handle the growing number of chronic neglect cases. They want a shift in funding toward early intervention and prevention programs. They have called for better communication between agencies that work with children, and more funding for innovative and independent community programs.
All that will come with a price tag.
In the wake of scathing federal reviews of Idaho's and Washington's state-run systems -- both states failed to meet standards and could face million-dollar penalties if they don't improve _ officials are pushing broad overhauls to programs designed to protect thousands of the region's abused and neglected children.
The theory behind child protective teams is that community experts can help guide the state's decision-making. That will be a focus of the system changes, said Uma Ahluwalia, Washington's director of child welfare.
"I think there are others in the community that need to help us," Ahluwalia said. "Child welfare cannot be there 24-7 protecting children. You wish you could. You want to be able to say that you did the very best you could with the information you had."
Idaho will focus on engaging parents to work with state programs without court intervention, as well as training social workers to conduct more thorough assessments of the risks to children.
Critics continue to view the child welfare system as reactionary and antiquated. In obvious cases of abuse, where broken bones and bruises tell the story, states can respond quickly. But the true test, they say, is whether states can intervene to prevent broken bones and broken homes.
Nationwide, child welfare systems have struggled to handle the boom in neglect cases, where harm to children may be more subtle but every bit as damaging. In Washington, the number of neglect cases rose 60 percent in the last decade to 40,000 -- more than physical and sexual abuse combined.
Those neglect cases include homes where children live with chronic maltreatment, often unsupervised, hungry and witness to violence.
"There are many cases where there have been 20 to 30 referrals for neglect and no real intervention has occurred," said Rep. Mary Lou Dickerson, D-Seattle. "By that time, the damage is done."
If the states hope to better protect their most vulnerable children, they must give social workers the authority to intervene in cases of chronic neglect, said Joan Sharp, executive director of the Washington Council for Prevention of Child Abuse and Neglect, a state policy group.
Washington's current standard requires that a child be at imminent risk of harm before social workers can remove the child. Dickerson said a new standard may be needed for neglect cases.
"A broken bone is more dramatic than years of neglect, but the research shows that chronic neglect is more damaging," Dickerson said.
Dee Wilson, a regional administrator for CPS, has urged the state to track neglect-related deaths.
"The time has never come," Wilson said. "This is one of those subjects that just doesn't seem to rise to the fore."
It is one of many issues facing the states.
In the past decade, calls to Washington's child abuse hotline grew steadily, yet the number of cases investigated by social workers dropped. In 2002, the most recent available data, state social workers investigated only 38,000 cases, the fewest number in a decade.
A state spokeswoman said the discrepancy may be because complaint screeners are doing a better job of assessing which cases truly need investigation.
To compound the problem: Across the Inland Northwest, well-respected nonprofit groups have struggled to raise money in a stagnant economy.
At the Vanessa Behan Crisis Nursery in Spokane, half of the beds sit empty. Almost daily, staff say, they must turn away young mothers fleeing desperate or violent situations and trying to find shelter for their children because they don't have enough staffers to take care of them. Similar problems can be seen in Idaho, where Children's Village in Coeur d'Alene has watched its incoming funds dwindle.
"There is a growing concern, at both a state and regional level, about our seeming inability to keep kids safe," said Mary Savage, executive director of the Vanessa Behan Crisis Nursery in Spokane. "There are no easy answers."
In a 2002 paper, a statewide network of advocacy groups urged the Washington Legislature to focus on preventive programs. Each dollar spent on home visits for parents saves $3 in cost for government assistance and criminal justice, according to the groups' estimate.
Child advocates push for support for women leaving domestic violence situations and mentoring programs for young parents.
But even with the most thorough system, advocates concede, some deaths are inevitable. The focus is on preventing as many deaths as possible, while working to improve the lives of children who live in abusive and neglectful homes day after day -- a far greater number than the relatively few deaths that make headlines.
Ultimately, despite the protective measures built into a system, the decisions come down to human judgment calls.
Which brings us back to the 18-year-old mother.
The conversation bounced around the table. A social worker said she was shocked by the girl's arrest. A nurse who taught parenting classes for young mothers said the girl was her star pupil.
But what about the lack of a father? The violent boyfriend? The involvement with marijuana?
"We're getting two very different pictures of this girl," said Dr. Alan Hendrickson, a Spokane pediatrician and longtime volunteer.
The social worker left with the team's recommendations: The boyfriend can't have unsupervised access to the child. Neither can the father.
The next case came in: A mother who admitted duct-taping her toddler into bed when he wouldn't sleep.
Sometimes, even veterans are shocked by what parents can do to their children. One by one, they review the troubled lives of the most vulnerable children.
"People want it to be simple," Hendrickson said after the meeting. "But every one is a tough decision." Benjamin Shors can be reached at (509) 459-5484 or by e-mail at firstname.lastname@example.org.