Editor’s Note: Eli Cahan is a resident physician in pediatrics at The Boston Combined Residency Program at Boston Children's Hospital and Boston Medical Center, and an investigative journalist whose work focuses on the intersection of health equity and social justice. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
In 2021, nearly 4 million families across the country—over 1 in 20 US children—were reported to their states’ child welfare agencies. Roughly half of these families were subsequently investigated by the agencies; in states like Indiana, Iowa, Kansas, and West Virginia, approximately 60% of reported families were investigated. In Texas, over 85% of families were investigated.
As is well-documented, racial and ethnic minority families are disproportionately impacted by the child welfare system. According to the 2021 data, the rate of Hispanic families investigated by child welfare agencies is 10% higher than their representation in the census. Black families are over 50% overrepresented in child welfare cases.
Children who are removed from their families enter the foster care system. Nearly 400,000 children were in the foster care system as of September 30, 2021—a population larger than the number of children in 12 states.
In many cases, following initial removal, there is the possibility of reunification. However, for various reasons, almost 20% of children who return are re-reported to child welfare agencies. According to the Department of Health and Human Services’ Administration for Children and Families (ACF), failed reunifications often relate, at least in part, to the services rendered—or not—by state child welfare agencies.
“Safe and stable reunification does not begin or end with the return of children to the care of their parents,” ACF wrote in a 2017 bulletin. “Agencies can pave the way for timely, safe, and stable reunification.”
In an article and video abstract being early released this week by Pediatrics, Constantino and colleagues evaluated the 10-year outcomes of almost 300 children reunified with their parents following protective custody (10.1542/peds.2022-060118). Each of these families received a combination of services, including multi-generational mental healthcare and parenting education.
The authors found that re-reporting rates were 7-fold less likely in enrolled families compared with other reunified families (who received a variable set of services) across the US, and they were 3-fold less likely to face re-reporting than other reunified families in Missouri. If enrolled families were re-reported, this occurred, on average, almost 2 years later than elsewhere across the country. Notably, the observed improvements in reunification outcomes occurred regardless of race or ethnicity.
“Evidence-based parenting education, two-generation psychiatric care and consultation, and a structure for active information-sharing…was associated with a very substantial reduction in re-entry into protective custody,” the authors wrote.
“Given that official-report child abuse/neglect is known to exhibit causal dose-response effects on serious adverse mental health outcomes,” they added, “such interventions are a matter of both urgency and medical necessity.”
Child advocates across the care continuum interested in supporting families impacted by child welfare can read more in the September issue of Pediatrics.
