DEE WILSON CONSULTING
Measuring Chronic Child Maltreatment and Minimizing Its Effects
(Originally published September 2026)
​
The Washington State Department of Children, Youth and Family Services (DCYF) posts a child welfare safe reduction dashboard on its website that tracks screened-in CPS referrals, rereferrals, percentage of children with 0,1-2, 3-4 or 5 or more CPS referrals and out-of-home placement rates by age of child, race/ethnicity and region of the state. It is important to emphasize that the dashboard tracks children rather than families, and that rereferral rates for children are likely to be less than for families, though how much less is uncertain.
The dashboard utilizes two measures of chronicity, i.e. repeated and prolonged CPS involvement: 1) the rate at which children with screened-in CPS referrals were rereferred within 180 days; and 2) the percentage of children with screened-in referrals with five or more prior screened-in referrals.
​
Child Welfare Safe Reduction Dashboard
​​​​​​​​
CPS 180-day Rereferral Rates and Placement Rates
Rereferral rate Placement rate
2019 19.9% 8.6%
2020 18.6% 7.9%
2021 21.3% 7.4%
2022 22.3% 6.1%
2023 22.8% 5.5%
2024 23.5% 5.1%
2025 23.8% 5.6%
The 180-day CPS rereferral rate has steadily increased from 2019 to 2024, with the exception of 2020, the year of the COVID 19 pandemic, while the out-of-home placement rate declined more than 40% before increasing slightly in 2025, mainly due to an increase in infant placements.
​
The CPS rereferral rate for infants, 0 to 12 months of age, increased by almost half from 2019 to 2024, from 15.7% to 23%. The infant placement rate declined by almost a third, from 24.7% to 17%, before increasing to 18.9% in 2025.
​
Prior CPS screened-in referrals before current intake
0 1-2 3- 4 5 or more
2019 41.9% 31.7% 13.4% 13.0%
2020 42.1% 31.2% 13.4% 13.2%
2021 40.0% 31.8% 13.6% 14.6%
2022 39.1% 30.6% 14.3% 16.0%
2023 38.3% 30.1% 14.2% 17.4%
2024 37.1% 30.2% 14.1% 18.6%
2025 36.9% 29.6% 14.2% 19.3%
Between 2019 and 2025, the percentage of children with a screened-in CPS referral who had five or more prior referrals increased by almost 50%, from 13% to 19.3%.
​
Five or more referrals by racial/ ethnic group
2019 2025
American Indian/Alaskan Native 19.1% 30.2%
Asian 7.1% 9.2%
Black 15.5% 23.9%
Hispanic 10.0% 17.1%
White 13.8% 22.6%
Percentage of children in 2025 with a screened-in CPS referral who had 5 or more prior referrals - by age group
​
​
​
​
​
​
​
​
​
​
​
​​Almost one in ten children from birth through age 4, one-fifth of young school age children, 5-9, and slightly more than one-quarter of youth, 10-17, with a screened-in referral during 2025 had five or more prior referrals. Five or more screened-in CPS referrals is a proxy indicator of chronic multitype maltreatment that includes pervasive neglect as well as physical abuse and/or sexual abuse, as indicated by research studies published by Anthony Loman, Melissa Jonson-Reid and Brett Drake, Diana English, David Marshall and their colleagues based on Washington State LONGSCAN data. (Loman, 2006, Jonson-Reid, et al, 2003, 2010, English, et al,1999, 2005, Wilson, 2013).
Chronic multitype child maltreatment is also associated with elevated rates of children with four or more adverse childhood experiences (ACE), a population of children at significant risk for a wide range of physical illnesses and mental health conditions across the life span, as well as increased risk of early mortality. For these reasons, the DCYF chronicity measure of children involved with CPS who have had at least six screened-in CPS referrals is a compelling measure of child safety considered more broadly than risk of imminent harm.
​
However, the immediate danger to pre-school children of living in a home with chronic multitype child maltreatment should not be minimized. In my review of DCYF child fatality reviews conducted in 2024-25 (February 2026 Sounding Board, “Chronic Child Maltreatment and Child Fatalities in Washington State”), I found that the median number of CPS referrals for children who died due to child maltreatment was nine. Many of these children and their caregivers had long histories of CPS involvement and had been assessed as “Safe” on multiple occasions by CPS caseworkers.
Developmental outcomes of chronic child maltreatment
There is widespread public concern with child maltreatment related fatalities and near-fatalities, but seemingly far less concern with the developmental and emotional harm to children and youth resulting from chronic maltreatment. These harms often take several years to become evident, but affect many more children than fatal maltreatment, which is a low base rate phenomenon, i.e. even in high-risk families a tiny percentage of children die due to maltreatment. In contrast, severe emotional and developmental harm that affects educational performance and brings chronically maltreated children of all ages to the attention of public systems of care, is common.
​
In an article, “Child and Adult Outcomes of Chronic Child Maltreatment,” (2012) Melissa Jonson-Reid, Patricia Kohl and Brett Drake discuss a study of 5994 low-income children in St. Louis, Missouri who were followed from 1993-94 through 2009; 3,521 of these children were reported for child maltreatment. The authors state: “Child maltreatment reports predicted negative childhood outcomes in a linear fashion.” Negative outcomes before age 18 included medical treatment for head injury and sexually transmitted disease, suicide attempts treated in an emergency department, mental health treatment, juvenile court petitions for a violent offence or problematic substance use. The study also tracked young adult outcomes, including the first alleged perpetration of child maltreatment for a child in their care or custody by youth 17 or older, mental health or substance abuse treatment after age 18 and arrest for substance abuse after age 18.
The study found that the percentage of children, youth and young adults with at least one negative outcome increased as the number of CPS reports increased:
Number of Children with one or more
CPS reports negative outcome
0 29.7%
1 39.5%
2 53.8%
3 59.8%
4 67.1%
5 69.5%
6 76.1%
7 79.4%
8 79.4%
9 83.3%
10 84.6%
11 86.2%
12 91.9%
Forty-one percent of the sample had no CPS reports; 19 percent had one report, while almost one fifth (19.1%) had four to twenty-two reports.
​
It is unclear how many children and youth had multiple negative outcomes. Clearly, many did as the regression models utilized to estimate the odds of negative adult outcomes controlled for one, two, three or four negative child outcomes. The authors comment: “The number of maltreatment reports is a strong general predictor of negative outcomes in both childhood and adulthood, although the relationship between repeated reports of maltreatment and problematic substance abuse in young adulthood did not persist once adverse childhood outcomes were controlled.”
​
The most common negative outcome among youth in the sample, i.e., diagnosis of a mental health condition, is different from head injury, suicide attempt, treatment for sexually transmitted disease or violent delinquency during adolescence. Children’s mental health conditions (along with neurological impairments) are mediators, sometimes the immediate cause, of suicide attempts and suicides, serious physical injuries resulting from reckless behavior, substance misuse and violent delinquent acts, vulnerability to “meltdowns,” and oppositional behavior in school, community, and families. Child welfare staff who understand the connection between chronic child maltreatment combined with multiple ACEs such as parental substance abuse, co-occurring mental health conditions and domestic violence, and children’s early onset mental health conditions, cannot in good conscience sit by and do nothing as affected children struggle in pre-school and the early grades, and begin to exhibit a wide range of self-harming and socially dysfunctional behaviors. However, how to effectively intervene often remains unclear.
​
Opportunities and challenges in assisting chronically maltreated children and their caregivers
​
Chronic child maltreatment does not spring fully developed from the womb of poverty, substance abuse, co-occurring mental health conditions and/or domestic violence, along with other afflictions of family life; it develops gradually through the erosion of social norms around parenting. Public and private agencies often have the opportunity to intervene and provide services before situational or sporadic neglect develop into chronic neglect and multitype child maltreatment. It is far easier to prevent chronic maltreatment than to intervene effectively after it has become embedded in habitual patterns of parenting.
​
Ideally, public health departments would be resourced to reach out to parents receiving substance abuse and/or mental health services before a CPS referral is received on the family. However, even in the absence of public health services, CPS caseworkers can make persistent efforts to engage caregivers with identified substance misuse, mental health and domestic violence issues in services following the first or second CPS referral, rather than waiting for a young child to be assessed as “Unsafe” before developing a service plan.
​
These service plans should include the goal of reducing the child care burden of caring for one or more preschool children, as well as addressing chronically relapsing conditions such as substance misuse, depression, anxiety and PTSD. Child welfare agencies need high-quality child-care resources for infants and toddlers who remain in the home, as well as therapeutic child care programs for pre-K young children. It is also important to provide poverty-related services to help families meet basic needs, and not just on an emergency one-time only basis.
​
CPS caseworkers should be using developmental screening of preschool children no later than the third CPS report, to be followed by developmental assessments and developmental services as indicated, with the goal of identifying and mitigating developmental and emotional harms, the most common outcome of chronic maltreatment.
​
Children with disabilities and other special needs are at highest risk of physical, emotional or developmental harm due to chronic neglect, sometimes combined with physical abuse or sexual abuse. One goal of service plans should be to ensure that children with special needs receive the services they need. Even when parents refuse to accept services for themselves, caseworkers can often assist children and youth with complex needs in multiple ways.
​
Child welfare agencies that wait until at-risk children have multiple CPS referrals or are assessed as “Unsafe” before offering services will often encounter caregivers who deeply resent CPS interference in their families and are resistant to any and all services. Frequent encounters with therapeutically intractable families may lead caseworkers to believe that families with extensive histories of CPS involvement (double digit prior referrals ) cannot be helped. Numerous CPS investigations/assessments become little more than periodic safety checks on school age children and youth that anger caregivers and waste caseworkers’ time, with little or no benefit to children.
​
The main challenge confronting caseworkers and other helping professionals in working with frequently encountered families is usually not angry resistance to CPS involvement but rather caregivers’ hopeless/helpless attitudes regarding their ability to benefit from therapeutic services. Caregivers who have entered but dropped out of substance abuse or mental health treatment may have given up on treatment programs or adamantly deny they need help in recovering from chronically relapsing conditions. Child welfare training programs should emphasize the development of engagement skills, i.e., the ability to connect with troubled persons in a way that motivates them to accept help. The inability to engage caregivers in services often leaves child welfare staff with a choice: place a child in foster care through legal action or leave the family alone. Many child welfare staff are strongly resistant to using in-home dependencies to legally require services, an approach which is both time-consuming and often ineffective, in their view.
​
Developing service delivery systems to respond to chronic maltreatment
​
The DCYF Safe Reduction Dashboard indicates that almost one-fifth of children with screened-in referrals have had 5 or more prior referrals, an indicator of chronic neglect and chronic multitype maltreatment. Even prior to implementation of the Keeping Families Together Act (KFTA), most chronically maltreated children in Washington grew up in their birth families. Furthermore, rates of out-of-home care are much higher for infants and other preschool children than for school age children and youth, while the rate of chronic maltreatment as indicated by the DCYF Safe Reduction Dashboard is much higher among school age children, ages 5-9 and 10-17.
​
Foster care often protects infants and other young children from fatality, near-fatality or other serious injury; more than 80% of child maltreatment fatalities and near fatalities occur among children 0-4. Foster care (in the aggregate) does not have the same protective benefits for many school age children, in part because they are less physically vulnerable, and also because rates of placement instability increase as children become older, especially behaviorally troubled school age children, who are at risk of multiple unplanned moves and eventual placement in residential care.
​
Child welfare systems should be reorganizing their services and approaches to service delivery to work more effectively with children and caregivers who have frequent and prolonged contact with local offices. It is not possible to develop effective interventions as an afterthought or by adding an evidence- based service program or two to agencies’ services, or by increasing expectations of an assigned CPS caseworker.
​
There needs to be a rethinking and reorientation of service delivery systems that includes the development of case management teams (4 or 5 persons) consisting of a substance abuse assessment professional, mental health therapist, child development specialist, CPS caseworker and parent advocate, teams which are co-located and share responsibility for case management and decision making.
Several decades of inadequate responses to chronic maltreatment have made one thing clear: child welfare agencies working independently cannot develop effective interventions for chronically maltreated children and youth who have periodic contact with CPS caseworkers throughout their childhood.
​
No public agency is likely to reorganize its practice model to better serve a group of chronically maltreated children without public pressure that pierces the denial of harm implicit in a narrow definition of child safety, and without the resources to alter current practices.
References
Child Welfare Safe Reduction Dashboard, Office of Innovation, Alignment & Accountability, Washington State Department of Children, Youth and Family Services, Olympia, Washington. Available online.
​
English, D., Marshall, D., Brummel, S. & Orme, M., “Characteristics of repeated referrals to child protective services in Washington State,” (1999), Child Maltreatment, 4 (4), 297-307.
​
English, D. Graham, C, Litrownik, A., Everson, M. & Bangdiwala, M., “Maltreatment’s wake: the relationship of maltreatment dimensions to child outcomes,” (2005), Child Abuse & Neglect,29 (5), 597- 618.
​
Jonson- Reid, M., Kohl, P. & Drake, B., “Child and Adult Outcomes of Chronic Child Maltreatment,” (2012), Pediatrics, Volume 129, (3), 839-845.
​
Jonson- Reid, Drake, B. , Chung, S. & Way, I., “Cross-type recidivism among child maltreatment victims and perpetrators,” (2003), Child Abuse & Neglect, 27 (8), 899-917.
​
Jonson- Reid, M., Emery, C., Drake, B., Stahlschmidt, M., “Understanding chronically reported families,” (2010), Child Maltreatment, 15 (4), 274-281.
​
Kaplan, C., Schene, P., DePanfilis, D. & Gilmore, D., “Introduction: Shining Light on Chronic Neglect,” (2009), Protecting Children, volume 24, 1, 1- 7.
​
Loman, A., Families frequently encountered by child protective services (2006), Institute for Applied Research, St. Louis, Missouri.
Wilson, D., “ Literature Review: Frequently Encountered Families” (2013), Casey Family Programs, Seattle, Washington.
​See past Sounding Board commentaries
​
©Dee Wilson
​
