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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 U.S. states must follow and provides significant funding, the states themselves have primary responsibility for establishing and operating their 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.

Contents 1 Historical Origins 2 International Comparisons 2.1 United states 2.2 Canada 2.3 England 2.4 UK 2.5 New Zealand 3 Effects of early maltreatment on children in child welfare 3.1 Disproportionality & Disparity in the Child Welfare System 3.2 Attachment disorder 3.3 Reactive attachment disorder 3.4 Treatment for Children with early chronic maltreatment experiences 3.4.1 Dyadic developmental psychotherapy 3.4.2 Theraplay 4 References 5 See also 6 References

The concept of a state sanctioned child welfare system dates back to Plato's Republic. Plato theorised that the interests of the child could be served by removing children from the care of their parents and placing them into state custody. To prevent an uprising from dispossed parents:

"We shall have to invent some ingenious kind of lots which the less worthy may draw on each occasion of our bringing them together, and then they will accuse their own ill-luck and not the rulers." [1]

In the U.S., the federal government provides some broad definitions for abuse and neglect and individual states develop their own guidelines for defining and responding to allegations of abuse/neglect. Most states recognize and define physical and sexual abuse and neglect. Many states also recognize emotional, medical, and educational neglect. The Adoption and Safe Families Act, passed in 1997, specifies that states must provide for the safety, permanency, and well-being of children who have been found to be abused or neglected. 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. 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.

In Canada, the child can be made a permanent crown ward and is therefore not freed for permanent adoptive placement. Recently in Ontario, bill 210 (http://www.afterfostercare.ca/downloads.html) was passed which is supposed to make permanent placement in adoptive homes easier to accomplish. More details can be found in the Canadian section of the article on foster care.

A child in suitable cases can be made a Ward of Court and no decisions about the child or changes in its life can be made without the leave of the High Court.

The UK has a comprehensive child welfare system under which Local Authorities have duties and responsibilites towards children in need in their area. This covers provision of advice and services, accomodation and care of children who become uncared for, and also the capacity to initiate proceedings for the removal of children from their parents care ('care proceedings'). The criteria for the latter is 'significant harm' which covers physical, sexual and emotional abuse and neglect. In appropriate cases the Care Plan before the Court will be for adoption. The Local Authorities also run adoption services both for children put up for adoption voluntarily and those becoming available for adoption through Court proceedings. The basic legal principle in all public and private proceedings concerning children, under the Children's Act 1989, is that the welfare of the child is paramount. In recognition of attachment issues, social work good practice requires a minimal number of moves and the Children's Act 1989 enshrines the principle that delay is inimical to a child's welfare. Care proceedings have a time frame of 40 weeks and concurrent planning is required. The final Care Plan put forward by the Local Authority is required to provide a plan for permanence, whether with parents, family members, long-term foster parents or adopters. Nevertheless, 'drift' and multiple placements still occur as many older children are difficult to place or maintain in placements.

In New Zealand, where 15% of children are born 'at risk' children are protected from "witnessing adult violence." The NZ authorities note: "children will not openly disclose that they are being traumatised." [2]

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 maltreated infants exhibited attachment disorder symtoms (disorganized subtype).^[1][2]

Children with histories of maltreatment, such as physical and psychological neglect, physical abuse, and sexual abuse, are at risk of developing severe psychiatric problems.^[3][4] These children are likely to develop reactive attachment disorder (RAD).^[5][6] 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.^[5][7][8] Disorganized attachment is associated with a number of developmental problems, including dissociative symptoms,^[9] as well as depressive, anxiety, and acting-out symptoms.^[10][11]

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.

In the United States, data suggests that a disproportionate number of minority children, particularly African American and Native American children, enter the foster care system.^[12] Additionally, once they enter foster care, research suggests that they are likely to remain in care longer.^[13] Research has shown that there is no difference in the rate of abuse and neglect among minority populations when compared to Caucasion children that would account for the disparity.^[14]

Main article: 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.

Main article: 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, which begins before the age of five and is associated with gross pathological care. Reputable interventions include theraplay and dyadic developmental psychotherapy.

Main article: 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.

Main article: Theraplay

Theraplay is a play therapy that 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 a model of healthy parent-infant attachment and interactions. Read more...

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. ^ Cicchetti, D., Cummings, E.M., Greenberg, M.T., & Marvin, R.S. (1990). An organizational perspective on attachment beyond infancy. In M. Greenberg, D. Cicchetti, & M. Cummings (Eds), Attachment in the Preschool Years (pp. 3-50). Chicago: University of Chicago Press.
3. ^ 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
4. ^ Malinosky-Rummell, R. & Hansen, D.J. (1993) Long term consequences of childhood physical abuse. Psychological Bulletin 114, 68-69
5. ^ ^{a b} 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
6. ^ Greenberg, M. (1999). Attachment and Psychopathology in Childhood. In J. Cassidy & P. Shaver (Eds.). Handbook of Attachment (pp.469-496). NY: Guilford Press
7. ^ Solomon, J. & George, C. (Eds.) (1999). Attachment Disorganization. NY: Guilford Press
8. ^ 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
9. ^ Carlson, E.A. (1988). A prospective longitudinal study of disorganized/disoriented attachment. Child Development 69, 1107-1128
10. ^ 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
11. ^ 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
12. ^ Hill R.B. (2004) Institutional racism in child welfare. In J. Everett, S. Chipungu & B. Leashore (Eds.) Child welfare revisited (pp. 57-76). New Brunswick, NJ: Rutgers University Press.
13. ^ Wulczyn, F. Lery, B., Haight, J., (2006) Entry and Exit Disparities in the Tennessee Foster Care System. Chapin Hall Discussion Paper.
14. ^ National Incidence Study (NIS), U.S. Department of Health & Human Services, Administration for Children & Families, (1996)

Adoption Adoption and Safe Families Act Attachment disorder Attachment in children Attachment theory Child Abuse Complex post-traumatic stress disorder Child protective services Domestic Violence

Dyadic Developmental Psychotherapy Elterngeld Foster care Goler clan Post traumatic stress disorder Reactive attachment disorder Social work Theraplay

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)

http://www.childwelfare.gov/ (accessed 10/19/06)