How do we determine which kids are most at risk of severe abuse or neglect, and what can we do to protect them? Answering these questions should be the primary concern of child protective services. In recent years, more advocates have become interested—reasonably enough—in the question of how to stop abuse and neglect before they happen. In academia and government, it’s about getting “upstream” of the problem.
Several years ago, in Texas, researchers started identifying communities by zip code with high rates of child maltreatment. They included in this measure kids exposed to maltreatment—often siblings who had been in families with substantiated reports of abuse or neglect against another child. Then the researchers tried to figure out the common characteristics of the communities.
This strategy differs from simply assessing the risk factors of a particular family. It would be complicated, as well as controversial, for government to single out a particular family (even if it did so only to offer help) just because it has characteristics that correlate with child maltreatment (such as a former felon living in the home). By focusing on whole communities at risk and then offering various services, the researchers hoped to avoid this difficulty.
Some factors correlated with high-risk communities won’t be surprising: a high percentage of residents with less than a high school diploma and high ratios of hospital-based deliveries to teen mothers or infant emergency-room visits. But the factor with the strongest correlation by far is the percentage of adults aged 35 to 64 receiving Social Security benefits for a qualifying disability. Again, this is not to say that adults getting benefits are more likely to harm a child but that their prevalence tells us something important about the likelihood of child maltreatment in an area.
Dorothy Mandell, a professor of community health at the University of Texas and one of the model’s creators, notes that “if an adult is under age 65 and receiving disability, chances are very high that adult has mental health problems or substance use problems.” The order in which these things occur can vary. As Mandel says, “there is a high association with adults who go on disability to then develop depression. But some go on disability for chronic mental health problems. And we can’t ignore the role of chronic injury and pain medication abuse either.”
Nicholas Eberstadt has chronicled the strong correlation between disability benefits and substance abuse, even explaining how disability benefits have funded much of the U.S. drug crisis: “How did so many millions of un-working men, whose incomes are limited, manage en masse to afford a constant supply of pain medication? Oxycontin is not cheap. As [the book] Dreamland carefully explains, one main mechanism today has been the welfare state: more specifically, Medicaid, Uncle Sam’s means-tested health-benefits program. . . . ‘For a three-dollar Medicaid co-pay, therefore, addicts got pills priced at thousands of dollars, with the difference paid for by U.S. and state taxpayers.’ ”
Evidence also points to high rates of substance abuse driving child welfare problems. While the reported rate of children removed to foster care because of substance abuse is about 40 percent, most experts believe that the number is closer to 80 percent. But measurement is hard. Do we depend on self-reports of drug use, caseworker reports of drug paraphernalia in the home, or evidence of actual impairment?
Widespread use of disability benefits is not only an objective measure; it also suggests a chronic and serious condition. People don’t get disability benefits for occasionally smoking a joint. It tells us that the mental-health concerns or substance-abuse issues are serious enough in a community to merit long-term intervention. (Whether disability benefits are the right intervention is a different question.)
Mandel says that advocates regularly ask her about poverty: Isn’t it strongly correlated with child-maltreatment risk in a community? It is not uncommon to hear people say that giving families more material help in the form of housing vouchers or food stamps or just cash would reduce the number of kids reported for neglect. But that is not what the Texas researchers found. While a higher level of correlation existed between poverty and maltreatment in older children, disability benefits were still “overwhelmingly” the strongest correlation for all age groups.
These findings suggest not only that something is wrong with the “neglect is really about poverty” narrative but also that policymakers might better target the crisis. If a community is suffering from elevated substance abuse and mental illness, sending it more cash will not solve things. Opening more rehab facilities may be more effective. Going upstream to fix a problem is fine, but it’s important to look at the actual evidence that we find there.