Academic journal article Child Welfare

Mortality in a Child Welfare Population: Implications for Policy

Academic journal article Child Welfare

Mortality in a Child Welfare Population: Implications for Policy

Article excerpt

The majority of children who are taken into care by the state are there because of neglect or abuse. Thus, as Nunno and Rindfleisch [1991] have reminded us, reports of children who experience further maltreatment while in care are especially disturbing. Such incidents are often widely discussed in the public media, replete with criticisms directed toward child welfare officials, politicians, and others charged with the responsibility of the care and protection of the children in question. Often, major investigations are held, heads roll, and policy changes ensue. Such activities imply that children in care may be at high risk for damaging outcomes because of the care system itself. This begs the question of whether some children may be better off left with their families than being placed in the care of the state, as has been recently reflected in the move toward family preservation [see Pine 1986; Stehno 1986].

Although there is some evidence of faulty process in many child welfare programs [e.g., Blatt & Brown 1986; Nunno & Rindfleisch 1991; Rindfleisch & Rabb 1984; Thomlison 1984], evaluations have not included an examination of the safety of state-operated care systems in comparison to a return to the family for those at risk. Investigations following a tragic event ordinarily involve a review of policies and procedures, with information on the state of the children in question being exemplified by illustrative case histories. In most cases, suspicions and/or allegations are confirmed, and the policies and procedures of the system are found to be sadly wanting. Such approaches, however, focus primarily on the child protection process in the absence of good information on the actual state of the children in care. Using data from individual cases without consideration of the level of care for all children presents the dangerous possibility of making generalizations based on "worst-case" situations that are not representative of the overall system.

The present study examined death rates in a one-year cohort to ascertain whether children in care show greater risk for these consequences of abuse and neglect than children not in care. Furthermore, data were collected to determine whether each child was in care at the time of death, because neglected and/or abused children may show elevated mortality rates as a consequence of their personal characteristics, irrespective of type of care or placement. For example, violent deaths are known to be predicted by conduct disorder [Robins 1974] and delinquency [Yeager & Lewis 1991], conditions that are highly prevalent among those with previous child welfare involvement [Robins 1974; Thompson 1988; Thompson & Fuhr 1992; Wolkind & Rutter 1973]. Furthermore, abuse and/or neglect during childhood has been found to be highly predictive of suicide attempts during adolescence [Deykin et al. 1985]. Thus, if the hypothesis that child welfare systems are idiopathic is true, we would expect to find that, of those who have moved in and out of care, more would have been in care at the time of death than not in care. The hypothesis that care systems are, in fact, safer than a neglectful, abusive home would result in a prediction of a lower mortality rate during time in care. A finding of no difference between the two would suggest that the mortality rate of the cohort (whether high or low) is dependent on the characteristics of the children, irrespective of living arrangements.

METHOD

The study cohort consisted of those individuals who had been assigned child welfare status in the province of Alberta during the period January 1, 1980, through December 31 of the same year. As child welfare services are available to children from birth to 17 years of age, those included in the study were restricted to this age range, plus those who had turned 18 during 1980. Follow-up continued until December 31, 1987, or until the death of the individual, whichever came first. …

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