Abstract
This paper provides a reflection on the evolution of child maltreatment systems and research across the globe during the time since the establishment of the Kempe Center for the Prevention and Treatment of Child Abuse and Neglect (Kempe Center) over 50 years ago. While research has demonstrated that children who are victims of maltreatment have poorer outcomes than their peers, it is also clear that the child welfare workforce faces workforce challenges, and the system established 50 years ago is not the same as it is today. Efforts to move this field of study forward in a changing world rely upon the understanding of child abuse and neglect in the broader culture of our world, including disentangling poverty and social structures from neglect, supporting underrepresented people and communities, and identifying how best to balance the role of child welfare with community services. The Kempe Center’s continued commitment to a multidisciplinary approach to understanding, preventing, and treating child maltreatment, while challenging professional and social reticence to address complex contributing issues and the impact of historical actions, is at the core of its work looking forward to the next 50 years. The continued focus of centering research as a critical component in moving the field forward in just and equitable ways is demonstrated in this sampling of current efforts to support better outcomes for children and families.
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When the Kempe Center for the Prevention and Treatment of Child Abuse and Neglect (Kempe Center) was created within the University of Colorado 50 years ago, child protection systems across the globe were just beginning to emerge. Despite the decades that have passed, child abuse and neglect continues to impact children and youth with serious life-long consequences. In 2021, there were an estimated 558,229 victims of child maltreatment in the USA; over three-quarters (76%) of victims were determined to be neglected, 16% were physically abused, 10% were sexually abused, and 0.2% were sex trafficked; and the rate of child fatalities was 2.46 children per 100,000 in the population (US Department of Health & Human Services (DHHS), 2023). Although child maltreatment is a worldwide issue, there is no central repository of worldwide statistics for child maltreatment incidence and prevalence. Current estimates vary widely depending on the country and the method of research used. The World Health Organization estimates that 50% of children worldwide experience some form of violence every year, forced sexual contact impacts approximately 120 million girls, and child maltreatment and violence are responsible for over 40,000 child deaths per year (World Health Organization, 2020). There remains much work to be done.
Research conducted by those at the Kempe Center and that of others has established that children who are victims of maltreatment and those who end up in foster care have poorer health, social-emotional, educational, employment, incarceration, substance use, and early pregnancy outcomes compared to their peers (Combs et al., 2018; Dubowitz et al., 2021; Garrido et al., 2018; Jafee et al., 2018; Misheva et al., 2017; Okpych & Courtney 2018; Okpych & Courtney, 2021). We also know that the child welfare workforce is faced with chronic burnout and turnover. More than half of the child welfare workforce leave their jobs within 2 years (Edwards & Wildeman, 2018). This fuels an ongoing crisis for agencies who need to replace their staff, for the children and families who need to re-establish rapport and trust every time a new worker is assigned, for co-workers left behind to shoulder the departing caseworker’s caseload, and for agency budgets. In 2022 dollars, it is estimated that agencies spend between $23 and $65,000 (USD) to replace each caseworker who departs (Dorch et al., 2008; Graef & Hill, 2000).
We clearly have work to do to prevent and successfully intervene when maltreatment occurs. Our vision at Kempe is a world without child abuse and neglect, where children and their families thrive. Our mission is to improve the well-being of children and families. We aim to do this through the integration of justice, equity, diversity, and inclusion in all areas of our work by way of discovery, leadership, action, accountability, evaluation, and transformation. In this way and through our work, we strengthen families, communities, and the systems that serve them. We believe that abuse and neglect are preventable, and people are resilient. We are curious. We take a stand. We test assumptions. Our leadership in advocacy, research, education, and clinical work drives innovative strategies that transform the field. We see ourselves as a catalyst, connecting people, information, and best practices to translate knowledge into action.
Still, the challenge remains in how to continue to move this field of study forward in a changing world, understanding that child abuse and neglect exists within the broader culture of our country and world. A system established 50 years ago to protect vulnerable children is not the same system that exists today. While neglect is, and has always been, the largest category of child maltreatment incidence and reports in the USA, risk factors such as intimate partner violence, drugs/substance abuse, trafficking, and even some forms of poverty have expanded the populations of concern for child welfare (DHHS, 2023). The rates of reporting and substantiation increased throughout the 1980s but have been relatively stable since the early 1990s when child protective services became the only/primary resource for children in most places due to volume and broadening inclusion of conditions that may put children at risk (Gilbert et al., 2012). Increasing incidents of child abuse through gun violence, online grooming and trafficking, and other social media dynamics have added complexity to the issue. Consequently, the current system is not working effectively to universally support children and families.
Current thinking has evolved to endeavor to disentangle poverty and social structures from neglect. Our systems of care to support underrepresented people, families, and communities are broken, and the COVID-19 pandemic has underscored the vast disparities including related to illness and death based on race, income, and living environment (Maness et al., 2021). Despite three decades of child welfare reform efforts, these disproportionalities in the US child welfare system have resulted in structures of oppression in the form of practices, policies, laws, and regulations (Merkel-Holguin, et al., 2022). There remains a lack of common consensus regarding how best to balance the role of child welfare with community services.
Just as Dr. Kempe did when he established the first multidisciplinary child protection team in 1958, the Kempe Center remains committed to a multidisciplinary approach to understanding, preventing, and treating child maltreatment, while challenging professional and societal reticence to address complex contributing issues and the impact of historical actions. Just as the field has evolved, so has the Center. Situated within the University of Colorado School of Medicine, Department of Pediatrics, core components of work remain clinical, research, education, and advocacy, but it is now more critical than ever to enhance integration and collaboration across these core areas and infuse tenets of justice, equity, diversity, and inclusivity (JEDI) into all aspects of the work and strategies. Clinical services include direct physical and behavioral health care for children at risk of or currently suffering abuse or neglect as well as consultative support for the most remote and underserved areas. While clinical care provides a direct lens into current trends and needs, the research core at Kempe provides a critical component assisting in analyzing real-time data across multiple systems while providing evidence to and for future clinical care, training, and policy efforts. Additionally, the changing landscape and complexity of issues are at the heart of the critical importance of translating knowledge from direct service delivery into researching better systems and translating research back into service delivery systems. For example, the Kempe Center has extensive efforts focusing on the ways the child welfare workforce can work to address the reality that most systems do not really create the space that enables traditional “helping hand social work” practice to thrive, ultimately further deepening workforce and system challenges. Through the utilization and integration of human resources and child welfare administrative data, more robust insights into workforce dynamics, including turnover, can be gained to inform system improvement and healing. A commitment to centering children, youth, and families to create an understanding of their perspectives regarding their child welfare/intervention experience, such as elevating participation of young adults with lived experience (ex. independent living services project) and work on differential response (e.g., Fluke et al., 2019) and family group decision-making (Merkel-Holguin et al., 2007), is fundamental to ensure a system that respects families’ strengths, honors them, and supports them to achieve their best. The knowledge obtained through direct clinical services, workforce assessment, and lived experience informed systems analysis informs educational resources developed and delivered through the training and education core work of the Kempe Center. For example, the delivery of the Colorado Child Welfare Training System provides a direct impact on the child welfare workforce, and training of medical and research professionals ensures growing capacity in the field into the future (Schwab-Reese et al., 2020). Policy and advocacy expertise allows the transformation of clinical experience and knowledge gained from research into application in community and clinical settings, sometimes through informing critical legislative and policy changes. Finally, a commitment to JEDI is fundamental to ensuring considerations of these tenets in research findings, directing research to better understand structures of oppression, and enhancing considerations of diversity and inclusion within team science. The Kempe Center’s Interdisciplinary Research Institute and International Call to Action to Change Child Welfare’s Conference serve as spaces to integrate science and practice.
The next 50 years will undoubtedly be a time of change and transformation in preventing and treating child abuse and neglect, and the Kempe Center is committed to centering research as a critical component in moving the field forward in just and equitable ways. This will need to be done through providing evidence for the effectiveness of interventions, uncovering/disentangling population-level disparities, and striving to reduce child abuse and neglect for all populations centered on the vision of a world without abuse and neglect. For successful and meaningful change to occur, elevating the voice of caregivers, children, and all those impacted by the system, within research and more generally, will be paramount. Establishing an evidence base for quality community-based services and interventions that reduce child welfare involvement, support families, and restructure systems needs to be coupled with effective implementation to ensure replicability and sustainability in times of limited resources and unpredictable political climates. Hopefully, this will lead to a more targeted child welfare system that is timely and effective when and where it is needed.
This issue of the International Journal of Child Maltreatment celebrates the 50-year anniversary of the Kempe Center by highlighting a sampling of our efforts to support better outcomes for children and families. By highlighting some past and recent research accomplishments, this issue offers select examples of the depth and breadth of our work. I invite you to read these articles, explore more about us at our website at www.Kempecenter.org, and reach out to our faculty and staff for more information or for partnerships. I am excited about the work we do, and we are always seeking opportunities and partners to establish and expand our knowledge about what works, for whom, and how.
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04 September 2023
A Correction to this paper has been published: https://doi.org/10.1007/s42448-023-00174-9
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Wells, K. Commentary on Kempe, the Next 50 Years. Int. Journal on Child Malt. 6, 347–351 (2023). https://doi.org/10.1007/s42448-023-00162-z
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DOI: https://doi.org/10.1007/s42448-023-00162-z