Abstract

Ethical and moral obligations to meet the needs of those who can not help themselves is deeply ingrained in American society, and especially in social work. Child welfare policy and practice has evolved since its inception with the first orphanages of the pioneer days. The development, implementation and revision of child welfare policies is guided largely by public opinion, incentives for positive change, and funding methods for service inclusion. The United States is now, at a financial crossroads wherein the importance of the role of state and federal government in the provision of quality services cannot be underestimated. The U.S. Department of Health and Human Resources under the jurisdiction of the House Committee on Ways and Means is charged with provision of entitlement programs including title IV-B Child Welfare Services, Promoting Safe Adoption Assistance, and Foster Care Independence programs. Many of these programs are currently at risk due to financial turmoil looming over the country.

The quality of life for all West Virginians intertwines not only with cultural norms but also with efforts of policy makers to design efficacious practices. Policy joins practice thru the system evaluation of outcomes for those engaged. Often the outcome variables fall short of practitioner and policy maker plans. Service approaches require very little scrutiny to reveal areas for improvement. Decisions made by service providers who may use correctional and protective approaches and decisions made by those who use supportive or preservative approaches affect individual lives for better or for worse. Protective interventions for children subjected to a neglectful or abusive home life require sensitivity to cultural values, critical decision-making skills and assurance that any intervention implemented, is indeed, the least restrictive option for the child and family. This approach applies to both voluntary and involuntary services.

In child welfare policy, research regarding the impact of home removal may show that children do better when families remain intact than when removal occurs. Use of a least intrusive, strengths based approach requires quality assessment, sound judgment, and development of creative options for intervention. Administrative and clinical decisions are grounded in the availability and accessibility of various programs. When current programs are cut, the subsequent human cost should not be underestimated. Child welfare workers need training in how to find natural supports to empower children and parents affected by issues such as economic climate thru the use of individualized goals and objectives selected by the families themselves. Improvement in the system of care; however, requires changes in judgmental attitudes with support from the advocacy community, especially social workers.

While protection of the health and safety of the utmost importance, improvements in the way emergency personnel respond to calls for help, such as in cases of domestic violence, and suspected or actual child abuse may reduce difficulties related to the need for intervention and can result in overall improvement in the way people enter services. Social services block grants and Title IV-E funds are used for research about outcomes of such intervention. Systems evaluation shows that children removed from an abusive home are subjected the lack of stability that comes from movement between placements, many of which may entail additional abuse. This paper examines the ethical dilemmas associated with child welfare and proposes a problem-solving framework for treatment recommendations to ensure both the fidelity of child welfare policies and outcomes for service participants.

Historical interventions to prevent maltreatment of children in the American culture and especially in West Virginia appear to be valiant; and include supportive, interceptive and corrective aspects. Authors Koger and Stoesz note that early 1874 federal protections for children incorporated the assistance of animal rights activists to bring focus to the need for more humane interventions than simply separating family members. They reference a sample case of abuse of a child called “Mary Ellen” in what was then today’s equivalent of foster care and is easily compared to today’s’ continuing episodes of neglect and abuse in foster care settings. Nonetheless, more modern, less costly child welfare reforms to maintain biological family units viewed as insufficient to protect endangered children whose locations may become unknown once authorities are notified.

Although animals cannot speak to us about the effects of removal from their natural environments, children separated from their roots often have painful stories to tell and many are unable to form healthy social bonds later in life. When children’s parents disappear with them because of a protective inquiry, the impact on policy is to strengthen the practice of removal. If a child is at imminent risk of danger, then ethically, a social worker cannot walk away. If preventive or protective factors are established, then families have opportunity for personal growth and development.

At the forefront of child welfare policies is the basic issue of “equality, equity and adequacy” of basic civil rights. The American Civil Rights and Liberties Union (ACLU) has a durable history of engaging the masses in efforts to ensure public participation in problem solving and law making. However, decision making by the masses is easily misguided and often teeters on hysteria. One such example is the Salem Witch Trials, in which many children falsely accused parents of witchcraft. The ACLU has cited federal cuts in TANF as reducing benefits to 25 percent of drug offenders in 2001, noting the cumulative effects of lack of help available to families. Authors, Koger and Stoesz note that sociologists; Bergers 1980’s child welfare recommendations favors the rights of parents; however, children also pay the price for parental loss of benefits because of drug convictions. Reductions in federal aid, barriers faced by children’s advocates, and sensationalistic media portrayals of the role of the protective authorities remain common. Subsequently, state authority to protect children from the effects of abuse remains inadequate, and inefficient, while available solutions such as foster care and residential settings give birth to new issues and the voices of children remain unheard.

The social and economic origins of the system we have today originated within the context of America’s political and economic needs during the pioneer days. Slavery was commonplace and women had yet to begin fighting for liberation from eons of discrimination. Orphans became an economic commodity as they could supplement the needs of farm workers. They automatically became second-class citizens and suffered the same stigma that foster care children often live with today. Historical foster care studies by Laura Curran of Philadelphia note “in 1939 children placed because of death or physical illness of a parent dominated agency cases, but by 1952, children placed because of family maladjustment formed the bulk…” of service demand. She further quotes, Henry Maas and Richard Engler, who “found that 40 percent to 50 percent of their foster care sample were maladjusted: “Many of these children gave evidence of a confused sense of identity—were unclear about who they were—and showed other than affectionate feelings toward their (foster) parents.” She further quotes a case record in which a worker attributes the retardation of a child as causally related to separation from his Mother.

Interviews of foster care children may reveal that residential placement indeed feels like punishment as reported in a 2006 Journal of Social Work article by Ian Milligan and Irene Stevens. These authors note a lack of normal experiences for custodial youth because of strict regulations about recreational options or special welfare assessments. The post-war era elevated foster Mothers to the status of therapists rather than providers of supports to families left behind. Two centuries later, children, remain as helpless and powerless to defend their own rights as they were then. Today, human rights advocates seek to put the strengths, rather than the needs of individuals first. A movement for quality of care, which treats people as humans rather than commodities, is underway. Much work spearheaded by the community of persons deinstitutionalized by the 1980’s has utility for improving how we treat children in America.

Between 1935 and 1996 Social Security funded Temporary Assistance for Needy Families (TANF) to increase parental capacities to provide supports. By 1996, conversion of this program into the Personal Responsibility and Work Opportunity Act reduced funding supports for children themselves and penalized states for failure to reduce “Welfare to Work” caseloads. A study of outcomes of reductions in TANF for West Virginia families showed more than 20% of survey “mailing addresses were returned undeliverable due to the transient nature of welfare recipients” (Lattimer, 2004).This essential homelessness points to the circular effects of poverty if not an underlying fear of protective services by parents who could benefit from their assistance.

In 1999, a national “victimization rate of 11.8 per 1, 000 children” (Harden & Webb, 2003) was identified, despite “more than a century of federal and state initiatives to prevent and reduce child maltreatment.” In addition, children in foster care maintain high mental health service costs. The passage of the Adoption and Safe Families Act (ASFA) of 1997 requires parental termination of rights if children remain in foster care for more than fifteen months and when parents commit felonies. Ninety-day windows for adoption are required in an effort to stabilize children using secure homes in which emotional bonds are more likely. As such, the ASFA resulted in a high proportion of children being adopted using incentive subsidy dollars, much to the satisfaction of state bureaucrats under pressure to reduce costs on an inadequate West Virginia tax base. Adoption, however, does not reduce foster care family reliance on social systems, and maintains the “client” status of the child.

West Virginia with a crime rate as high as Miami may not be compliant with the requirement for children of parents who have committed felonies to be adopted due to a lack of willing families. Indeed, the adoption law may reduce the willingness of emergency responders to call protective authorities in fear of child removal rather than facilitation of needed help from an array of protective options, such as parental detoxification to improve home life. Domestic violence is often related to substance abuse; and a study by authors Doris, et al (2006) in Child Maltreatment did not find an inverse relationship between rates of child abuse and cocaine use itself. Authorities may not be as likely to respond to evidence of illicit drug use in homes with children because of an array of other protective factors that may be present. If supportive and remedial options were more readily available, then officers may be better equipped to address issues discovered during domestic violence response. High rates of substance abuse among the general population and the transient nature of many welfare recipients may subsequently point to a tendency for addicted parents to use their children to obtain state resources to supply the costs of addiction.

Also, requirements for expedited adoptions may be in conflict with the American’s with Disabilities Act, (ADA) which protects parents who have mental health or diseases such as alcoholism. Waiting lists may be unavoidable again due to lack of adequate funding for increased resources for a population with high rates of recidivism. In appropriate cases, Title XX and Title IV-B grants to prevent out of home placement are available as workers seek to push candidates for reform into programs when options arise. Accessibility is crucial, since substance abusers are not often likely to seek help unless court ordered. Effective collaboration to address the mental health needs of dysfunctional parents and to help investigators locate them and successfully serve them once in treatment is crucial. The standards for mental health intervention need to be the same for both welfare members and the community at large. Children may be carted from parent to parent, door-to-door, have Fathers who purport to live elsewhere to maintain food program eligibility and child welfare benefits or manipulate child support policies. Women may also find themselves faced with domestic violence, essentially jailed by the abusers needs for free housing. Rather than seeking help that could actually further endanger them, they may spiral into despair and depression. In such cases, the experiences of Mothers deemed legally “unfit” may be best described according to author Nora J. Smith in, as “mothers interrupted” (p 10). The Child Abuse and Prevention Act provides funding for such research and services, since ultimately children whose small voices are the quietest, are the biggest victims of all.

The Child Welfare Information Gateway notes that many child homicides are not only preventable, but they often go unreported as actual homicides. They estimated almost 1500 cases of child death because of abuse in 2004. In addition, they noted deaths most often occurred because of neglect related to ignorance or accidental foolishness and fear of reprisal. When out of home placement is necessary, room and board payments are accessible using Title IV-E funds (The Aid to Families with Dependant Children Act) and the ASFA program. The 1993 IV-B Part B of the Social Security Act called “Promoting Safe and Stable Families Act” promotes the use of funds for preventive services and increases needed collaboration with mental health providers. Collaboration between and among a variety of systems including family planning clinics, social services, correctional officers, and judicial authorities is a vital step towards solving the circular nature of many underfunded and highly needed prevention and intervention programs targeting the parents and children living on welfare rolls in West Virginia.

1n 1999, The Foster Care Independence Act implemented as the Chafee Transitional Living Supports program in West Virginia to provide assistance for children between ages 18 -21 who exit foster care without the ability for independence. Children with special needs remain especially vulnerable at this age. Those whose deficits are not significant enough to warrant an intermediate level of care for Medicaid funding using Title XIX Home and Community Based Mental Retardation/Developmental Disability Waiver program and institutionalized in long-term care settings often find themselves in state hospitals, incarcerated or returning to their homes of origin once they reach adulthood.

The intrusive and legalistic approach to family needs can be unjustly destructive. As stated, system, entry often begins with domestic violence calls to law enforcement. Upon arrival, officers may often find the role of enforcer requires unique adaptation to a role of mediation and marriage counseling, of which they are not equipped to do. Redesign of the process of intervention without relying on corrections, but rather “adaptations” as primary intervention could have a positive impact on service delivery. Crisis intervention provided by mental health professionals in such scenarios, using a supportive approach rather than a demeaning approach negates the need for retribution by a perpetrator whose isolation methods are now defeated because a system of support for the victim rather than the perpetrator now exists to facilitate a healthy home.

Such an intervention could not only prevent continued spousal and child abuse but also reduce the increased use of drugs, which is common once Mothers do loose the battle against abusers, drugs and a punitive system of intervention. Further, the self-fulfilling prophecy of hopelessness and despair, currently reinforced by a system, which punishes victims, multiplies the amount of strength needed for a Mother to retrieve and support her children. The witness protection program is not always readily available and may not be foolproof. Children who escape violence do better when they maintain ties to those they love. Family support programs and parenting education has been incorporated in Head Start and has been found to lead to use of more positive parenting strategies, less harsh discipline, improved child behavior, and higher parenting engagement (Stormshak, Kaminski, & Goodman, 2002; Webster-Stratton, 1998).

Indeed the social service system is taking steps in a more therapeutic direction. In 2005, the Rural Domestic Violence & Child Victimization Enforcement report noted “some people (may) feel programs are not inviting, accommodating, or do not meet their individual needs…(p 11).” The report also shows need for a concerted effort between law enforcement and social services including diversity training. In addition, a 2005 Government Accountability Office Report states “during 2005 alone, 33 states reported 1,619 staff members involved in incidents of abuse in residential programs.” (Kutz, Gregory D., & O’Connell, Andy.) The report also notes risks include poor staff training, poor living conditions, and even actual deaths for teens in custody. Services fragmentation, lack of expedient interventions, and attitudes about protection mean many at risk children may go unidentified and poorly served when they are.

Many workers do not comply with The Child and Family Services Improvement Act of 2006. Public law 109-288 which requires monthly foster home visits by workers. State guardians consumed with emergent situations may need additional resources, to facilitate reunification efforts or parent-child needs to process the next steps in their cases when the possibility of reunification after substance abuse treatment is expected. Therefore, in essence, children removed from neglectful homes, may find themselves in similar or worse situations without adequate supports. However, according to Section 13.15 of the General Foster Care Policy in West Virginia, such children do receive some relief since they become eligible for state funded college tuition waivers if they remain in foster care for one year.

Sending in a crisis intervention team to build a circle of supports may be more productive than child protective services when educators suspect neglect or abuse but also recognize similar behaviors among all students. Protective service workers may find virtually everyone has potential for benefit from services, but only the most blatant cases get help. The effects on children placed in the homes of strangers, or group settings, and the impersonal nature of urban replacements of traditional helping networks requires proactivity. Lessons from rural communities where traditional helping networks meet each other’s needs may be more beneficial than removal of a child from the home. Increased use of competency based interventions such as teaching parenting skills, behavioral interventions, and supportive funding in the home environment helps reduce the impact of abuse within families. Resolution of the dynamics of abuse is therefore, a cultural issue, a challenging part of life wherein supportive interventions may be more valuable than correctional.

A 2007 Report to Congress by the Substance Abuse and Mental Health Services Administration emphasizes the benefit of using preventive programs such as nurse visitors to the homes of pregnant women with an at risk status. More importantly, a public health approach to increasing child resiliency among all children is emphasized. Authors Patricia M. Ulbrich and Jami Stockdale documented evidence of positive outcomes for abuse survivors and their children using visiting nurses in their Pennsylvania report entitled “Making Family Planning Clinics and Empowerment Zone for Rural Battered Women.” In “Natural Helping Networks: Assets for Rural Communities, ” author Ted Watkins quotes Attneave and Specks 1973 recommendation to use a Native American method; that of pulling together a group of friends of a disrupted or disruptive person to engage a stronger support system, to increase adaptive attachments. Crockenberg, (1981)

The trajectory of intervention and prevention along a continuum of care contains gaps. Questions need asked regarding the practice of selective referral in West Virginia. For example, research indicates police officers have the highest rates of domestic violence of among all occupations. The wives of officers’ friends may be at equal risk of arrest as perpetrators. Officers’ may find themselves helpless in situations of repeat calls in which only yelling appears to be occurring. Individual rights, or needs, civil liberties, and cultural apathy complicate situations. Foster care parents could be required to facilitate neighborhood watch groups. Watch groups could serve as witnesses to occasions when violent offenders recidivate, are not prosecuted, to prevent others from being hurt. Further, authors, Koger and Stoesz show the relationship between values, poverty and abuse by comparison of West Virginia, Vermont, and Hawaii’s rates of child abuse. In 2001, forty-three more children per 1000 substantiated allegations occurred in West Virginia than in either Hawaii or Vermont, which are equal in terms of both per capita income and poverty.

The federal government initiated monitoring of available services and the effectiveness of foster care programs. The “Child and Family Service Review” sheds light on the need for more collaboration and natural helping networks within families and communities where preservation is possible. Measurable foster care objectives can create a strong sense of community in which neighbors provide for unmet financial, social and emotional needs by acting as role models and thereby closing the gaps. In 2008, USA Today reported The National Science Foundation conducted a study, recognized by the Jim Casey Youth Opportunities Initiative, which shows that kids in “marginally abusive” homes had better outcomes than did children in foster care. The article goes on to report that kids in foster care are more likely to quit school, have babies early and get addicted to drugs. Although, findings may be attributable to differences in severity of abuse, the paradigm shift may be helpful in light of both the costs and the perspectives of successes and failures in foster care practices.

Arming social workers for intervention in such instances could play a crucial role in collaborating with mental health providers to reduce the rates of domestic violence, and the subsequent trauma to children. Advocates for battered women support no drop policies when Mothers or Fathers suffer physical abuse at the hands of an abusive mate. But what about the emotional abuse related to extended episodes of verbal rage which may be attributable to reactionary stress? Changing the way systems respond using collaborative funding can reduce gaps in service, and enhance the overall well-being of entire neighborhoods and communities. When children require hospitalization related to behavioral needs, associated with trauma, or due to existing health conditions, alternatives to hospitalization often exist. In the Journal of Behavioral and Emotional Disorders, authors, Boothroyd and Evans (2003) found that programs, which provide intense in home support “can result in children experiencing a psychiatric crisis being maintained in their natural environments” (p 10.) Further, supportive opportunities using “clarification” with sexual perpetrators as presented by authors DeMaio, Davis and Smith (2006) could provide otherwise unavailable confrontational opportunities for victims of sexual abuse to be relieved of “shame and blame” while holding the perpetrator accountable to the victim (p 28). Rather, authorities remove the perpetrator from the home, instead of the victim.

Increasing the quality of in-home services using the home visitation model may not be sufficient in cases in which lives may be at stake. If America sincerely wants to address the homicide rate then, ethical concerns about privacy rights requires a cultural adaptation. Rural and urban community supports would be required to open their eyes to see the pained expressions on the children’s faces, and hear the pain in the yells next door. They would have to understand the impact of the gangs selling drugs on the street corner, and know the fear of the bullet. They would have to feel the blank stare of the child numbed by a society, which is not safe. The price of the change in society may come at a bargain price in the end, if all of West Virginian society, rather than just the poor, could see, hear and feel the impact.

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