The following study from the University of Pennsylvania points a very negative picture of Child Protective Services in that state.

As budgets shrink, more states and counties have fewer resources to save abused and neglected children from the immediate dangers they face in their homes and the future problems that come along with the abuse (preteen pregnancy, adolescent felons, dropouts, chronic illness & mental illness).

It hurts me greatly to acknowledge that a big part of our nation does not see the need to support at risk children.

The authors suggestion that child abuse should be treated as a crime only adds to the violence and ignores the pain and dysfunction these families have been living through. To send the police into private homes to solve child abuse problems has to be the harshest and most ungrounded suggestion that I’ve heard on the subject. The trauma these children suffer even with trained and caring social workers is beyond description; uniformed police officers taking children out of homes would be extremely hurtful to children.

Our nation already has more people incarcerated per capita than any other nation. Thirteen million prison and jail releases in the U.S. last year. 5% of the world’s population and 25% of the world’s prison population.

In my experience as a guardian ad-Litem, almost always the abuser had been the abused growing up. Jails have not solved this nations problems so far and perhaps are a large contributor to what is hurting us.

Many would argue that America’s huge investment in prisons and jails (and privatization) have created a stigmatized and almost hopeless population of folks who know they are not going to achieve a quality of life like they see all around them no matter what they do.

Decent paying work with a criminal record is almost impossible to find, felons can’t vote in many states, and they are hard pressed to climb out of poverty, let alone raise a family and lead a productive life.

There is no doubt that America’s challenge of saving abused and neglected children far exceeds the training, resources, or public support this nation has been willing to give to the people doing the work. We are now blaming teachers for failing schools. How long will it be before we blame the police for the criminals?

The system needs help at many levels and there usually are not simple answers to complex social problems.

One thing is certain; these children need and deserve our help and it will pay us big dividends as a community to provide it. “What we do to our children, they will do to society” Pliny, 2500 years ago

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Child Protective Services Found Ineffective

By John Gever, Senior Editor, MedPage Today
Published: October 04, 2010
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
Earn CME/CE credit
for reading medical news

Investigations by Child Protective Services (CPS) agencies following suspected episodes of child abuse were seldom followed by improvements in household risk factors for future abuse — casting doubt on the agencies’ effectiveness, researchers said.

Among 595 households followed in a longitudinal study of risk factors for child abuse, those subjected to CPS investigations showed few major differences afterward in abuse risks that existed before the inspection, compared with households that had not been assessed, according to Kristine A. Campbell, MD, MSc, of the University of Utah in Salt Lake City, and colleagues.

Even in those households where child abuse was substantiated, interviews afterward indicated that “modifiable risk factors” — such as social support, family functioning, and child behavioral problems — remained largely unchanged, the researchers reported in the October issue of Archives of Pediatric and Adolescent Medicine.Action Points
Note that this study failed to show benefits of CPS investigations.

Note also that while the editorialist suggests that it is time the responsibilities of these programs be reallocated, he also feels that it is highly unlikely that any changes will be accomplished.
“Our finding that CPS investigation is not associated with improvements in common, modifiable risk factors suggests that we may be missing an opportunity for secondary prevention,” Campbell and colleagues concluded. They noted that CPS investigations provide “unique access into high-risk households” and an opportunity for interventions that “reduce repeat maltreatment and improve outcomes.”

In an accompanying editorial, a pediatrician at Harborview Medical Center in Seattle went further, arguing that the current CPS model “has outlived its usefulness.”

Abraham Bergman, MD, contended that the findings of little influence on future risk should surprise no one. “Who expects CPS to affect such basic factors as poverty, family functioning, and social support?” he asked rhetorically.

Bergman recommended that child abuse be treated as the crime that it is — with investigations handled by the police instead of social workers. The latter should focus on providing counseling and access to services that may actually modify the long-term risk child abuse factors.

In between, he added, public health nurses should be “first-line responders” for cases of suspected child neglect, as they are better equipped than social workers to be accepted in high-risk homes and can evaluate child health and family functioning.

“The changed picture of child maltreatment in the U.S. demands, at the very least, that we begin a wide-ranging discussion and testing of alternative responses,” Bergman wrote.

Study Design May Have Skewed Picture

Janet Warren, DSW, of the University of Virginia in Charlottesville, offered a more upbeat perspective on CPS.

Contacted by MedPage Today and ABC News for comment, she noted that the study examined only children who stayed in their homes. “Many children are taken out of very dangerous living situations permanently based upon investigations conducted by CPS,” Warren said in an e-mail

“CPS serves an essential front line of protection for the most vulnerable children in our society,” she added.

For their research, Campbell and colleagues used data from the prospective LONGSCAN study. This project recruited four-year-old children in five locations nationwide from 1991 to 2000 who were in foster care or in households reported for or with known risk factors for child maltreatment. One of the locations also recruited children without known risk factors for abuse who served as controls. A total of 1,249 children were included in the study.

Children were interviewed at enrollment and again at age 8, and demographic data on their households were collected. For purposes of this study, the analysis was limited to 595 children who had the same maternal caregiver and adequate data were provided at the two interviews.

Of these 595 participants, 164 were the focus of CPS investigations during the follow-up period.

Baseline data indicated some differences in risk factors that reached statistical significance but did not differ markedly in absolute terms. These included poorer household family functioning, poverty, low maternal education, maternal depressive symptoms, and aggressive or destructive child behaviors, all of which were more pronounced in the investigated households.

Of those, the largest absolute difference was in maternal depression, with a mean score of 14.4 (SD 10.7) in investigated households versus 12.9 (SD 10.6) in other homes.

Over time, however, multivariate analysis showed no improvements in the investigated homes with respect to households that were not investigated.

Adjusted measures of social support, poverty, and children’s anxious, depressive, aggressive or destructive behaviors grew worse, though not significantly, in household subjected to any CPS investigation, compared with uninvestigated homes. As well, maternal depression also worsened — to a statistically significant (P<0.05) degree.

The same held true when Campbell and colleagues looked only at the 74 homes where investigations found evidence of child abuse, relative to households that had not been investigated.

The researchers indicated that the latter finding was especially remarkable, since such households were most likely to have interventions intended to reduce the risk of future abuse.

But Campbell and colleagues added that it wasn’t a surprise since, as Bergman also noted, CPS interventions do not address the risk factors analyzed in the study, poverty or social support. They focus on “more immediate threats to safety such as substance abuse or domestic violence,” the researcher wrote.

One Rx: Address Broader Issues

“Changing long-term outcomes for families and children may require a shift in our attention to the broader household, caregiver, and child risk factors identified in the course of CPS involvement in the home,” they added.

However, Bergman, in his editorial, was pessimistic about the prospects for such changes.

“Addressing child neglect is not a popular action item for politicians or the public,” he wrote — at least until child deaths make headlines, at which point new policies are established and rigidly followed “until the next child homicide.”

Similarly, Warren pointed out that society as a whole is “ambivalent” about how to address problems such as poverty, limited education, and unemployment that contribute to child abuse.

Empowering CPS agencies to help at-risk households overcome these problems would require, at a minimum, “smaller case loads, more money to fund services for indigent persons, and a long-term commitment to work with children even when the risk is not acute,” Warren said.

Campbell and colleagues noted that the LONGSCAN study had limitations that extend to the current analysis, including lack of data on intimate partner violence in participating households, substance abuse, and other factors also known to affect risks of child abuse.

The researchers also were unable to directly examine risk factors in individual households as they may have changed over time. The age of the data may also limit the study’s applicability to present-day CPS interventions.

The study was supported by a Public Health Services grant from the National Center for Research Resources.

Study authors and the editorialist all declared they had no financial conflicts of interest.


  1. Child Protective Services (CPS) is a supportive agency….overwhelmed with cases the courts cannot hear fast enough. In the meantime, children’s lives hang in the balance waiting the court’s decision of their fate for months or years to come. The complexity surrounding this subject matter is greatly sensitive and difficult. Where does one start in finding resonable solutions?

    We can readily identify problems of child abuse. In most cases, we know some of the probable causes but yet, we struggle with finding answers. Is it because, we might be part of the problem? Until we can honestly answer the question, “Am I we part of the problem?” we cannot move forward in our discussions without placing blame. As a socitey, I believe we have had enough aimless debates on this subject matter.

  2. “To send the police into private homes to solve child abuse problems has to be the harshest and most ungrounded suggestion that I’ve heard on the subject.”

    Isn’t that suggestion grounded on the idea that laws against killing, maiming, raping, burning, etc. people should be enforced even when the people being killed, maimed, raped, burned, etc. aren’t adults?

  3. Lise,

    I apologize for my lack of clarity.

    Enforcing the law yes, but the point I had hoped to make was that children can be even more traumatized by uniformed and armed police officers removing them from their birth homes (often without toys, clothing, or comforting personal things) instead of by trained and caring social workers.

    The better way is by employing well trained social workers and a process for minimizing the nightmare that by nature is child protection. Social workers can reduce the trauma.

    It has been my experience that there is real value in a process that reduces trauma to already abused children.

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