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In the United States, the term child welfare is used to describe a set of government services designed to protect children and encourage family stability. These typically include investigation of alleged child abuse and neglect ("child protective services"); foster care; adoption services; and services aimed at supporting at-risk families so they can remain intact ("prevention services" or "family preservation services"). Though the Federal government sets rules which all States must follow and provides significant funding, it is the fifty states that have primary responsibility for establishing and operating child welfare systems.

Most children who come to the attention of child welfare social workers do so because of any of the following situations, which are often collectively termed child maltreatment:

• Neglect (including the failure to take adequate measures to protect a child from harm)
• Emotional abuse
• Sexual abuse
• Physical abuse

The Federal government's Administration for Children and Families reports that in 2004, approximately 3.5 million children were involved in investigations of alleged abuse or neglect, and an estimated 872,000 children were determined to have been abused or neglected. An estimated 1,490 children died that year because of abuse or neglect. As of September 30, 2004, there were 517,000 children in the United States in foster care.

Purpose of the Child Welfare System

The child welfare system generally operates to protect children. In the U.S. another purpose is to ensure a safe permanent home for children. The Adoption and Safe Families Act ASFA requires concurrent planning in all instances in which a child is removed from a home because of maltreatment. It also requires that a permanent placement be made or planned within fifteen months of removal. This is different that the Canadian and English child welfare systems in which the child can be mad a permanent Crown Ward and, therefore, not freed for adoption. In addition, in the U.S. child welfare system, when a child is freed for adoption, there are incentives to encourage families to adopt the child. For example, subsidies are provided until the child is eighteen in certain circumstances, such as an older child, special needs child, etc. The subsidy rate varies, depending on the needs of the child.

Effects of early maltreatment on children in child welfare

The National Adoption Center found that 52% of adoptable children (meaning those children in U.S. foster care freed for adoption) had symptoms of attachment disorder. A study by Dante Cicchetti found that 80% of abused and maltread infants exhibited attachment disorder symtoms (disorganized subtype). Cite error: The <ref> tag has too many names (see the help page).

Children with histories of maltreatment, such as physical and psychological neglect, physical abuse, and sexual abuse, are at risk of developing severe psychiatric problems . These children are likely to develop Reactive Attachment Disorder (RAD) . These children may be described as experiencing trauma-attachment problems. The trauma experienced is the result of abuse or neglect, inflicted by a primary caregiver, which disrupts the normal development of secure attachment. Such children are at risk of developing a disorganized attachment . Disorganized attachment is associated with a number of developmental problems, including dissociative symptoms , as well as depressive, anxiety, and acting-out symptoms .

Children who have experienced such early chronic trauma often experience Complex post-traumatic stress disorder and require extensive and specfic treatment to address multi-dimensional problems experienced by these children.

Attachment disorder

Attachment disorder refers to the failure to form normal attachments with caregivers during childhood. This can have adverse effects throughout the lifespan. Clinicians have identified several signs of attachment problems. Attachment problems can be resolved at older ages through appropriate therapeutic interventions. Reputable interventions include Theraplay and Dyadic Developmental Psychotherapy.

Reactive attachment disorder

Reactive attachment disorder, sometimes called "RAD", is a psychiatric diagnosis (DSM-IV 313.89, ICD-10 F94.1/2). The essential feature of Reactive attachment disorder is markedly disturbed and developmentally inappropriate social relatedness in most contexts that begins before age 5 years and is associated with gross pathological care.

Treatment for Children with early chronic maltreatment experiences

Dyadic developmental psychotherapy

Dyadic developmental psychotherapy is an evidence-based treatment approach for the treatment of attachment disorder and reactive attachment disorder. Children who have experienced pervasive and extensive trauma, neglect, loss, and/or other dysregulating experiences can benefit from this treatment. Dyadic Developmental Psychotherapy is based on principles derived from attachment theory.

Theraplay

Theraplay is a play therapy which has the intention of helping parents and children build better attachment relationships through attachment-based play. It was developed in 1967 by the Psychological Services staff of a Head Start program in Chicago. Theraplay is based on model of healthy parent-infant attachment and interactions. Read more...

References

1. Carlson, V., Cicchetti, D., Barnett, D., & Braunwald, K. (1995). Finding order in disorganization: Lessons from research on maltreated infants’ attachments to their caregivers. In D. Cicchetti & V. Carlson (Eds), Child Maltreatment: Theory and research on the causes and consequences of child abuse and neglect (pp. 135-157). NY: Cambridge University Press.
2. Gauthier, L., Stollak, G., Messe, L., & Arnoff, J. (1996). Recall of childhood neglect and physical abuse as differential predictors of current psychological functioning. Child Abuse and Neglect 20, 549-559
3. Malinosky-Rummell, R. & Hansen, D.J. (1993) Long term consequences of childhood physical abuse. Psychological Bulletin 114, 68-69
4. ^ Lyons-Ruth K. & Jacobvitz, D. (1999) Attachment disorganization: unresolved loss, relational violence and lapses in behavioral and attentional strategies. In J. Cassidy & P. Shaver (Eds.) Handbook of Attachment. (pp. 520-554). NY: Guilford Press
5. Greenberg, M. (1999). Attachment and Psychopathology in Childhood. In J. Cassidy & P. Shaver (Eds.). Handbook of Attachment (pp.469-496). NY: Guilford Press
6. Solomon, J. & George, C. (Eds.) (1999). Attachment Disorganization. NY: Guilford Press
7. Main, M. & Hesse, E. (1990) Parents’ Unresolved Traumatic Experiences are related to infant disorganized attachment status. In M.T. Greenberg, D. Ciccehetti, & E.M. Cummings (Eds), Attachment in the Preschool Years: Theory, Research, and Intervention (pp161-184). Chicago: University of Chicago Press
8. Carlson, E.A. (1988). A prospective longitudinal study of disorganized/disoriented attachment. Child Development 69, 1107-1128
9. Lyons-Ruth, K. (1996). Attachment relationships among children with aggressive behavior problems: The role of disorganized early attachment patterns. Journal of Consulting and Clinical Psychology 64, 64-73
10. Lyons-Ruth, K., Alpern, L., & Repacholi, B. (1993). Disorganized infant attachment classification and maternal psychosocial problems as predictors of hostile-aggressive behavior in the preschool classroom. Child Development 64, 572-585

See also

adoption

Adoption and Safe Families Act

Attachment disorder

Attachment theory

Complex post-traumatic stress disorder

Dyadic Developmental Psychotherapy

foster care

Post traumatic stress disorder

Reactive attachment disorder

social work

Theraplay

References

http://www.acf.hhs.gov/programs/cb/pubs/cm04 (accessed 8/4/06)

http://www.acf.hhs.gov/programs/cb/stats_research/afcars/tar/report11.htm (accessed 8/4/06)

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