States in foster care.
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Historical origins
The concept of a state sanctioned child welfare system dates back to Plato's Republic. Plato theorised that the interests of the child could be served by removing children from the care of their parents and placing them into state custody. To prevent an uprising from dispossed parents:
"We shall have to invent some ingenious kind of lots which the less worthy may draw on each occasion of our bringing them together, and then they will accuse their own ill-luck and not the rulers." [1]
International comparisons
United States
In the U.S., the federal government provides some broad definitions for abuse and neglect and individual states develop their own guidelines for defining and responding to allegations of abuse/neglect. Most states recognize and define physical and sexual abuse and neglect. Many states also recognize emotional, medical, and educational neglect. The Adoption and Safe Families Act, passed in 1997, specifies that states must provide for the safety, permanency, and well-being of children who have been found to be abused or neglected. The Adoption and Safe Families Act ASFA requires concurrent planning in all instances in which a child is removed from a home because of maltreatment. It also requires that a permanent placement be made or planned within fifteen months of removal. In addition, in the U.S. child welfare system, when a child is freed for adoption, there are incentives to encourage families to adopt the child. For example, subsidies are provided until the child is eighteen in certain circumstances, such as an older child, special needs child, etc. The subsidy rate varies, depending on the needs of the child.
Canada
In Canada, the child can be made a permanent crown ward and is therefore not freed for permanent adoptive placement. Recently in Ontario, bill 210 (http://www.afterfostercare.ca/downloads.html) was passed which is supposed to make permanent placement in adoptive homes easier to accomplish. More details can be found in the Canadian section of the article on foster care.
England
A child in suitable cases can be made a Ward of Court and no decisions about the child or changes in its life can be made without the leave of the High Court.
UK
The UK has a comprehensive child welfare system under which Local Authorities have duties and responsibilities towards children in need in their area. This covers provision of advice and services, accommodation and care of children who become uncared for, and also the capacity to initiate proceedings for the removal of children from their parents care ('care proceedings'). The criteria for the latter is 'significant harm' which covers physical, sexual and emotional abuse and neglect. In appropriate cases the Care Plan before the Court will be for adoption. The Local Authorities also run adoption services both for children put up for adoption voluntarily and those becoming available for adoption through Court proceedings. The basic legal principle in all public and private proceedings concerning children, under the Children's Act 1989, is that the welfare of the child is paramount. In recognition of attachment issues, social work good practice requires a minimal number of moves and the Children's Act 1989 enshrines the principle that delay is inimical to a child's welfare. Care proceedings have a time frame of 40 weeks and concurrent planning is required. The final Care Plan put forward by the Local Authority is required to provide a plan for permanence, whether with parents, family members, long-term foster parents or adopters. Nevertheless, 'drift' and multiple placements still occur as many older children are difficult to place or maintain in placements.
New Zealand
In New Zealand, where 15% of children are born 'at risk' children are protected from "witnessing adult violence." The NZ authorities note: "children will not openly disclose that they are being traumatised." [2]
Effects of early maltreatment on children in child welfare
The National Adoption Center found that 52% of adoptable children (meaning those children in U.S. foster care freed for adoption) had symptoms of attachment disorder. A study by Dante Cicchetti found that 80% of abused and maltreated infants exhibited attachment disorder symtoms (disorganized subtype).[1][1]
Children with histories of maltreatment, such as physical and psychological neglect, physical abuse, and sexual abuse, are at risk of developing severe psychiatric problems.[1][1] These children are likely to develop reactive attachment disorder (RAD).[1][1] These children may be described as experiencing trauma-attachment problems. The trauma experienced is the result of abuse or neglect, inflicted by a primary caregiver, which disrupts the normal development of secure attachment. Such children are at risk of developing a disorganized attachment.[1][1][1] Disorganized attachment is associated with a number of developmental problems, including dissociative symptoms,[1] as well as depressive, anxiety, and acting-out symptoms.[1][1]
Children who have experienced such early chronic trauma often experience complex post-traumatic stress disorder and require extensive and specific treatment to address multi-dimensional problems experienced by these children.
Disproportionality & Disparity in the Child Welfare System
In the United States, data suggests that a disproportionate number of minority children, particularly African American and Native American children, enter the foster care system.[1] Additionally, once they enter foster care, research suggests that they are likely to remain in care longer.[1] Research has shown that there is no difference in the rate of abuse and neglect among minority populations when compared to Caucasian children that would account for the disparity.[1] The Juvenile Justice system has also been challenged by disproportionate negative contact of minority children.[1] Because of the overlap in these systems, it is likely that this phenomenon within multiple systems may be related.
Attachment disorder
Attachment disorder refers to the failure to form normal attachments with caregivers during childhood. This can have adverse effects throughout the lifespan. Clinicians have identified several signs of attachment problems. Attachment problems can be resolved at older ages through appropriate therapeutic interventions.
Reactive attachment disorder
Reactive attachment disorder, sometimes called "RAD", is a psychiatric diagnosis (DSM-IV 313.89, ICD-10 F94.1/2). The essential feature of reactive attachment disorder is markedly disturbed and developmentally inappropriate social relatedness in most contexts, which begins before the age of five and is associated with gross pathological care.
Treatment for Children with early chronic maltreatment experiences
References
See also
Websites
http://www.acf.hhs.gov/programs/cb/pubs/cm04 (accessed 8/4/06)
http://www.acf.hhs.gov/programs/cb/stats_research/afcars/tar/report11.htm (accessed 8/4/06)
http://www.childwelfare.gov/ (accessed 10/19/06)de:Kinderschutz no:Barnevern sr:Дечја заштита fi:Lastensuojelu
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
