DEE WILSON CONSULTING
Measuring Chronic Child Maltreatment
(Originally published January 2026)
One of the most puzzling features of U.S. states’ child welfare systems is their limited ability – or unwillingness – to utilize cogent measures of child safety, the main goal of agencies’ child protection programs. The federal Administration for Children and Families (ACF) requires state child welfare systems to measure the rate of investigated CPS cases substantiated for child abuse or neglect substantiated a second time within 12 months. Substantiation decisions, however, have been shown to be influenced by factors other than the occurrence of child maltreatment, e.g., by parents’ willingness to engage in services or a caseworker’s desire to build a legal case for dependency action. In addition, public agencies can easily reduce their substantiation rates and rates of maltreatment recurrence without practice improvements, e.g., by assigning CPS reports to a family assessment response that does not utilize substantiation or by declining to substantiate abuse and neglect for a variety of reasons.
Even when case determinations such as “founded” vs. “unfounded” accurately reflect CPS caseworkers’ investigative findings, they do not provide important and essential information regarding children’s experiences of harm. Child physical abuse may include a wide range of harm, everything from a spanking that leaves bruises on a child’s buttocks and upper legs to skull fractures, and a host of other minor and major injuries. Substantiations of neglect may refer to a specific incident of lack of supervision, or reflect a pattern of chronic pervasive neglect profoundly damaging to a child’s physical, cognitive and emotional development. A child maltreatment recurrence rate, as currently measured according to ACF rules, indicates little or nothing about child safety. There might have been an increase or decrease in child fatalities, near fatalities and other serious injuries on open or recently open cases, or no change at all. ‘Neglect’ is a broad umbrella term that refers to a wide range of caregivers’ intentional and unintentional acts and omissions. Neglect may be situational, sporadic or chronic neglect, types of neglect that have vastly different effects on children’s health and development.
To its credit, Washington State’s Department of Children, Youth and Families Services (DCYF) is one of the few state child welfare agencies that makes a good faith effort to identify and count “near fatalities” due to child maltreatment, a category of serious injuries. In addition, the Washington State Office of Family and Children’s Ombuds issues yearly reports on child fatalities and near fatalities that utilize a standard for classifying and counting child maltreatment fatalities and near fatalities (i.e. caused by or contributed to) more credible than DCYF’s dependence on substantiation decisions. As a result, Washington is one of the few states with credible measures of child maltreatment fatalities and near fatalities that can be used as child welfare performance indicators. Most states, by their own design, lack such measures.
Why it is important to measure chronic maltreatment
There are two main ways in which child maltreatment seriously harms children:
1) through inflicted injury or unintentional injury resulting from various forms of abuse and neglect, and
2) through pervasive chronic neglect and abuse that affects multiple child care domains, i.e., feeding, clothing, hygiene, supervision, nurturance, etc., often combined with physical abuse and/or sexual abuse that leads to cumulative emotional and developmental harm.
Chronic neglect and chronic multitype maltreatment are associated with parental substance abuse and mental health conditions, and sometimes domestic violence as well, in addition to poverty. It is the combination (and total) of adverse childhood experiences (ACEs) rather than any specific adversity that leads to elevated rates of physical disease and mental health conditions, along with elevated rates of early all-cause mortality over the life span, according to studies of ACEs.
Child protection systems that limit child safety concerns to risk of imminent physical harm are either poorly informed regarding how child maltreatment harms children, or have made an unconscionable decision to ignore the cumulative harm of adverse childhood experiences resulting from chronic maltreatment and the chronically relapsing conditions with which it is associated. Public child welfare agencies should be accountable for what they are doing to ameliorate chronic maltreatment. Measuring chronic maltreatment of children reported to CPS is essential to evaluating agencies’ effectiveness in protecting children from serious harm due to caregivers’ mistreatment.
Indicators of CPS performance should include a chronicity measure, i.e., a measure of multiple CPS referrals. It is not enough to measure a CPS re-referral rate. Families can have more than one screened-in referral without being involved in chronic neglect or chronic multitype maltreatment, i.e. a combination of both neglect and abuse. However, as the number of both screened-in and screened-out referrals increases, it becomes much more likely that a child or sibling group is being pervasively maltreated, per the research studies of Anthony Loman, Melissa Jonson-Reid, Brett Drake, Diana English and others. Measuring the number and percentage of families or children with five or more screened-in CPS reports is a good proxy for chronic maltreatment.
DCYF’s chronicity dashboard
Washington State’s Department of Children, Youth and Family Services’ (DCYF) Office of Innovation,
Alignment and Accountability (OIAA) has begun to produce a publicly accessible dashboard that
contains CPS re-referral data for 2019-2024. The “Safe Reduction Dashboard: Placement and re-referral
trend for cases assigned at higher and lower risk levels,” introduces this data with the following
comment:
“Over the past six years, placements have gone down, while re-referrals have gone up. The
increase in re-referrals is linked to a growing number of children who are identified as victims
multiple times in CPS intakes, especially in families assessed as higher risk.” And: (In families
with multiple referrals), “maltreatment is often not a single incident, but an ongoing condition
connected to unmet basic needs, depression, substance use and unstable housing.”
The dashboard tracks children with multiple CPS referrals, not families. Concretely, what this means is
that OIAA re-referral data is lower than the family re-referral rate, given that many families reported to
CPS have more than one child, some of whom may not be included in any single CPS referral. The
dashboard includes data on screened-in cases only, meaning that families may have much more
extensive histories of CPS reports than indicated by the OIAA dashboard. In addition, the dashboard
provides re-referral data for 180 days following the index referral, not for 12, 18 or 24 months as has been common in research studies of CPS re-referral rates. Despite these caveats, the Safe Reduction Dashboard has a powerful story to tell.
Re-referral and placement trends within 180 days
2019 2020 2021 2022 2023 2024
Re-referral 19.7% 19.3% 22.2% 22.3% 23.9% 23.7%
Out-of-home placement 8.1% 7.7% 6.5% 5.9% 5.1% 5.3%
As placement rates have sharply declined, the 180-day screened-in CPS re-referral rate has increased. In 2024, the six-month screened-in CPS re-referral rate was similar to the one-year re-referral rate in 2020. (2022 Annual Progress and Services Report).
CPS re-referral rates for cases classified as moderately low or low risk on the structured decision making (SDM) actuarial tool completed at case closure changed very little from 2019 to 2024 (14.2% to 14.8%), while the placement rate for these lower risk cases declined by half (2.8% to 1.4%). However, the trend line for moderately-high and high-risk cases was different:
2019 2022 2024
Re-referral 25.9% 30.2% 32.4%
Out-of-home placement 14.8% 10.7% 9.1%
The data report comments: “Cases indicated as higher risk are the primary driver of both the reduction in out-of-home care, as well as the increase in re-referrals.” What this data suggests is that the large reduction in foster care in Washington has been the result of decisions to leave larger numbers of children with multiple risk factors such as substance abuse, mental health challenges and DV in the home, but without being able to significantly reduce these conditions, which has led to large increase in CPS re-referrals.
Chronicity for children with screened-in CPS referrals
The dashboard indicates that the percentage of children with five or more prior screened-in CPS referrals, i.e., at least six screened-in referrals, has steadily increased since 2019:
2019 2020 2021 2022 2023 2024
13.3% 14.0% 14.8% 16.8% 18.1% 18.9%
According to this data, there was an almost 50% increase in chronic maltreatment as reflected in the percentage of families with five or more prior screened-in CPS referrals from 2019- 2024. This is a cogent measure of diminishing child safety, and a likely explanation of how the nearly 50% reduction in entries- into-foster care has been achieved in Washington, i.e., by ignoring or minimizing chronic maltreatment.
Percentage of children with five or more prior CPS referrals re-referred, placed out-of-the-home, or neither within 180 days
The most debatable feature of the Safety Reduction Dashboard is the use of an outcome measure titled “Growing the Green” for screened-in CPS referrals of children who are not re-referred or placed out-of-home within 180 days. The dashboard views the lack of CPS re-referrals or out-of-home placement for 180 days following a prior referral as a positive outcome.
2019 2022 2024
Re-referral 23.7% 30.3% 32.5%
Placed out-of-home 17.1% 19.9% 27.0%
Neither re-referred or placed 10.0% 12.4% 13.7%
The dashboard indicates that the percentage of children with screened in CPS referrals classified as lower risk on the SDM who were neither re-referred or placed out-of-home increased by 0.8% from 2019 to 2024, while the percentage of higher risk children declined by 0.8%.
But what if children with multiple referrals (who may have double digit screened-in and screened-out CPS referrals) have additional referrals from 7-18 months following case closure? Why assume that these children were ever safe from chronic neglect or from chronic multitype maltreatment? These children may have had reduced visibility in the community for a variety of reasons. It is highly unlikely they were ever safe if safety means” basic needs met” and “no physical abuse, sexual abuse or emotional abuse and neglect.” For other children with open CPS cases, there is no sound reason for evaluating safety outcomes based solely on six-month data.
The period for evaluating outcomes for children in chronically maltreating families should be extended to 12 and 18 months, and for school age children and youth, incorporate measures of school performance and involvement with juvenile rehabilitation services. Outcomes for children with lengthy histories of CPS involvement cannot be meaningfully measured by depending solely on CPS re-referral data and entry-into-foster care rates.
In past decades, Washington State’s child welfare system was a national leader in understanding the developmental effects of chronic maltreatment through Diana English’s and her colleagues’ Seattle LONGSCAN study, a longitudinal study that extended for almost twenty years. LONGSCAN research can inform a renewed interest in evaluating the outcomes of chronic maltreatment, which may require DCYF to find an academic partner.
Nevertheless, the chronicity dashboard represents a big improvement in DCYF’s evaluation of its child protection program. Paying attention to children with extensive CPS referral histories is an essential first step in reorienting CPS practice to take on the challenge of reducing chronic maltreatment and ameliorating its developmental harm to children.
If release of the chronicity dashboard motivates DCYF staff at all levels to change the agency’s response to chronic maltreatment, DCYF faces a difficult process of revising its safety framework, which could not be more ill suited to assessing chronic neglect and chronic multitype maltreatment, developing an array of needed services for both children and parents and, most importantly, creating interagency case management teams to work with troubled families and adapt case plans to circumstances.
Chronically maltreating families present a difficult child protection challenge that cannot be adequately met through current administrative arrangements. An assigned CPS caseworker needs the assistance of substance abuse, mental health, domestic violence and child development experts and the support of a full-time case management team. This can only occur with legislative support and with the support of child advocates whom legislators depend on for guidance in developing public policy.
References
2022 Annual Progress and Services Report, Department of Children, Youth and Families Services, Olympia, Washington.
English, D., Marshall, D., Brummel, S. & Orme, M.,” Characteristics of repeated referrals to child protective services in Washington State, Child Maltreatment, 4 (4), 1999.
English, D., Litrownick, A., Marshall, J., Runyan, D., Graham, J. & Dubowitz, H., “Maltreatment’s Wake: the relationship of maltreatment dimensions to child outcomes,” Child Abuse and Neglect, 29, 2005.
Jonson-Reid, M., Emery, C., Drake, B.& Stahlschmidt, M., “Understanding Chronically Reported Families,” Child Maltreatment, 15(4), 2010.
Klinman, D., “Safe Reduction Dashboard: Placement and re-referral trend for cases assigned at higher and lower risk levels.” (January 2026) Office of Innovation, Alignment and Accountability, Department of Children, Youth and Families Services, Olympia, Washington. Available online
Loman, L.A., “Families Frequently Encountered by Child Protective Services,” (2006), Institute for Applied Research, St. Louis, Mo.
Wilson, D., “LONGSCAN Brief: Chronic CPS Referral Histories and the Effect on Children’s Development,” (2016) Casey Family Programs, Seattle, Washington.
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©Dee Wilson
