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Preserving Families and Protecting Children:

Finding the Balance

Duncan Lindsey
University of California, Los Angeles


Nothing is more horrifying to the public than the brutal killing of an innocent child. Observing that "Last year 1,300 abused kids died-though authorities knew that almost half were in danger" Newsweek magazine began major coverage on family preservation asking "Is it time to stop patching up dead-end families?" Unquestionably children have died at the hands of families which have been "preserved" even though retaining children in the "preserved" family represented endangerment. In Chicago, the Tribune newspaper tracked child fatalities for one year and found more than 50 children in the Chicago area alone who died from abuse (Ingrassia & McCormick, 1994). Without a proven technology to protect children who have been abused in their home, the Newsweek reporters questioned an approach-family preservation-which keeps children in a family where their health and safety is endangered.

Obviously, children should not be taken from their family if it is possible to keep them safe at home. The problem is that the child welfare field has not developed a proven technology which can assure the adequate safety of endangered children. The risk with inappropriate removal of a child is that it may tear apart a family unnecessarily. However, the risk of leaving a child in an endangered home is a child fatality. Neither is acceptable, but protecting the child's life must always be paramount.

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Evidence for the Effectiveness of Family Preservation Technology

Family preservation can be viewed as both an intervention technology and a philosophy of practice. In this discussion I will examine family preservation from both vantage points beginning with an assessment of the intervention technology developed.

In the late seventies a group of behavioral science researchers in the state of Washington began reporting on the use of intensive casework services directed at families where children were in "imminent need of placement." Their Homebuilders program claimed to have prevented the placement of almost 97 percent of children served. The results were remarkable but viewed with a healthy degree of skepticism because of crucial limitations with the research design (i.e., they did not use a control group). Subsequent research reported in the early 1990s in the states of Washington and Utah also produced supportive results, although not as spectacular as earlier reports. However, the recent Washington and Utah studies have also been criticized as "fatally flawed" because of nonresponse in a small control group (Rossi, 1994, 453-457 this issue). As Rossi indicates, the core of family preservation technology, especially as it is embodied in the the Homebuilders model, has been built upon a set of studies with serious methodological flaws.

Yet, there have been more than thirty evaluation studies of family preservation programs published since the early Homebuilders studies. The research studies report conflicting results. On balance most of the studies fail to provide evidence for substantial success of the intensive casework services approach of family preservation and correspond with earlier evaluations of casework effectiveness (Segal, 1972; Sheldon, 1986). A group of distinguished researchers at the University of Chicago have recently completed the most comprehensive, rigorous, and impartial evaluation of the family preservation approach (Schuerman, Rzepnicki, & Littell, 1994). Families were randomly assigned to experimental and control groups at several different sites around the state of Illinois. There were 995 families in the experimental intensive casework services group and 569 families in the routine services control group. The experimental families received on average ten (10) times more contact hours with their caseworker, with many of these contacts in the family home. What was the difference between the experimental and control groups? The experimental families were slightly more likely to have their children removed. In addition, the experimental children were more likely to be subsequently reported for abuse. These results correspond with similar findings from experimental research in California and New Jersey (Rossi, 1994). In short, the most rigorous tests of family preservation to date fail to find evidence of its effectiveness in either protecting children or keeping families together.

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Child Protective Services

Family preservation services have not been alone in failing to demonstrate effectiveness. During the 1970s and 1980s the child welfare system in the United States was transformed into child protective services by the enactment of mandatory child abuse reporting laws (Lindsey, 1994a). As a result of these laws the number of child abuse reports in the United States increased from about 250,000 a year in the early seventies to more than 3,000,000 today. Advocates of the transformation of child welfare services into protective services promised that child abuse and child abuse fatalities would decline. Yet the evidence suggests this promise has gone unfilled. Contrary to proponents of child protective services, the number of child abuse fatalities did not decline. As seen in Figure 1, although child abuse reports increased sharply, there was no collateral change in child abuse fatalities. Increased child abuse reporting did not reduce child abuse fatalities.

Figure 1. Trends in Child Abuse Reporting and Child Fatalities, 1975-91

 

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Family Preservation as a Philosophy of Practice

Historically the residual child welfare system has swung between the two competing demands of (1) protecting children from homes where either they are being abused or neglected and (2) making every effort to keep children with their family even when the child is at risk (see Figure 2). The main effect of increased reporting was the transformation of child welfare services into a system of child protective services situated on the child rescue end of the residual services continuum. In large measure, the increased emphasis on family preservation in the 1990s has been in response to this overemphasis on protective services during the 1980s-an elixir to the excesses of the child protection approach. As the pendulum swings between these two ends of the residual services continuum major changes in the child welfare system occur but the progress is more often sideways than forward.

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Policy and Program Analysis

In this special issue we examine family preservation from several different perspectives. Family preservation has come to mean different things to different people. There is widespread debate and disagreement about its various aspects. This volume gives voice to these different and sometimes discordant views. We begin with an analysis of family preservation as a program and policy approach. Maluccio, Pine, and Marsh (1994) draw out the interconnection of the family preservation and child protection approaches to child welfare services. They write that preserving the family is an essential part of child protection. The family is the most reliable and consistent source of support for a child. Thus, every effort must be made to preserve the family when that is possible in order to protect the child.

The federal government has made a major commitment to developing family preservation services within the states. Early and Hawkins (1994) indicate that this presents great opportunity for innovation and reform of service delivery at the state level. Family preservation legislation represents a major step toward developing a family policy that goes beyond child protection toward "meaningful family support and family preservation." The current program instructions provide flexibility and allow for innovation in implementing the family preservation philosophy.

History has a way of repeating itself. As Hutchison, Dattalo, and Rodwell (1994) show, the child welfare field had its beginnings in the public response to the cruel and brutal treatment suffered by some children. In response, groups of individuals formed societies and organizations for the protection of children. By the early 1900s there were numerous child protection organizations. In their zealous effort to protect children from abuse and neglect several of these groups showed little regard for the rights of parents. When children were endangered or neglected or improperly cared for, parents risked having them taken away with minimal safeguards all in the name of rescuing the child.

The excesses of the child protection movement eventually gave rise to a counterweight--the family preservation movement. The early family preservation movement emphasized the need to keep families together and decried the limitations of child removal and foster care. Family preservation advocates argued that children were too often taken from their family with little concern about the impact such removal would have on keeping the family together. One of the major concerns of Hutchison, Dattalo, and Rodwell (1994) is the separation of child welfare services that recent child protection efforts have produced. These two components need to be connected. Furthermore, they are concerned with recent discussion about separating the investigation of child abuse from child welfare and transferring it to the police.

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Evaluating Family Preservation

One of the key attributes of the family preservation studies has been a commitment to empirical research and evaluation. Lewis (1994) begins with a review and analysis of intensive family preservation services (IFPS) technology to efforts applied to reunification of foster children with their biological parents. Efforts at reunification require some modification of the family preservation services. Lewis examines these and suggests that family preservation can also prove useful in this area.

The study reported by Scannapieco (1994) is illustrative of the evaluation studies which have assessed the effectiveness of family preservation services. Scannapieco found that home based services to both low and high risk families led to statistically significant differences between pre and post test in family functioning. Scannapieco uses a broad group of measures to assess the effectiveness of family based services examining psychological, social, and environmental domains.

In rural communities there is a growing crisis of children being placed out of their home. Van Hook (1994) indicates that it is particularly important to identify children who are referred to emergency services because they are especially likely to receive out of home placement. Van Hook examines the patterns of placement that have occurred in rural communities and approaches to reduce the need for out-of-home placement.

Several of the studies in the family preservation field have examined family well-being in minute detail and tried to capture it with a broad group of measurement scales. In its extreme form this work mirrors the dustbowl empiricism that pushed many in the field of sociology to consider qualitative research methodologies. Wells and Freer (1994) suggest there are many things happening in studies of family preservation which current approaches fail to adequately assess. Effort is needed to more carefully capture these events which do not lend themselves to quantitative analysis. Qualitative approaches contribute to a more comprehensive approach to assessing progress with family preservation approaches.

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Issues Affecting Family Preservation

The social and behavioral sciences, including social work and child welfare, are characterized by lively and critical analysis of major issues. It is difficult to bring to bear a scientific approach in areas where intense personal and collective values and beliefs are involved. Doing so requires extra effort to insure that all viewpoints are heard, that rigorous methods of analyses are used whenever possible, and that the objective search for the truth is given the highest priority. These are values shared by members of the research community in child welfare. Although in theory it is easy to agree on these standards, in practice a number of competing motives and interests enter into play. It is probably not possible to limit the influence of these motives and interests entirely. In the physical and natural sciences these same motives have been seen to have influence (Mitroff, 1974). Scientists naturally seek to promote their particular theoretical and methodological views (Mahoney, 1976; Ravetz, 1971). Yet the strength of science derives from the extent to which it is able to control and minimize these influences.

Recent efforts to promote family preservation have received substantial support from private foundations. In a field with relatively limited research funds, the allocation of funding support from these foundations has had enormous influence. Adams (1994) examines this influence. It is remarkable how successful the family preservation advocates have been, especially in promoting a particular approach to family preservation-Homebuilders. Adams indicates that funding from private foundations holds both opportunity and risk. The risk is greatest when the funds are used to promote a particular idea and limit others as the ideas are examined and debated within the scientific community.

Family preservation has been offered as a solution to the rising number of children inadvertently entering into foster care. The rising numbers of children in foster care have represented a great public expense with little evidence that foster care does more than provide a temporary safe haven for children at risk. However, a number of other factors have also led to the increasing number of children entering foster care. The Adoptions Assistance and Child Welfare Act of 1980 included provisions to ensure systematic and regular case review for children in foster care. Ellertson (1994) shows that this provision has not been effectively implemented. Many states fail to provide timely case reviews of children in foster care. Further, when states fail to provide for this needed review, the consequences are minimal. Consequently, Ellertson suggests reform of the federal foster care review system.

One of the key features of family preservation is to provide crisis intervention services within a short period of time. Most family preservation programs limit services to 30, 60 or 90 days. Besharov (1994) points out that while this may be a useful strategy for some families, there are other families and children who may require long-term treatment and intervention services. Besharov suggests that for children and families who are most troubled the child welfare system will need to allow flexibility and long term treatment.

In reviewing this collection of papers Rossi (1994) examines the wider issue of effectiveness studies in the family preservation area. This sobering analysis from the preeminent scholar in the area of program evaluation, as well as someone who is essentially outside the child welfare field, should be a cause for us to reconsider the often heard incantation that evidence indicates the effectiveness of family preservation services. In fact, as Rossi indicates, the balance of evidence so far fails to indicate such effectiveness.

In the remainder of this introduction I examine the central concerns I have with the family preservation approach. It is an approach that, although an improvement on the previous child protection approach, is fraught with difficulties and may divert child welfare reform from its central focus.

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Going Beyond Family Preservation

After several decades of benign neglect the child welfare field entered the 1990s with a renewed sense of optimism. One of the major advocates for the children's cause, Hillary Rodham Clinton, was at the center of power in the federal government. The problems confronting children growing up in the United States, especially poor children, were again receiving national attention. The major concern with family preservation is that it seems to have captured the new reform energy and diverted it from the core problem of child poverty and focused it on an historic and recurring debate within the residual child welfare system--a debate whose very nature prevents resolution.

As a philosophy of practice, family preservation is a welcome change from the earlier accusatory focus of the child protection philosophy which has dominated the child welfare system since the early 1960s. However, family preservation is a residual approach. It focuses on abused and neglected children who are at "imminent risk of placement" in foster care. As such, family preservation doesn't go far enough. It doesn't go to the root cause of child maltreatment-which is child poverty. Family preservation either skirts the root problem or fails to confront it. The theoretical underpinnings of family preservation represent an assortment of therapeutic and behavioral theories (Barth, 1988; Wells, forthcoming) that essentially identify the cause of maltreatment as rooted in the aberrant behavior of the individual. To bring about fundamental advances for the millions of children living in poverty, and whose problems are rooted in that poverty, will require going beyond family preservation.

The primary concern with family preservation is not the failure to find empirical evidence to indicate that it represents a significant treatment advance in the child welfare field. In fact, family preservation represents a return to a service approach that was advocated at the turn of the century. Advocates of the current family preservation effort have embraced more current treatment approaches as part of the arsenal of home based services. As Wells (forthcoming) has pointed out, family preservation is essentially a service approach in search of a theory and a knowledge base.

Family preservation is a response to the over emphasis on removal of children at risk of abuse from their family. The child removal aspect of protective services has led to increasing numbers of children in foster care. It is difficult to assess the risk of abuse children are exposed to. Efforts at risk assessment have failed to yield reliable assessment methods. In the context of investigating and assessing abuse, it is often too easy for a child welfare social worker to recommend removal in order to avoid the risk of error and both the potential harm to the child and the public outrage that would follow for leaving a child in a home where he or she was in danger. Although it is not possible to definitively determine whether family preservation has, on balance, shifted the emphasis back in the proper direction of providing services and help to the family, I believe it has.

The concern I have with family preservation is a wider concern. It is a concern that applies to both family preservation and child protection. Both of these approaches represent the residual perspective. Before discussing the limitations of the residual perspective I will examine intensive casework services that form the fundamental treatment technology of intensive family preservation services (IFPS).

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The Technology of Family Preservation: Intensive Casework Services

Family preservation relies on an unproven approach for solving the problems of families and children--the casework method. The casework method assumes that the client, in this case the parents of the child, are unable to manage their own affairs. The task of the caseworker is to collect information, analyze and investigate the situation of the parent and child. The original term was social diagnosis and also included examination of the social context of the family's problems (Richmond, 1917; Wenocur & Reich, 1989). The underlying premise is that the child welfare social worker can identify the family's problems, figure out a solution and develop a case plan to achieve remedy. Yet, there is an absence of empirical evidence that casework services make a significant difference (Ezell & McNeese, 1985; Segal, 1972).

The problem isn't that the families served by child welfare agencies can't manage their own affairs. The problem is that most of these families do not have adequate resources to manage their own affairs. The casework method shifts control over a subject's life to a therapeutic professional (Specht & Courtney, 1993). The professional is now the one to figure out the causes of the client's difficulties and to assist in solving them. This places the fault for client failure and dysfunction squarely with the client being served. More important, this approach encourages a form of dependency. The client being served becomes dependent on the solutions and approaches developed by the family preservation caseworker. Yet the caseworker doesn't have proven treatment methods. The skills and technology of the caseworker are not like those of the physician. The fundamental fallacy of family preservation is that the caseworker can administer treatment and assure a cure (Specht, 1990).

But at least family preservation caseworkers are willing to roll up their sleeves and wade into the difficult task of helping families in severe distress--a far more difficult task than simply investigating a report of abuse and possibly removing a child. Family preservation premises casework services on the possibility of family improvement. With the shift towards protective services the family was less often provided casework services. Instead, the family was subject to investigation for a report of child abuse and, if the report was substantiated, then the child was removed from the home and placed in foster care. The transformation of the child welfare system into child protection meant families and children went from receiving ineffectual casework services (Fischer, 1973; Mullen & Dumpson, 1972) to being subject to coercive child abuse investigations. Neither approach was desirable but at least family preservation was less onerous.

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The Problem is the Residual Model

What is required to make substantive headway for the families who come to the attention of the public child welfare system are approaches which empower them. In a recent book I have suggested directions for child welfare policy and program reform (Lindsey, 1994b; also Danziger & Danziger, forthcoming, see p. 478 this issue). Children must be assured that they live in families that have adequate income. In fact, this factor is what differentiates the current model of family preservation from the one developed at the turn of the century.

The child welfare system needs to focus on placing resources directly under the control and management of parents as much as possible. Policies and programs must encourage independence and self initiative. This will requires a different approach to child welfare than has been taken so far. The family preservation approach is guided by the same residual paradigm which has shaped the child welfare field's outlook and understanding from the beginning. The residual paradigm is a minimalist perspective that requires identifying those children most in need and singling them out for services. Operating within the family preservation approach this paradigm limits the scope of child welfare services to the residual group of children who are alleged at "imminent risk" of removal from their family.

Within the residual paradigm child welfare services have come to be viewed as the provision of casework services to families having difficulty with the parent/child relationship. Yet empirical studies of the effectiveness of these casework services have been equivocal (Fischer, 1973; Segal, 1972). Instead, most children seem to be temporarily removed from their parents only to be returned at a much later date with little changing in the interim. Operating within this residual paradigm the child welfare field has been unable to make substantive advances in reducing poverty, abuse, and neglect among children.

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History of the Residual Model

Since the 1950s when the residual paradigm solidified, there have been major changes that have impacted families and children. The two parent family with a division of labor that had the father working outside the home and the mother remaining in the home to raise the children has given way to families where both parents work outside the home. This has led to major changes in role responsibilities for both the mother and the father. Many families have had difficulties in adjusting and reapportioning responsibilities. There has been a substantial increase in the divorce rate. There has also been a substantial increase in the number of lone mothers keeping their children even when born out of wedlock. These factors have led to a large increase in the number of lone parent families.

The changes in the family have not meet with the necessary adjustments in the broader social order. The needs of the increasing number of lone parent families have not been adequately considered by social policies and programs. Perhaps the most fundamental social policy failure of the last several decades has been in the area of family policy. Specifically, social policies and programs have failed to consider the needs of lone parent families. Lone mothers have had a very difficult time collecting child support. They have been required to use a slow, cumbersome and expensive civil court system to collect child support due their children by absent parents. The civil court system designed to allow business enterprises to collect money owed has not proven effective for lone parents with limited resources.

Lone parents have had to carry the burden of child care by themselves. These difficulties are compounded by the barriers to adequate child care at reasonable costs. For many lone mothers, the cost of child care often rapidly depletes wage earnings. This is extraordinarily difficult in a labor market that provides limited opportunities to women. In addition, the limited employment opportunities have been in positions, such as sales clerk or secretary (where 2/3's of women are employed), that have been traditionally low paying.

As a result of these trends, lone mothers and their children now constitute the largest category of households living in poverty. More than half of the children raised in these lone parent households live in poverty. The stress and strains lone parents face are transmitted to the children (Siegal, 1985). Is there reason to believe that the promises of achievement for children proffered by the advocates of family preservation will be realized? I fear not. Rather, it appears more likely that in the next decade the child welfare system will simply swing back to child protection with little advance made for children and this is the heart of my concern.

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The Limitations of the Family Preservation as a Residual Approach

Although three-year-old Eli Creekmore was at risk, he had, after all, been hospitalized for serious injuries inflicted by his father before, he was able to remain with his family because of intensive family preservation services provided by the state of Washington. Numerous relatives and friends pleaded that something more be done to protect Eli. But they were advised not to meddle in family affairs. Eli Creekmore died of ruptured intestines after being kicked in the stomach by his father. (KCTS/Seattle)
In San Diego family preservation services were provided to a thirteen-month-old girl who had been reported after hospitalization for a broken arm and ribs. Neighbors had repeatedly complained of bruises on the child. The child's death was so brutal that her skull was fractured in two places and her internal organs were lacerated. She was visited by her social worker the day before she was killed.
Two months later in San Diego, another three-year-old child whose family had received Intensive Family Preservation Services was found suffocated to death. (San Diego Tribune Union Tribune, September 11 & October 4, 1993)
Murphy is the Cook County (Illinois) public guardian, the court appointed lawyer for 31,000 abused and neglected children. Last year, campaigning to rein in one "family preservation" program, Murphy sent every Illinois legislator color autopsy photos of a girl scalded and beaten to death after caseworkers taught her family new disciplinary skills. (Newsweek, April 25, 1994)

...and how many more hundreds of children suffer a similar fate? Who is responsible? Who shall be held accountable for these tragic failures? How many such deaths shall we allow as we experiment with an unproven technology? What safeguards should be required?

The case for family preservation has yet to be made. But maybe we expect too much. After all, the question both family preservation and child protection address is moral in tone and substance. They require a search for balance. We don't wish to risk the life and health of a child simply in order to preserve a family. Nor do we wish to tear a family apart simply to protect a child from the possibility that abuse may occur. Every effort needs to be made to keep the family together. Yet keeping the family together requires more than crisis intervention and intensive casework services delivered directly to the home. These are unproven remedies. No research has appeared that would challenge the observation of Kempe and colleagues (1962) that effective treatment of parents who batter have yet to be developed. They observed, "Hopefully better understanding of the mechanisms involved in the control and release of aggressive impulses will aid in the early diagnosis, prevention of attack, and treatment of parents, as well as give us better ability to predict the likelihood of further attack in the future. At present there is no safe remedy in the situation except the separation of battered children from their insufficiently protective parents" (1962, p. 20). Nor can the child welfare system adequately determine where to target the services. Moreover, the problems the child welfare worker faces may not have technological solutions. As Dingwall, Eekelaar and Murray (1983, p. 161) have written:

As we have shown, child protection raises complex moral and political issues which have not one right technical solution. Practitioners are asked to solve problems every day that philosophers have argued about for the last two thousand years and will probably debate for the next two thousand. Inevitably, arbitrary lines have to be drawn and hard cases decided. These difficulties, however, are not a justification for avoiding judgments. Moral evaluations can and must be made if children's lives and well being are to be secured. What matters is that we should not disguise this and pretend it is all a matter of finding better checklists or new models of psychopathology - technical fixes when the proper decision is a decision about what constitutes a good society. How many children should be allowed to perish in order to defend the autonomy of families and the basis of the liberal state? How much freedom is a child's life worth?"

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Conclusion

The disappointment many in the child welfare field have with the family preservation services is that it represents a reemergence of the standard residual model which has captured the opportunity for reform and may divert reform energy from the larger and far more important task of ending child poverty. Despite the absence of evidence indicating the success of intensive casework services (family preservation) to prevent placement and protect children, family preservation advocates have been able to capture substantial public funds in support of this approach. The passage of federal budget provisions have allocated 60 million dollars in 1994, rising to 240 million in fiscal 1998 (cumulatively more than one billion dollars) for states to establish family preservation services. In the coming years efforts to make a difference for children will have to set aside parochial and often fruitless debate over family preservation versus child protection and get on with the central task of ending child poverty which is at the root of the problems these residual strategies attempt to solve.

At the end of their exhaustive study evaluating family preservation services, Schuerman and colleagues (1993, 1994) ask why, with 10 times more intensive casework services delivered directly in the home, children were just as likely to end up in foster care or to be abused again as children who received conventional services. They suggest two main explanations. First, the child welfare system is unable to identify those in "imminent need" of placement and thus target residual services. But more importantly, for many of the families in their study the overwhelming impact of severe poverty limited any intervention. This is the state of child welfare today. The extent of child poverty is so severe that it creates problems that are beyond the scope of the residual model.

Continuing to invest the minimal amount in the development of children, especially children from low income or poor families, is an unwise investment decision. The future of society is determined by the achievements of its young people. Children who grow up in poverty--about one fifth of all young people in North America--are, through current social programs, being effectively denied both hope and opportunity. The result is despair and resentment against the society in which they have so little stake. This is the essential problem confronting child welfare and it is beyond the scope of family preservation. If we hope to make substantial progress for children a broader and more comprehensive approach will need to be developed. This broader effort may include family preservation but only as a small part of a much larger effort that recognizes the best interests of the child and ensures the child's safety.

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References

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