Reforming Child Protection: A Public Health Perspective

Abstract:     
In this article, I consider why legal reforms aimed at improving the effectiveness of state child protection efforts have failed to meet their goals and conclude that the failures stem, at least in part, from reformers' failure to conceptualize child maltreatment as a public health problem and to design a system consistent with accepted public-health practices and principles.

I find that reform efforts and legislation relied on assumptions instead of evidence and thereby underestimated the gravity of harm associated with child maltreatment, the difficulty of cure, and the cost of treatment. Moreover, the assumptions on which reformers relied derived from a simplistic, antiauthoritarian ideology that cast the state child welfare system as villain and the families served by that system as victims. This perspective both ignored the fact that child maltreatment as a serious behavioral disorder that typically inflicts grave harm long before child protection workers become involved and the limited, unreliable treatment options that are available.

I also find that both the structure and focus of current state child-protection efforts are inconsistent with standard public-health methods. The child protection system has failed to develop evidence-based treatments or even standardized diagnostic procedures. It has failed to develop an understanding of the institutional context in which treatment is delivered. It has woefully neglected prevention, the key to most successful public health campaigns. Perhaps most importantly, both federal law and local practice rely on the wrong medical model: law and practice reflect an "acute care" treatment paradigm that aims at rapid cure and exit, while all the evidence suggests that child maltreatment - for both the maltreating parent and the victimized child - is a chronic condition which requires ongoing treatment and services.

Number of Pages in PDF File: 52

Keywords: Children, parents, family law, child welfare, public health

JEL Classification: I38, K32, K19, J78

Accepted Paper Series