Thursday, March 7, 2013

Research and child welfare programs

The child welfare system is as subject to the winds of fashion as any other field - in my time uniform case records, family-centered practice, intensive preventive services, family group decision-making and concurrent planning and community-based services are among the new approaches that have come and gone. And that's just in New York City. And in fact, now, New York City is moving its large preventive services program to an evidence-based set of programs, though it is not clear that those programs can be replicated here easily.

So it was with some interest that I read Elizabeth Bartholet's article "Creating a Child-Friendly Child Welfare System: Effective Early Intervention to Prevent Maltreatment and Protect Victimized Children." Bartholet is a professor at Harvard Law School, and here she focuses on the prevention of abuse and neglect, criticizing the current climate that values family preservation to the extent possible. She also highlights two promising approaches: early prevention through home visits using a public health model, and early protection - that is, monitoring for children at risk of maltreatment.

The problem is, there's a lot of short-term research (some of which Bartholet rightly criticizes) but not enough long-term research: what approach really is better for children. Removal? Foster care? Adoption? Open adoption? Because of ethical problems, we can't do random assignment of children or families into programs, but Bartholet calls over and over for comparative research. She's right. We also need longitudinal research. Long-term research with followups is expensive, but until we have it we will continue lurching from one approach to another - we may call it research-intensive or evidence-based, but Bartholet convincingly shows that most approaches are neither.



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