July/August 2019Vol. 20, No. 6The Need to Balance the Evidence in Child Welfare
Written by Jerry Milner and David Kelly
In recent years, talk of evidence has dominated the field of child welfare. During this time, grants have been awarded, research has been conducted, and evaluation has become a hallmark of most federal, state, and philanthropic efforts to support work in the field. These efforts have made important contributions. We have gained knowledge about the effectiveness of specific interventions with specific populations.
The quest to understand what works, for whom, and under what conditions is critical and will help us better serve children, youth, and families. It is a quest that is closely associated with ensuring the judicious use of resources. It can also be a mechanism for limiting investment in families before the need for expensive, intensive remedial services are needed, which, as such, can lead to greater expenditures of limited funds.
The language of evidence is central in the most recent child welfare legislation enacted by the congress, which limits federal financial participation in prevention services only to those that meet certain levels of evidence, as defined in the statute (promising, supported, and well-supported) for three types of services families may need (substance use treatment, mental health, and in-home parent skill building). This approach to using evidence promotes technical considerations of issues such as dosages and time limits in an effort to ensure just the right levels and lengths of service are offered, and nothing more. It opens the door to overvaluing cost control and budget efficiencies over prevention and familial needs.
Despite their value in certain situations, and they will likely always be needed at some level, clinical interventions supported by evidence do not represent the whole picture of what children and families need. Child welfare data are clear that the majority of families that make contact with the child welfare system do so on allegations of neglect, not abuse. There is also evidence that poverty is often a major contributor to neglect.
This is a different kind of evidence. It is evidence of the need to take on the root causes of what leaves families vulnerable to more serious difficulties requiring more serious and expensive interventions. It is compelling evidence that not every family who comes to child welfare, or is at high risk of coming to child welfare, needs a clinical intervention. It is strong evidence that many families need help making ends meet, that they need basic supports, such as housing, food, and legal assistance. It is plainly apparent that many vulnerable families need people and places to turn to in times of need to boost their resilience and help them enhance their protective capacities.
This type of evidence must not be ignored or forgotten in our quest to focus on what works.
I fear we have entered a time where this human evidence has become undervalued. I fear we have become fixated on treating symptoms of the trauma we allow to develop, instead of intentionally and aggressively acting to prevent it. I believe our reluctance to do so reflects a deeply concerning challenge of conscience as opposed to a challenge of science.
Neglect is something that is within reach to prevent. The problem is, under the current evidence regime, most of the supports that vulnerable families struggling with poverty need do not and may never have a randomized control trial study to justify their provision. Our current child welfare funding structure perpetuates this gap.
Yet, as a field we continue to deeply entrench ourselves in ways of thinking and funding that are wed to reacting to trauma and damage alone, instead of working to prevent as much of it as we possibly can. In the process, we risk pathologizing families' vulnerability and reinforcing stereotypes about families who are served by the child welfare system.
There is evidence that can, should, and does help us understand what families need to maintain their protective capacities and to care for their children in safe and healthy ways. Yet, our values and judgments regarding parents who need help may make it more palatable to fund rescue missions and clinical services designed to fix the damage rather than acting on the evidence of what families need to avoid the damage.
We need to balance the evidence in child welfare.