Child Maltreatment Study Findings—Not Surprising

It is quite frustrating for all of us as children’s advocates to see little change in a high-risk family’s situation, despite the provision of available resources. Most pediatric health care providers and Child Protective Services (CPS) professionals would probably be able to share some uplifting accounts of families improving. However, I assume they could recall many more instances in which nothing seemed to change, or perhaps these instances are the ones that stand out in our minds. I remember one case from years ago that involved a single, teenage mother who could never keep enough infant formula at home to adequately feed her emaciated triplets in the first months of their lives. The mother and I relived the same office visit over and over again—each baby was weighed, and each baby had inadequate weight gain since the previous visit. In this case, pulling out all the stops to provide every service I could find was not enough. I’m not sure what would have been enough for a teenager parenting 3 newborns.

Thus, I am not surprised by the findings of the recent study in Archives of Pediatric and Adolescent Medicine by Campbell and colleagues.¹ I’d bet many pediatricians and social workers are not surprised either. The authors of the study found that child maltreatment investigations were not associated with improvements in abuse risk factors and concluded that these investigations were missed opportunities to enact change.¹ Factors such as family functioning and poverty were no different in investigated families versus families not investigated by CPS.

Today, I consider CPS investigations to be a means of identifying a high-risk family. Ideally, the involvement of CPS should foster positive change, thereby bring about the opportunity for prevention of more abuse and neglect. But how can change occur? It’s an age-old question of how to eliminate the risk factors of abuse, such as poverty. As pediatric health care providers, our obligation is not only to recognize and report abuse but also to intervene, when we can, to prevent some of these risk factors (teenage pregnancy, maternal depression, etc).

The study by Campbell and colleagues has now put a spotlight on the missed opportunities. In an editorial in the same issue as this study, Bergman² writes that CPS “has outlived its usefulness” and provides a list of suggestions on how its duties could be parceled out to other experts. For example, some of its duties could go to law enforcement to investigate the crime of abuse, public health nurses to evaluate family functioning, and social workers to coordinate child welfare services. Anecdotal experience and the report by Campbell and colleagues do cause us to question the role of CPS investigations. Has CPS outlived its usefulness? Or has its role of shining the spotlight on the high-risk family prevented further abuse?