What’s Changed? Reflections from 50 Years of Child Welfare Research and Practice

Background and Purpose: Fifty years ago, Dr. C. Henry Kempe published “The Battered Child Syndrome”, recognized as the seminal work in child maltreatment research. This publication laid the groundwork for the next 50 years of child welfare policy, practice, and research. Despite decades of research and practice dedicated to child maltreatment, the national incidence in the United States is 28.7 out of every 1,000 children. This represents a decline since the 1990s; however, child maltreatment remains a significant and addressable public health concern. Further, conversations about the disparate impacts of the child welfare system, particularly on Black and Indigenous families, and calls for reform began within 10 years of Dr. Kempe’s article and continue to this day. Given persistent concerns about child maltreatment as a public health issue, and the ongoing debate about the utility and potential harm of current child protection practices, the current study aimed to understand the perspectives of child welfare professionals on what, if anything, has changed in the past 50 years of child welfare research and practice.

Methods: This study used a cross-sectional, integrated mixed-methods survey design. Participants (n=52) were interdisciplinary professionals in the field of child maltreatment with at least 20 years of experience in the field. Participants were recruited using convenience and snowball sampling. The survey consisted of several six-point Likert scale questions asking participants’ agreement with a series of statements on improvements in the field of child maltreatment (e.g., “We know better how to prevent the physical abuse of children.”). Finally, open-ended questions asked participants about their perceptions of progress made in the field, barriers and facilitators to that progress, missed opportunities, and possible areas for improvement. Finally, participants were given space to include any additional thoughts. Descriptive statistics were used to characterize participant demographics and responses to questions. Qualitative data were analyzed using an iterative thematic analysis approach with multiple coders.

Results: Participants noted progress over the past 50 years regarding recognition of ACEs, PCEs, and the development of evidence-based treatment and prevention programs. Qualitative responses indicated that professionals acknowledge improvements in processes such as diagnostics, trauma-informed approaches to care, evidenced-based practices, and inter-professional collaboration. Participants also noted increased societal recognition of child maltreatment. Despite these advances, participants reported a lack of progress in improving focus on prevention efforts, particularly secondary prevention. Responses did not indicate perceptions of achieving demonstrable change in rates of well-being for children and families.

Conclusions and Implications: At the half-century mark, this study shares reflections from long-time professionals on what progress has been made. While there are perceived advances in the recognition of abuse and neglect, there remains unacceptable rates of child abuse and a general lack of confidence that sufficient supports are available at a population level to adequately support families and reduce the risks of child maltreatment. The field of child maltreatment must increase focus on measuring demonstrable progress in improving the wellbeing of children and families, including increased understanding of effective prevention at both the individual and societal level.