Seeking a Balanced View of Child Protective Services

Dubowitz, Howard; Barth, Richard P.

doi:10.1001/jamapediatrics.2023.2578

JAMA Pediatr

2023

DOI: 10.1001/jamapediatrics.2023.2578

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Seeking a Balanced View of Child Protective Services

Howard Dubowitz

Richard P. Barth

Abstract: This Viewpoint discusses the strengths and shortcomings of child protective services, including mandatory reporting policies, with a goal of enhancing its role in ensuring children’s safety and strengthening families.

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2024

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“…Freisthler asserts that the child welfare system supports systemic and structural racism without addressing the data we cited and without offering any evidence. We fully recognize the terrible toll of all forms of racism throughout our society.…”

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confidence: 95%

We Have More Tools to Support At-Risk Families Than Just Child Protective Services With Mandated Reporting—Reply

Dubowitz,

Barth

2024

JAMA Pediatr

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COMMENT & RESPONSEIn Reply We fully agree with Freisthler that there are an array of strategies and tools to protect children; indeed, we never intended to imply that Child Protective Services (CPS) was the only one. The letter creates a misleading strawman.Freisthler asserts that the child welfare system supports systemic and structural racism without addressing the data we cited 1 and without offering any evidence. We fully recognize the terrible toll of all forms of racism throughout our society. However, we were pointing to the important and confounding role of poverty that explains much of the disproportionate rates of children from racial and ethnic minority groups in the child welfare system. We also questioned whether it is reasonable to expect CPS to tackle racism in the broader community.Regarding newborns exposed to opioids, here too we did not suggest the alleged dichotomy of doing nothing vs referral to CPS. Clearly, efforts should be made to facilitate treatment and offer support. We also did not suggest that individuals using opioids are necessarily unfit to parent. Instead, we expressed concern about the well-being and safety of such newborns, given the challenges of accessing and engaging in treatment. In 2021, 94% of individuals with a substance use disorder received no treatment. 2 The role of CPS is to help facilitate treatment and monitor the child's circumstances; it should not simply be viewed as only punitive. 3 As to the specifics of approaching substance misuse, we naturally agree that those taking medication to maintain recovery should not be reported to CPS. We understand the racist practices Freisthler refers to in the health care system, but how these are "magnified within the child welfare system" is unclear. We do agree that medications for opioid use disorder should be more broadly accepted as the intervention of first preference.Freisthler's third point is also puzzling. We certainly recognize that parents with an opioid use disorder may adequately care for their children. That said, not being involved in the child welfare system is hardly an indicator of adequate parenting. We know that much of what happens in families behind closed doors is unknown. Children exposed to harmful substances prenatally are twice as likely as those who are not exposed to be separated from their parents by age 3 years. 4

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We Have More Tools to Support At-Risk Families Than Just Child Protective Services With Mandated Reporting—Reply

Dubowitz,

Barth

2024

JAMA Pediatr

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“…To the Editor Dubowitz and Barth call for a “balanced view of the shortcomings and strengths of CPS [Child Protective Services]” despite concerns about how the child welfare system supports systematic and structural racism. The words we choose and how we use them signal our viewpoints.…”

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confidence: 99%

We Have More Tools to Support At-Risk Families Than Just Child Protective Services With Mandated Reporting

Freisthler

2024

JAMA Pediatr

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Seeking a Balanced View of Child Protective Services

Abstract: This Viewpoint discusses the strengths and shortcomings of child protective services, including mandatory reporting policies, with a goal of enhancing its role in ensuring children’s safety and strengthening families.

Cited by 2 publications

References 12 publications

We Have More Tools to Support At-Risk Families Than Just Child Protective Services With Mandated Reporting—Reply

We Have More Tools to Support At-Risk Families Than Just Child Protective Services With Mandated Reporting—Reply

We Have More Tools to Support At-Risk Families Than Just Child Protective Services With Mandated Reporting

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