Child Welfare System for Medical Providers

A working knowledge of the child welfare system may help health care professionals successfully treat children who are under the supervision of child welfare authorities, whether living at home or in foster care, group homes, or other out-of-home settings. This section provides a brief overview of how the child welfare system works and includes information for effective collaboration with child welfare teams.

How the Child Welfare System Works

The child welfare system is complex and varies in structure and operation from State to State under broad Federal regulations. Though States have the authority to customize their child protective efforts, the overarching goals of the child welfare system are the same across the country: to ensure safety, permanency, and well-being for children.

  • Safety: Children are free from harm
  • Permanency: Children have permanent homes
  • Well-being: Children are thriving physically, emotionally, educationally, and in other ways that contribute to healthy development

These goals are accomplished by the coordinated efforts of a network of public and private service providers. State and County child protective services agencies lead child welfare activities and routinely work together with community organizations to provide services to children and families. It is important to understand that no one single organization carries out all child welfare activities. Accordingly, as a health care professional treating a child in foster care, you may interact with a team of people from multiple organizations, such as mental health and substance abuse treatment providers, foster care agencies, residential treatment centers, and educational support programs. Ideally, one person---often the State or County caseworker---acts as a point person and coordinates services.

How Does Child Welfare Involvement Begin?

Child welfare involvement typically begins when a State or County child protective services agency receives a report of suspected child abuse or neglect. Reports are screened in if the information warrants an investigation and screened out if there is insufficient information or if the State's definition of child abuse or neglect is not met. Reports that are screened in are accepted for investigation. Investigations may be initiated immediately or within several days, depending on the urgency of the report and State law. During this investigative period, caseworkers may seek emergency court orders to remove children in immediate danger from their homes and place them with a relative, in a foster home, or in a shelter.

What Happens After the Child Welfare Investigation?

When the investigation is complete, the caseworker determines whether the report is "substantiated" ("founded") or "unsubstantiated" ("unfounded"). In some cases, children can remain safely at home under the frequent supervision of a caseworker while in-home protective services are provided to strengthen the family. Children who are in danger in the home setting may be removed by the Court and usually enter foster care with relatives ("kinship care") or with non-relative "resource parents" (also known as foster parents) who are selected, licensed, trained, and supervised by State or County child welfare authorities or their contract partners. Sometimes children are placed in group homes or residential treatment facilities ("congregate care"), depending on their needs. While in foster or congregate care, children attend school and receive medical care and other needed services. Their families also receive services with the aim of enhancing the parents' ability to provide appropriate care for their children. Visitation plans allow for children to visit with parents and siblings, unless visitation is prohibited by the Court. The Court reviews the progress of children in protective custody at least every 12 months, and more frequently in many jurisdictions.

What is the Goal for Children in the Child Welfare System?

Most often, the goal for children in foster or congregate care is to return home to their parents. Sometimes, this is not possible, and States and Counties are responsible for "concurrent planning." This means that the team must have an alternate plan for the child's permanent living arrangements in the event that reunification becomes unrealistic. Adoption is the most frequent alternate plan for children who cannot return home to their biological parents. Some older youth participate in independent living programs and exit foster care without being adopted.

For a more detailed description of the child welfare system and trauma guide for pediatricians, see the following resources:

Learn more about working with child welfare professionals and earn continuing education credit by completing For Health Care Professionals: Pediatric Medical Traumatic Stress (PMTS) and Working with the Child Welfare System (1.0 CEU)