Nationally, more than 7.8 million children are involved in a report of child abuse or neglect each year, but 44% of those reports are screened out. Of the children involved in a report that is screened in for an investigation or assessment, fewer than 1 in 5 are substantiated. As such, hotlines are an ineffective and inefficient system for identifying children who may be unsafe or at risk of harm. They unnecessarily traumatize many families, and disproportionately traumatize communities of color.
Child protection agencies around the country are recognizing that warmlines or helplines offer a proactive option for families seeking supports and services. San Diego is one community that acknowledged the need to do things differently, launching the Family Strengthening and Prevention Initiative (FSPI) in January 2020, a partnership of the County of San Diego’s Child Welfare Services (CWS) and 2-1-1 San Diego aimed at improving families’ access to services and intake decisions, and reducing the number of unsubstantiated reports to the child welfare hotline.
Catalyst for change1
An analysis of the approximately 44,000 calls reporting suspected child abuse or neglect to the San Diego CWS hotline in fiscal year 2018-19 found about half of the reports were evaluated out (screened out) and warranted no response. The percentage of unsubstantiated calls from mandated reporters specifically was even higher — for example, 95% of children involved in screened-in allegations of maltreatment from educational mandated reporters (such as teachers) were not substantiated.2
We recognized that many of our calls were getting screened out. A lot of families still have needs, and the majority (of the calls) are related to neglect, so we asked ourselves if we could address those needs in a different way.
– Kimberly Giardina, Director, Child Welfare Services, County of San Diego
Although the families that were the subject of screened out reports did not need intervention from the child protection agency, many still had service needs. In fact, about half of those families were reported again to CWS within the next two years, usually for child neglect, but CWS was not structured to offer prevention services to families with unsubstantiated reports.
The challenge was to connect these families with resources — including employment, housing, and food — to proactively strengthen them. With the support of the County’s Child and Family Strengthening Advisory Board, CWS leadership began to explore a partnership with 2-1-1 San Diego, which already had information about more than 6,000 different types of services, including housing and utilities, health care, mental health, jobs and financial aid, food and meals, childcare, senior care, transportation, and criminal justice.
FSPI’s focus on connecting families to services before they came to the attention of CWS was in line with the agency’s emphasis on front-end prevention. The partners also hoped that steering families to the specific services they needed would reduce the duplication of services and efforts across agencies, giving child protection staff the opportunity to focus on the cases that really needed their expertise. CWS leadership hoped that implementing reviews of intake decisions also would strengthen those decisions for both families and CWS in the long run.
Operationalizing the partnership
FSPI required both CWS and 2-1-1 to train personnel for new positions. CWS developed a Review, Assess, and Direct (RAD) multidisciplinary team to review hotline reports for general neglect that meet the CWS criteria for a five- or 10-day in-person response. Team members include hotline supervisors, emergency response supervisors, social workers, public health nurses, and community partners. After reviewing the reports, the RAD team determines whether to maintain the response, initiate a quicker response, refer the report to 2-1-1, or evaluate out the report. RAD teams use a Structured Decision-Making hotline screening tool that includes information about a family’s strengths and risks in making their decisions.
San Diego 2-1-1 trained navigation specialists to work specifically with families referred by CWS or RAD teams. Navigation specialists are assigned to a specific team at 2-1-1 San Diego called 2-1-1 Connect. Once a week, the RAD teams send a list of families eligible for 2-1-1 services to the 2-1-1 Connect staff. There are two opportunities for families to connect with 2-1-1 services: the hotline can refer families directly to 2-1-1, or RAD teams can refer families reported for child neglect or with risks for neglect but with reports that have been evaluated out.
When a family is referred to 2-1-1 for services, CWS sends a letter to the family explaining that the family was reported for child abuse or neglect, but the report was evaluated out. Families are then encouraged to contact 2-1-1 services through a special phone number to learn more about the program and then decide whether to enroll. For families that do not reach out, 2-1-1 San Diego follows up with a flyer to the family with detailed information about the services they can receive by being enrolled in 2-1-1 Connect. When a family calls, the 2-1-1 navigation specialist completes a risk assessment that considers 14 areas of need to ensure the family is referred to the appropriate services. The most common needs are for income assistance, food assistance, childcare and afterschool care, and parenting classes. Navigation specialists follow up with the family once a week or as individually indicated to ensure that families have been connected to the community resources they need. Once the family has met the goals established with their navigator, the navigation specialist reassesses the family’s needs using the same assessment tool.
If a family doesn’t call 2-1-1 Connect to enroll within five days of receiving the CWS letter, then the navigation specialist calls the family. Navigation specialists are trained to encourage families to opt in to the program. While stressing that family participation is voluntary, the specialists emphasize the supportive aspects of the program.
Importance of an effective service array
The FSPI partnership between CWS and 2-1-1 began within the smallest of San Diego County’s six districts and will expand to the other districts over the next two years. The gradual rollout allows the partners to refine their approaches and processes as they experience challenges and successes. It also gives CWS an opportunity to ensure that community services have the capacity to meet families’ needs once the program begins, recognizing that it would not be helpful for families to be directed to services and then be placed on a waiting list. CWS already had a robust network of community providers with contracts in place, which made it relatively easy to expand capacity so that interested families would be able to access services in the districts where FSPI was first introduced.
One of the early challenges of the partnership was building trust between CWS staff and 2-1-1 staff. There was initial disagreement about how families should be told that they had been reported to CWS. The 2-1-1 staff worried that families would be fearful or resistant if the program was branded under CWS rather than a trusted community-based organization. This program was the first time CWS shared that a report had been made to CWS but was evaluated out. However, in the interest of transparency, everyone eventually agreed on that disclosure and decided to deploy a two-step outreach process that included an introductory letter on CWS letterhead to be followed by a 211-branded program flyer. Thus, the building of trust happened over time and with discussion and training for both the RAD teams and the 2-1-1 navigation specialists.
Another challenge has been encouraging families to actually enroll in services through 2-1-1. As of June 2020, about 17% of families referred for 2-1-1 services opted to enroll. Navigation specialists are addressing low enrollment by focusing on each family’s strengths, and emphasizing the community support that families can receive. They also assure families that individual information will not be shared with CWS and that CWS will not be involved in their care coordination as a way to reduce any stigma and fear associated with receiving services.
A final challenge has yet to be addressed: training mandated reporters and others to call 2-1-1 instead of the hotline for cases that don’t require immediate intervention (general neglect). CWS leadership hopes that training mandated reporters — including teachers, medical professionals, and law enforcement personnel — to call 2-1-1 as a prevention tool will result in helping families access needed resources and reduce calls to the hotline.
The goal of the partnership is to strengthen families by helping them access needed services before they come to the attention of CWS. Easily accessed prevention services can reduce the number of unsubstantiated hotline calls, reduce trauma for children and families, and be beneficial to both families and to CWS. Families can get the help they need in their communities without the stigma and trauma of CWS involvement. In addition, CWS intake decisions overall are strengthened by the second review that the RAD teams conduct.
A three-year formal evaluation of FSPI by an outside organization is underway. The evaluation will include interviews with families to see what services they accessed and how their experiences helped meet their needs. It also will look at data on re-referrals to CWS. CWS leadership hopes to see results that show more streamlined service access — especially for prevention services — stronger and safer families, and reduced CWS caseloads.
1 Most of this information was gleaned from two presentations from the County of San Diego’s Child Welfare Services: (1) on April 29, 2020, Kimberly Giardina, Director, and Alice Kennedy, Assistant Director, presented to the COVID Peer-to-Peer Child Welfare Leadership Forum hosted by Casey Family Programs; and (2) on June 18, 2020, Kimberly Giardina, Director, presented to staff at Casey Family Programs.
2 Based on data from the National Child Abuse and Neglect Data System (NCANDS) made available by the National Data Archive on Child Abuse and Neglect Data (NDACAN) at Cornell University.