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Lifetime Prevalence of Investigating Child Maltreatment Among US Children
Abstract
Objectives:
To estimate the lifetime prevalence of official investigations for child maltreatment among children in the United States.
Methods:
We used the National Child Abuse and Neglect Data System Child Files (2003-2014) and Census data to develop synthetic cohort life tables to estimate the cumulative prevalence of reported childhood maltreatment. We extend previous work, which explored only confirmed rates of maltreatment, and we add new estimations of maltreatment by subtype, age, and ethnicity.
Results:
We estimate that 37.4% of all children experience a child protective services investigation by age 18 years. Consistent with previous literature, we found a higher rate for African American children (53.0%) and the lowest rate for Asians/Pacific Islanders (10.2%).
Conclusions:
Child maltreatment investigations are more common than is generally recognized when viewed across the lifespan. Building on other recent work, our data suggest a critical need for increased preventative and treatment resources in the area of child maltreatment. (Am J Public Health. Published online ahead of print December 20, 2016: e1-e7. doi:10.2105/AJPH.2016.303545).
... Before reaching their 18 th birthday, an estimated one-third (37.4%) of all children in the U.S. are reported for suspected maltreatment, one in ten (11.8%-12.5%) experience confirmed maltreatment and one in twenty (5.9%) spend time in foster care (Kim et al., 2017(Kim et al., , 2020Kim & Drake, 2019;. Maltreatment reporting most commonly occurs during infancy and early childhood, which are widely recognized as periods of heightened vulnerability to neglect, injury and death (Putnam-Hornstein, 2011). ...
... Distributions of poverty, maltreatment and CWS-involvement follow similar geographic patterns and reveal racial disproportionality (Roberts, 2021). Whereas one third (37.4%) of the total child population are reported to the CWS for suspected maltreatment by age 18, over half (53.0%) of all Black children in the U.S. child population are reported cumulatively (Kim et al., 2017). Once socioeconomic factors are controlled for, however, White children are found to be at higher risk of maltreatment than Black children (Kim & Drake, 2018). ...
... Cumulatively, it is estimated that over one-third (37.4%) of the U.S. child population will be reported for suspected maltreatment by the age of 18 (Kim et al., 2017), between 11.8 -12.5% will have their alleged maltreatment substantiated (Kim et al., 2017;, and an estimated 5.9% of children will be placed in foster care before their 18 th birthday . While the probability of having a screened-in allegation of abuse or neglect reported once before age 12 is estimated to be 32.4%, the likelihood of having additional screened-in reports drops to 13.7% for 2 reports, 7.6% for 3 reports, 4.5% for 4 reports and only 2.8% for 5 reports, nationally (Kim & Drake, 2019). ...
In response to recent federal legislation, the child welfare system assumed primary responsibility for responding to commercial sexual exploitation (CSE) of children. CSEC complicates the notion of child maltreatment because, unlike other forms of maltreatment, it can simultaneously involve the behavior of abusers and constrained action by the child, often requiring distinct safety planning and service provision. Further, this form of abuse is uniquely embedded within the economy. Historically, much of the available research on the subject approached youth involvement in the sex trade as a form of delinquent behavior, rather than an experience of maltreatment. Emergent contemporary research on CSE indicates that early experiences of sexual abuse and child welfare system-involvement are strongly associated with subsequent CSE risk and victimization. Administrative child welfare data can be leveraged to fill some of the existing empirical gaps, and efforts have been made to document associations between CSE victimization and system involvement. However, much of this research focuses exclusively on youth already being served by the CWS. The relationships between child welfare interventions, case characteristics and subsequent CSE remain largely unexamined. This dissertation is based on a unique dataset constructed using administrative child protective service records and American Community Survey data. The final dataset captures 13,193 children with documented concerns of commercial sexual exploitation (CSE) identified by California’s child welfare system between 2015 and 2020 and includes maltreatment allegation information on 3,205 de-duplicated reports of suspected CSE submitted to child protective services (CPS) in Los Angeles County, California between 2017 and 2021. Three analyses were conducted to address the following unanswered questions: (1) Do child characteristics and CWS involvement histories of children with identified CSE concerns differ from CWS trajectories of similar children? (2) Are there identifiable subgroups of young people facing CSE risk and/or victimization that have distinct patterns of prior CWS involvement? (3) Is CSE reporting associated with neighborhood-level concentrated disadvantage in Los Angeles County, California? To answer these questions, three distinct analyses were conducted. One relied on a case-control comparison of child welfare trajectories prior to the identification of CSE risk or victimization. The second used latent class analysis to identify subgroups of children with known CSE risk or victimization based on their CWS involvement. The third analysis used geo mapping and logistic regression to describe allegations of CSE in a Los Angeles County and test for an association between CSE reporting and neighborhood-level concentrated disadvantage. Findings indicate that among all youth with identified CSE risk or victimization experiences, nearly all had been reported to the CWS at least
2
one month prior to the first identified CSE concern, yet less than half (43.4%) had prior cases and under one-third (32.1%) had previously been in out-of-home care. CWS trajectories leading up to CSE identification did not differ significantly by CSE confirmation; however, racial disproportionality was observed in the identification of confirmed CSE victimization. Specifically, Black children were at higher estimated odds of having victimization documented relative to Hispanic youth. After controlling for child and initial CPS report characteristics, the CWS intervened later in childhood for youth that went on to have CSE risk or victimization identified in their case records. Those with identified victimization spent less of their overall lifetime in CWS-supervised cases, but experienced more placement moves and had more entries into medical, psychiatric and/or correctional facilities. Across Los Angeles County, the estimated odds of exploitation being reported to CPS were positively associated with neighborhood concentrated disadvantage. To date, this study represents the most rigorous population-level analysis of child welfare involvement prior to CSEC, and has several key implications for practice and policy. Results show that a majority of children had a history of CSW involvement but were no longer under CWS jurisdiction at the time CSE was identified. This exposes an ongoing need for CSEC-specialized interventions that explicitly include family participation. In addition, CWS decisions not to investigate, intervene or continue providing formal services and supervision appear to have long-term consequences related to CSE victimization, and may indicate that that families’ underlying needs went unmet during their initial contact with the CWS. Findings from this analysis identify racial disproportionality in CSE identification within a statewide predominantly non-White child population, and expose a need to test for differences in CSE screening and investigative practices by first responders within different cultural contexts. Finally, this analysis documents a relationship between neighborhood-level concentrated disadvantage and CSEC, and in doing so draws attention to child and family-level resource scarcity as drivers of CSEC. Youth and parent social and economic motivators have been largely absent from discourse on CSE in child welfare scholarship, but this analysis suggests that addressing social, material and economic resource scarcity may optimize CSEC prevention efforts.
... Around the country, child protection agencies manage about 2 million maltreatment reports each year. Though there is a substantial body of research that identifies risk factors for involvement with the child protection system (Aron et al., 2010;Drake & Pandey, 1996;Kim et al., 2017;Putnam-Hornstein et al., 2011, 2021Schneiderman et al., 2021), less research has been done that takes what is known about contact with the child protection system and views it through a simulation lens. This is a potentially important gap in the literature. ...
... Department of Health and Human Services, Administration for Children and Families, Administration for Children, Youth, and Families, Children's Bureau, 2023). At the child level, lifetime rates of contact with the child protection system may reach as high as 40 % but are even higher for children of color (Edwards et al., 2021;Kim et al., 2017). ...
Simulation models are an important tool used in health care and other disciplines to support operational research and decision-making. In the child protection literature, simulation models are an under-utilized source of research evidence.
In this paper, we describe the rationale for and the development of an agent-based simulation of a child protection system in the US. Using the investigation, prevention service, and placement histories of 600,000 children served in an urban child welfare system, we walk the reader through the development of a prototype known as OSPEDALE.
The governing equations built into OSPEDALE probabilistically simulate the onset of investigations. Then, drawing from empirical survival distributions, the governing equations trace the probability of subsequent interactions with the system (recurrence of maltreatment, service referrals, and placement) conditional on the characteristics of children, their assessed risk level, and prior child protection system involvement.
As an initial test of OSPEDALE’s utility, we compare empirical admission counts with counts generated from OSPEDALE. Though the verification step is admittedly simple, the comparison shows that OSPEDALE replicates the empirical count of new admissions closely enough to justify further investment in OSPEDALE.
Conclusions: Management of public child protection systems is increasingly research evidence-dependent. The emphasis on research evidence as a decision-support tool has elevated evidence acquired through randomized clinical trials. Though important, the evidence from clinical trials represents only one type of research evidence. Properly specified, simulation models are another source of evidence with real-world relevance.
... Decades of research have documented that Black children constitute a disproportionate share of children involved with the U.S. child protective services (CPS) system. Recent state and national research found that about half (46-53%) of all Black children are investigated by CPS by age 18, compared with 22-28% of White children and 28-32% of Hispanic children (Kim et al., 2017;Putnam-Hornstein et al., 2021), resulting in a national Black-White disparity ratio (DR) of approximately 1.89. A DR value above one indicates that Black children are overrepresented in reports relative to White children while a DR value equal to 1 would indicate that rates between Black and White children are equal. ...
In the U.S., Black children are overrepresented in Child Protective Services (CPS) reports relative to their share of the population. Although a large body of research has described and delineated possible causes of this disparity, the potential role of racial residential segregation is understudied. Racial residential segregation imposes vastly unequal built and social environments on Black children, including higher rates of poverty and crime and fewer amenities. These under-resourced environments may contribute to disproportionate exposure to maltreatment and related social adversity, to differences in CPS reporting decisions by professionals and community members, and to differences in CPS screening and decision-making. Using data on 584 large counties from the 2019 National Child Abuse and Neglect Data System (NCANDS), this exploratory study examines how county-level racial residential segregation is associated with CPS report and substantiation rates for Black and White children and with the Black-White disparity in CPS report and substantiation rates. Measures of county segregation — dissimilarity and isolation indices — were calculated from the American Community Survey and U.S. Census data. We found that the Black-White CPS report disparity ratio was largest in the most segregated counties. Yet, both Black and White CPS report rates were lower in the most segregated counties compared to counties with low to moderate segregation. The law enforcement–initiated CPS report rate for Black children was especially high in moderately segregated counties compared with both high- and low-segregation counties. Segregation was not associated with CPS substantiation disparities. The highest-disparity counties did not have above-average reporting rates for Black children. Together, these findings suggest that community characteristics may contribute differently to the absolute rates of CPS reports for Black children and the extent of the Black-White disparity within these rates. Racial residential segregation is an important consideration for future research, policy, and program development focused on reducing racial disparities in, and levels of, CPS contact.
... Child maltreatment is an act of commission or omission on the part of a caregiver that results in harm or risk for harm toward an individual under the age of 18 years, including acts of physical abuse, sexual abuse, psychological abuse, and neglect. 1 Approximately 12.5% to 37.4% of all children in the United States are exposed to maltreatment before age 18 years. [2][3][4] Exposure to maltreatment is not only associated with greater risks for a number of adverse pediatric outcomes 5,6 but also lifelong economic, societal, and health care costs estimated at $2 trillion dollars. 7 Child behavior problems, including noncompliance with directives, depressed mood, hyperactivity, worry, and delinquency, are early transdiagnostic indicators of adverse health, 8,9 and are among the most common complaints in pediatric settings. ...
OBJECTIVES
Establish the longitudinal cross-lagged associations between maltreatment exposure and child behavior problems to promote screening and the type and timing of interventions needed.
METHODS
The Longitudinal Studies of Child Abuse and Neglect, a multiwave prospective cohort study of maltreatment exposure, enrolled children and caregivers (N = 1354) at approximately age 4 and followed them throughout childhood and adolescence. Families completed 7 waves of data collection with each wave occurring 2 years apart. Maltreatment was confirmed using official case records obtained from Child Protective Services. Six-month frequencies of behavior problems were assessed via caregiver-report. Two random-intercept, cross-lagged panel models tested the directional relations between maltreatment exposure and externalizing and internalizing behaviors.
RESULTS
Maltreatment exposure predicted increases in externalizing behaviors at ages 8 (b = 1.06; 95% confidence interval [CI] 0.14–1.98), 12 (b = 1.09; 95% CI 0.08–2.09), and 16 (b = 1.67; 95% CI 0.30–3.05) as well as internalizing behaviors at ages 6 (b = 0.66; 95% CI 0.03–1.29), 12 (b = 1.25; 95% CI 0.33–2.17), and 14 (b = 1.92; 95% CI 0.76–2.91). Increases in externalizing behaviors predicted maltreatment exposure at age 12 (odds ratio 1.02; 95% CI 1.00–1.05).
CONCLUSIONS
Maltreatment exposure is robustly associated with subsequent child behavior problems, strengthening inferences about the directionality of these relations. Early screening of externalizing behaviors in pediatric settings can identify children likely to benefit from intervention to reduce such behaviors as well as prevent maltreatment exposure at entry to adolescence.
... Given the racial disparities within child protective services and the particularly detrimental impact on Black families (Edwards et al., 2023;Boyd, 2014;Gourdine, 2019;Kim et al., 2017), there has been great debate about the best way to address the disproportionately detrimental aspects of child protective services with calls to both abolish and reform the current system (Barth et al., 2021). To address racial disparities within the system, calls for the abolition of child protection services and for those services to be replaced with community-based support focused on the overall well-being of families. ...
It is widely known that those in the helping professions are mandated to report suspected incidences of child maltreatment. However, few are aware of the historical resistance to mandated reporting that helping professionals demonstrated before the passing of the Child Abuse Prevention and Treatment Act (CAPTA) of 1974 and the associated federal mandates that compelled helping professionals to engage in mandated reporting, oftentimes against their will. By analysing historical policy documents through a grounded theory approach, the authors identified three themes that describe the rationale for the passage of CAPTA: (1) identifying national evidence of child abuse; (2) resistance to intrusion of the helping professional-client relationship; and (3) the necessity of immunity waivers for those who reported instances of child abuse and misdemeanor punishment for those who failed to report such instances. In light of conversations around abolishing or reforming child protective services, it is important to understand how the first federal child protective services policy in the United States originated and how these regulations embedded social control into the foundation of the helping professional-client relationship, thus turning helping professionals into unwilling agents of the state. Implications of mandated reporting, including introducing a penal aspect to the helping professional-client relationship, are also explored.
... Approximately, 1 in every 10 children in America is referred to CPS each year (CRM, 2021). Current estimates suggest that 37% of American children are investigated by CPS before their 18th birthday, and this increases to 53% for African-American children (Font and Maguire-Jack, 2020;Kim et al., 2017). In 2021, nearly 7.2 million children appeared in roughly 4 million referrals which were received by CPS. 7 For a systems overview, see Fig. 1. ...
Domestic violence is a commonplace and serious societal problem with vast public health and economic consequences. Childhood exposure to domestic violence can blight children’s biological and social development. Often, local police departments are first responders to domestic violence. This is because danger is associated with these events, which requires police presence. Yet, children are often unseen victims of domestic violence. In general, law enforcement agencies (i) are ill-equipped to identify the risks experienced by children; (ii) struggle to find alternative outcomes for children at risk other than removal or criminalization; (iii) do not use scientifically informed assessment tools which might improve their interactions with children; and (iv) inconsistently share data with other agencies in a timely manner. Moreover, gaps in criminal legal, child welfare, and family court responses to violence in the family create circumstances where children may fall through the cracks. Positive interventions in relation to domestic violence and children who suffer as a result of it should be viewed as a public priority. Improving responses to these issues should be reframed as (i) a way to reduce the amount of future violent crimes committed, and (ii) reduce the resource burden felt by public services. This commentary discusses the scope and scale of children’s exposure to domestic violence and child maltreatment and discusses international best practices that can serve as models to improve law enforcement’s response to children.
... The results can be subject to ecological fallacy and do not provide specific insights into the degree to which the study population overlaps with the individuals interacting with the child welfare system. Third, it is essential to note that while NCANDS is the most reliable federally sponsored annual administrative dataset for child welfare, it is understood that due to underreporting, the numbers in this dataset reflect a conservative estimate of the true incidence of child abuse and neglect (Kim et al., 2017). ...
Background: Growing research points to economic policies as protective mechanisms for vulnerable families. Research on pediatric abusive head trauma suggests that paid family leave (PFL) may protect infants in the general population from physical abuse.
Objective: To examine the association of state-level paid family leave policies with infant (ages 0-1) maltreatment rates. Participants and setting: A state-level panel dataset was constructed from the National Child Abuse and Neglect Data System (2002-2019) data on infant maltreatment investigations among four states with PFL (California, New Jersey, New York, and Rhode Island) and 36 states without PFL.
Methods: A piecewise longitudinal model and a nested model comparison were conducted to estimate the treatment effect of PFL on the population rate of infant maltreatment investigations. Supplementary analyses examined the moderating effect of three covariates.
Result: PFL reduced the linear rate of change in infant maltreatment rates in the states where it was enacted by a factor of 0.979 for each year post-policy implementation compared to states without such policies, B =-0.021, SE = 0.008, 95 % CI = [− 0.036,-0.005]. Examining treatment states only, the slope of infant maltreatment became significantly shallower post-policy implementation , χ 2 (1) = 3.178, p = .075. Interactions testing the moderating effects of family poverty and adults with less than high school education were significant, B =-0.304, 95 % CI = [− 0.564,-0.052]; B =-0.511, 95 % CI = [− 0.799,-0.249], respectively.
Conclusion: Results suggest that PFL has a beneficial effect on infant maltreatment rates and add to growing evidence that policies aimed to support household economic stability could be a vital child maltreatment prevention policy tool.
... It should be noted that the disparity between essentiality and frequency performed may not always represent cause for concern. For example, reporting suspected child abuse and/or neglect was deemed essential by 97.56% of participants, though reported as a frequent task by only 40.60%-a difference potentially explained by mandated reporting requirements (essential) and overall estimated prevalence of child abuse and neglect (frequency) (Kim et al., 2017). However, other tasks performed infrequently may be cause for concern. ...
As the need for school social work (SSW) practitioners increases, more research may be useful to understand how roles and practices are shaped and how this differs from their perceptions of essential practice. To understand the roles and functions of SSW, a survey of nine critical components was developed through an evaluation of national association’s standards that offer guidance for SSW practice. Survey respondents (N = 318) consisted mostly of SSW practitioners (85%), evaluated nine critical components: advocacy, building capacity, home-school liaison, multi-tier system of support, navigating school settings, professional values, service delivery, social work theory, use of data and evidence, and suggested the addition of new essential components. The results focus on which practices are deemed essential and the frequency of performing these tasks. We conclude with implications of practice essentiality and frequency discussed across the nine critical component domains, offering suggestions for future research, education, training, and professional development of SSW practitioners.
... For example, Black youth were forcibly separated from their families as a purposeful feature of slavery in order to eradicate family bonds (Roberts, 2022). Today, children are separated from their homes and families through the foster system's bloated stream of maltreatment reports; in fact, more than one third of children (37.4%) across the United States are subjected to state-run investigations, and more than half of those involve Black children (53%; Kim et al., 2017). Indigenous youth were forcibly taken from their home communities and families and sent to boarding schools whose mission was to assimilate them into modern American subjects devoid of their Indigenous cultural ways of being (Grinnell Davis et al., 2022). ...
... Contextually, it is important to recognize that CPS is most likely an involuntary and unwelcome intrusion into family life (Merritt, 2020). Recent research has estimated that before the age of 18, approximately 37% of children will experience a CPS investigation, a statistic that rises to a 53% likelihood for African American children (Kim, Wildeman, Jonson-Reid, & Drake, 2017). The sheer number of children and families who will be investigated by CPS makes it imperative to understand the impacts and consequences of this government inquiry into family life. ...
Families impacted by the child welfare system can find themselves overwhelmed and lost in agency-driven service planning, with fragmented support and changing needs. This qualitative study explored the role of parent advocates in supporting families during the period between the initial and follow-up child safety conferences. Three domains of support emerged: service-related, concrete, and moral. The findings suggest that these vital supports, delivered by parent advocates to families, not only helped them navigate the system but also enabled them to feel supported, guided, and equipped with the necessary tools to overcome barriers and gain access to needed resources.
... Studies have found that investigations triggered from mandatory reporting disproportionately target low-income families, particularly Black and Native families (Roberts 2022b;Kim et al. 2017). Today, half of Black children, as well as half of Native American children, experience a CPS investigation before they turn 18 (Putnam-Hornstein et al. 2021). ...
Mandatory reporting laws require the reporting to a designated government agency of a known or suspected case of abuse or neglect of children, elders, or other dependent adults. While these laws vary, researchers can be mandated to report suspected cases of abuse or neglect under a wide range of circumstances. This paper argues that a survivor-centered and trauma-informed research praxis calls for (1) actively challenging biased or uncritical reporting and the myth of a neutral researcher/mandated reporter, (2) working to minimize avoidable reporting, (3) moving from mandatory reporting to supporting, and (4) using harm reduction strategies to center survivors at all stages. Ultimately, a survivor-centered approach to mandatory reporting in research means valuing the consent and agency of those who will live with the life-altering consequences of researcher-made reports.
... Early life stress (ELS) is alarmingly prevalent (1,2). Nearly 40% of children have a Child Protective Services investigation prior to age 18 (3) and over 13% of children have confirmed maltreatment (4). These cases reflect more severe forms of ELS such as abuse or neglect; far more children experience moderate levels of ELS, such as bullying, experiencing financial strain, or moving. ...
... Childhood maltreatment (CM), which includes sexual abuse, physical/emotional abuse, and neglect, is widespread and can have negative health consequences. Approximately one in three people reported experiencing maltreatment during their childhood (Hanlon et al., 2020;Kim et al., 2017;Scher et al., 2004). CM experiences are strong risk factors for psychiatric illnesses, such as mood and anxiety disorders (Kessler et al., 2010), and they can negatively affect the course of illness or treatment outcome of depression (Nanni et al., 2012). ...
Childhood maltreatment (CM) causes early deviations in cognitive and affective processes, leading to future adaptation failures and psychopathology. Specifically, CM has been linked to cognitive distortions, and recent studies have focused on the impact of CM on the higher level of metacognitive beliefs. However, only a few studies have revealed the neural mechanisms underlying the association between altered metacognition and CM. Therefore, this functional magnetic resonance imaging (fMRI) study investigated the neural correlates of thought–action fusion (TAF) tendency and CM experiences. Overall, 40 young and healthy adults (21 men) participated in this study and underwent fMRI during the TAF task as well as psychological evaluation for CM, TAF tendency, anxiety, and depressive symptoms. During the TAF task, they were asked to read negative (Neg) or neutral (Neu) statements about neutral or close people (CP). Notably, significant activations were found in regions such as the bilateral anterior insula, dorsal anterior cingulate cortex (dACC), caudate, thalamus, medial prefrontal cortex, precuneus, and right amygdala in the NegCp > NeuCP contrast. Furthermore, anterior insula and dACC activities were significantly correlated with total scores of CM experiences and TAF. Exaggerated TAF tendency in persons with CM experiences was associated with increased response of the anterior insula and dACC, which are two core hubs of the salience network. Our results therefore seem to suggest insights for a better understanding of the neural mechanisms underlying metacognitive beliefs related to CM experiences.
... According to Wittchen, the severity of depression extends to being "by far the most burdensome disorder of all diseases in the EU". There are several studies that have suggested that by the end of the year 2026, the development and prevalence of depression will have escalated to the second position [1]. ...
The exploration of childhood trauma and its profound impact on the mental health of teenagers has garnered increasing attention in contemporary research. This study delves into the incidences of childhood trauma and investigates its association with the prevalence of depression and post-traumatic stress disorder (PTSD) in adolescents. Childhood trauma, encompassing experiences such as abuse, neglect, or witnessing domestic violence, can imprint lasting psychological effects, particularly during the vulnerable teenage years. In a very literal sense, childhood trauma refers to highly distressing and adverse experiences that occur during an individual’s formative years, typically before the age of 18. These experiences can have profound and lasting effects on a person’s physical, emotional, and psychological well-being. Childhood trauma can have far-reaching consequences, influencing various aspects of a person’s life, including their mental health, relationships, and overall well-being. This research study involves a comprehensive examination of the prevalence of different types of childhood trauma within the teenage population, utilizing validated assessment tools and surveys. The study aims to enlist the correlation between specific traumatic experiences and the manifestation of depression and PTSD symptoms. Through this exploration, the research seeks to contribute to the growing body of knowledge surrounding the intricate interplay between adverse childhood experiences and mental health outcomes during adolescence.
... Approximately one-third of all children and over half of Black children in the United States experience a Child Protective Services investigation for maltreatment (ie, physical, sexual, or emotional abuse or neglect) before the age of 18 years [1]. In 2020, a total of 631,832 youth were served by foster care (ie, out-of-home placement organized by child welfare services) [2], with Black and Indigenous youth having the highest risk of placement [3]. ...
Background
Between 2016 and 2020, over 600,000 youth were served annually by the foster care system. Despite approximately half of foster youth struggling with emotional or behavioral challenges, few receive much-needed services to address their mental health concerns. Family-based interventions are efficacious in addressing both youth and caregiver mental health needs; however, foster youth participation in these family-based interventions is limited by many barriers, including out-of-home placement far from their family of origin. Telehealth is a promising tool for mitigating barriers to access to treatment interventions for foster youth and their families.
Objective
This study aims to understand child welfare system professionals’ perspectives on enabling factors and barriers to providing family-based interventions via telehealth to youth in out-of-county foster care placement.
Methods
This qualitative study derived themes from 3 semistructured focus groups with child welfare system professionals. Participants were asked to discuss how family-based interventions are delivered to foster youth and their caregivers in their jurisdictions, as well as to share their thoughts about how to use telehealth to improve access to family-based interventions for families with youth in out-of-home placement. Data were analyzed using constant comparative analysis and inductive thematic analysis, with the Behavioral Model for Vulnerable Populations as the theoretical framework.
Results
Participants were 19 child welfare system professionals (eg, social workers, residential treatment staff, and supervisors) who participated in 1 of the 3 focus groups (6-7/group). Most participants were women (n=13, 68%), White individuals (n=10, 53%), and social workers (n=8, 42%). On average, participants worked in the child welfare system for 16.6 (SD 8.3) years. Participants identified multilevel factors impacting family-based intervention delivery including environmental factors (eg, Medicare billing and presumptive transfer), predisposing characteristics (eg, psychological resources), enabling factors (eg, transportation and team-based youth-centered care), and need factors (eg, motivation to engage). Participants expressed optimism that telehealth could increase access to needed mental health care, diverse providers, and longevity of care while also expressing some concerns regarding telehealth access and literacy.
Conclusions
Child welfare system professionals highlight the need to develop policies and telehealth interventions that are youth versus placement centered, include resources that limit barriers and bolster motivation for engagement, and follow a team-based care model. Findings from this study inform how telehealth can be used to increase access to and engagement with family-based interventions for youth in out-of-home placements and their caregivers of origin.
... Child maltreatment is a significant societal problem impacting many children, as indicated by official and self-reports (Jud et al., 2016). Before the age of 18, roughly a third of children in the United States will be the subject of a child abuse investigation (Kim et al., 2017), one in 8 will be determined to have experienced maltreatment and one in 17 will be placed in out of home care due to maltreatment . Child maltreatment can have serious consequences and its impact has been found to be as serious as other significant health concerns that affect children's well-being . ...
Background: Mandated reporting policies, a core response to the identification of child maltreatment, are widely debated. Currently, there are calls to abolish or scale back these policies to include only certain professionals. These calls warrant evaluation of whether there are any differences in child welfare outcomes based on report source. Objective: To determine if the initial report source predicts immediate and long-term risk of re-referral, substantiation, and placement. Participants and setting: We used yearly National Child Abuse and Neglect Data System (NCANDS) hotline report and placement data. Children (0-14y) with a first ever hotline report in 2012-2014 were followed for three years. The final sample included 2,101,397 children from 32 states. Methods: We use descriptive and bivariate statistics to show initial report outcomes by reporter source type and logistic regression models to evaluate the effect of report source on immediate and subsequent report outcomes. Results: Professional sources varied in levels of substantiation and placement, with law enforcement , medical, and social service sources showing much higher rates. Reports from professional sources have higher odds of initial report substantiation and foster care entry, and slightly lower odds of later re-report than nonprofessional sources. We found no differences between professional and nonprofessional sources in subsequent foster care entry. Conclusions: Reports from professional, nonprofessional, and unclassified sources have varying levels of risk in some of their short-and long-term outcomes. To the degree that child protective services embrace a long-term preventative role, reports by nonprofessional report sources may provide opportunities for prevention.
... The FFCWS consists of a purposive 3:1 oversample of urban, largely unmarried mothers, yielding a disproportionately Black, Hispanic, and low-income sample (Princeton University, n.d.). Evangelist et al. cited prior analyses of the cumulative risks of CPS reports among all U.S. children (Kim et al., 2017). The Kim et al. study (Wildeman & Emanuel, 2014). ...
... Relatedly, residence in a racially and ethnically diverse neighborhood increased the risk for CPS contact, i.e. reports, for White, Hispanic, and Black families (Klein & Merritt, 2014). The elevated risk for initial child welfare contact is presumably due, in part, to structural racism and racial biases (Dreyer, 2020;Kim et al., 2017) resulting in more non-white families with high levels of structural risk (Feely & Bosk, 2021) and a greater propensity for non-white families to be reported. Taken together, the extant evidence indicates that race/ethnicity likely interacts with poverty to impact reporting decisions (Kim & Drake, 2018) and may impact decisionmaking processes in child welfare system (Dettlaff et al., 2011;Fong, 2020;Merritt, 2021). ...
Economic support programs for low-income families may play an important role in preventing child abuse and neglect. In the United States, childcare subsidies are provided to low-income families who meet certain requirements to offset the high cost of childcare. States have flexibility in setting many policies related to the provision of childcare subsidies, which results in a great deal of variation in how the programs operate between states. One policy dimension on which states vary is the number of employment hours required to receive childcare subsidies. A small body of work has begun to investigate the ways in which these state policy variations might relate to child maltreatment. Using 11 years of administrative data from the United States, the current study sought to estimate the relationship between two sources of variation in childcare subsidy policies: employment requirements and copayment size; and child neglect, physical abuse, and emotional abuse substantiations. The study found a nuanced relationship between required employment and neglect substantiations. Specifically, requiring some level of work was not associated with neglect substantiations, but requiring 30 hours of employment was associated with higher rates. The study did not find a relationship between copayment size and maltreatment substantiations.
... [17][18][19] Their carceral logics pervade medicine through the excessive restraining of Black children, drug testing of Black mothers, and reporting of Black families to child welfare. [20][21][22] Abolition, a term originally applied to the movement to end slavery and more recently to the movement to vanquish the prison industrial complex, represents an emerging movement in medicine. It reimagines the work of medicine as an anti-racist practice by abolishing practices reinforcing biological race, desegregating the medical profession, demanding reparations for communities devastated by forced medical experimentation, and insisting on longitudinal anti-racism training rooted in the history of racism in medicine. ...
Introduction
Understanding the legacy of slavery in the United States is crucial for engaging in anti-racism that challenges racial health inequities' root causes. However, few medical educational curricula exist to guide this process. We created a workshop illustrating key historical themes pertaining to this legacy and grounded in critical race theory.
Methods
During a preclinical psychiatry block, a second-year medical school class, divided into three groups of 50–60, attended the workshop, which comprised a 90-minute lecture, 30-minute break, and 60-minute small-group debriefing. Afterwards, participants completed an evaluation assessing self-reported knowledge, attitudes and beliefs, and satisfaction with the workshop.
Results
One hundred eighty students watched the lecture, 15 attended small-group debriefings, and 132 completed the survey. Seventy-six percent (100) reported receiving no, very little, or some prior exposure to the legacy of slavery in American medicine and psychiatry. Over 80% agreed or strongly agreed that the workshop made them more aware of this legacy and that the artwork, photographs, storytelling, and media (videos) facilitated learning. Qualitative feedback highlighted how the workshop improved students' knowledge about the legacy of slavery's presence in medicine and psychiatry. However, students criticized the lecture's scripted approach and requested more discussion, dialogue, interaction, and connection of this history to anti-racist action they could engage in now.
Discussion
Though this workshop improved awareness of the legacy of slavery, students criticized its structure and approach. When teaching this legacy, medical schools should consider expanding content, ensuring opportunities for discussion in safe spaces, and connecting it to immediate anti-racist action.
... The intersection of early childbearing and the child protective services (CPS) system Youth involved in the child protective services (CPS) system are a large, policy-relevant, sub-population of those at risk of early pregnancy. Thirty-seven percent of all U.S. children, including more than 50 % of Black children, encounter the CPS system prior to age 18 (Kim et al., 2017). In terms of high engagement with the system, 6 % of U.S. children and 12 % of Black U.S. children, experience at least one foster care placement as a child (Wildeman & Emanuel, 2014). ...
Understanding service disposition pathways is critical to provide deeper insight into why certain subgroups of the population are at risk for recurrent Child Protective Services (CPS) involvement and may highlight disparities across groups or geographic areas. Using the Decision-Making Ecology Framework as a lens, the present study examines whether service disposition pathways are influenced by risk assessment, safety concerns, child age, maltreatment type, previous CPS involvement, and/or county-level structural vulnerability. We linked administrative data from New Mexico’s Department of Children, Youth and Families (DCYF) to data from the American Community Survey. Multilevel models examining associations between case ( N = 12,960) and county ( N = 33) characteristics revealed that both case (age, maltreatment type, risk/safety assessments, previous CPS involvement) and county-level factors (transportation and housing) were associated with service disposition. Additionally, we observed considerable variation at the county level in both the provision of services and the relationship between risk assessment and service provision. By linking different factors of the decision-making process in child welfare cases to intervention strategies, the analysis reveals that the perception of risk can vary based on geographical context resulting in different outcomes for families who have similar risks but different county-level vulnerabilities.
Researchers have shown how punitive state contact shapes the lives of poor Black individuals but have paid less attention to the role of punitive state contact in the lives of the Black middle-class. Drawing on in-depth interviews with 29 middle-class Black mothers recently investigated by Child Protective Services (CPS)—a punitive state institution with the ability to remove children from their homes—this article asks how Black mothers who are not poor assess risk of future CPS contact and navigate the threats it poses. Armed with greater resources than poor mothers, middle-class Black mothers work to evade future CPS contact through institutional shuffling—a resource-intensive evasion strategy that involves shuffling children out of certain types of institutions and into others. I find that middle-class Black mothers shuffle their children out of formal institutions and into informal ones, out of predominantly white institutions and into predominantly Black ones, and out of institutions where they have weak ties and into institutions where they have strong ties. While shuffling may shield mothers and children from future CPS contact, it may also shrink mothers’ networks, isolate children from a broad array of institutional resources, and inadvertently expose middle-class Black families to greater surveillance and punishment.
Purpose
The current study focused on exploring the impact of maltreatment of child laborers on their psychosocial health condition from the views of their parents.
Methods
A total of 100 parents of child laborers were recruited using snowball sampling. The structured questionnaire comprised two validated scales including ISPCAN Child Abuse Screening Tool (ICAST-P), and Paediatric Symptom Checklist (PSC) were used for the survey. Factor analysis and multivariable linear regression analysis were performed to examine the data using SPSS version 26, and Stata version 16.1.
Results
A three-factor model consisting of internalizing, externalizing, and attention associated psycho-social impairments of child laborers were derived from the 35-item scale of PSC tool and represented a good fit to the data. A mean estimate of maltreatment indicates that a majority of child laborers are maltreated psychologically, followed by physical maltreatment and neglect. The factor analysis resulted that maltreated child laborers are highly prone to exhibit internalized psycho-social difficulties, followed by externalized and attention-associated emotional and behavioral difficulties among child laborers. The regression model further depicts that child laborers, who had been physically and psychologically maltreated, are significantly more likely to be affected by internalized and attention-related psycho-social impairments.
Conclusions
The study concluded that victimized child laborers exhibited significant internalized, as well as attention-related problems. These findings may be useful for future studies that examine emotional and behavioral problems among maltreated child laborers and, therefore, for developing prevention strategies.
We develop empirical tools for studying discrimination in multiphase systems and apply them to the setting of foster care placement by child protective services. Leveraging the quasi-random assignment of two sets of decision-makers—initial hotline call screeners and subsequent investigators—we study how unwarranted racial disparities arise and propagate through this system. Using a sample of over 200,000 maltreatment allegations, we find that calls involving Black children are 55% more likely to result in foster care placement than calls involving white children with the same potential for future maltreatment in the home. Call screeners account for up to 19% of this unwarranted disparity, with the remainder due to investigators. Unwarranted disparity is concentrated in cases with potential for future maltreatment, suggesting that white children may be harmed by “underplacement” in high-risk situations.
Issues
Although maternal substance use is a known risk factor for child maltreatment, evidence on the scale of substance use is needed to inform prevention responses. This systematic review synthesised prevalence estimates of maternal substance use during pregnancy and early life among children at risk of maltreatment. Ovid, Pubmed, CINAHL, PsychInfo and ProQuest databases were searched. We included observational studies that sampled children at risk of maltreatment in high‐income countries and reported information on maternal substance use during pregnancy and/or the child's first year of life. We extracted study characteristics and data to calculate prevalence, assessed risk of bias and conducted a narrative synthesis; there were insufficient comparable populations or outcomes to quantitatively synthesise results.
Key Findings
Thirty five of 14,084 titles were included. Fifteen studies had adequately sized and representative samples to estimate prevalence. Maternal substance use prevalence ranged from 2.4% to 40.6%. Maternal substance use was highest among infants referred to child protection at birth (40.6%) and children in out‐of‐home care (10.4% to 37.2%). Prevalence was higher when studies defined substance use more broadly and when maternal substance use was ascertained from both child and mother records.
Implications
Supportive, coordinated responses to maternal substance use are needed from health and child protection services, spanning alcohol and other drug treatment, antenatal and postnatal care.
Conclusions
Prenatal and early life maternal substance use is common among child maltreatment populations, particularly among younger children and those with more serious maltreatment.
I estimate whether the ability to anonymously surrender an infant to a safe haven site such as a hospital, police station, or fire station in the United States affects child well‐being. By analyzing variation in state safe haven policies, I find safe haven laws significantly increase infant foster care entrance. I further find suggestive evidence of safe havens reducing infant deaths. The mortality effects are immediate but subside over time, implying infants have been relinquished when their alternative was not death from abuse or abandonment. Robustness checks and falsification tests support these findings.
Health-care professionals face multiple challenges treating patients in crisis in the outpatient setting. Primary care clinicians may not be comfortable assessing and addressing social and mental health crises in clinic. This chapter serves as an overview of mental health and social crises that clinicians are likely to encounter while in clinic and provides strategies on how these may be addressed through preparation, identification, intervention, and post-event debriefing.
Parents with serious mental health (MH) and substance use disorders (SUD) can face profound challenges caring for their children. MH/SUD treatment can improve outcomes for both parents and their children. This study evaluated whether parents with Medicaid with MH/SUD conditions whose children had child protective services (CPS) involvement were receiving MH/SUD treatment and whether receipt differed by race. We analyzed the 2020 Child and Caregiver Outcomes Using Linked Data (CCOULD) which contains Medicaid and child welfare records from Kentucky and Florida on 58,551 CPS-involved caregivers. Among caregivers with an MH diagnosis, White individuals were more likely than Black individuals to have received counseling (42% vs. 20%) or an MH medication (69% vs. 52%). Among caregivers with an SUD, White individuals were more likely than Black individuals to have received counseling (43% vs. 20%) or an SUD medication (43% vs. 11%). More effort is needed to connect parents with CPS involvement to MH/SUD treatment, particularly Black parents.
This paper conducts a scoping review to identify studies which
use the framework of intersectionality to understand the overrepresentation
of Black women, children, and families within the
child welfare system. A comprehensive review of electronic
databases was conducted as of June 2021. Of the 4,663 records
identified, ten peer-reviewed journal articles met criteria for
inclusion within the study across the disciplines of social work,
law, public health, and criminal justice. Additional empirical,
peer-reviewed journal articles are needed to understand the
overrepresentation of Black women, children, and families
within the child welfare system using the framework of
intersectionality.
Importance
Public benefit programs, including state spending on local, state, and federal-state partnership programs, have consistently been associated with overall reductions in child protective services (CPS) involvement. Inequities in eligibility and access to benefit programs may contribute to varying associations by race and ethnicity.
Objective
To determine whether associations between state spending on benefit programs and rates of CPS investigations differ by race and ethnicity.
Design, Setting, and Participants
This cross-sectional ecological study used repeated state-level measures of child maltreatment from the National Child Abuse and Neglect Data System and population estimates from the US Census Bureau for all Black, Hispanic, and White children. All 50 US states from October 1, 2009, through September 30, 2019 (fiscal years 2010-2019), were included. Data were collected and analyzed from May 13, 2022, to March 2, 2023.
Exposures
Annual state spending on benefit programs per person living below the federal poverty limit, total and by the following subcategories: (1) cash, housing, and in-kind; (2) housing infrastructure; (3) child care assistance; (4) refundable earned income tax credit; and (5) medical assistance programs.
Main Outcomes and Measures
Race- and ethnicity-specific rates of CPS investigations. Generalized estimating equations, with repeated measures of states, an interaction between race and spending, and estimated incidence rate ratios (IRRs) and 95% CIs for incremental changes in spending of US $1000 per person living below the federal poverty limit were calculated after adjustment for federal spending, race- and ethnicity-specific child poverty rate, and year.
Results
A total of 493 state-year observations were included in the analysis. The association between total spending and CPS investigations differed significantly by race and ethnicity: there was an inverse association between total state spending and CPS investigations for White children (IRR, 0.94 [95% CI, 0.91-0.98]) but not for Black children (IRR, 0.98 [95% CI, 0.94-1.02]) or Hispanic children (IRR, 0.99 [95% CI, 0.95-1.03]) ( P = .02 for interaction). Likewise, inverse associations were present for only White children with respect to all subcategories of state spending and differed significantly from Black and Hispanic children for all subcategories except the refundable earned income tax credit (eg, IRR for medical assistance programs for White children, 0.89 [95% CI, 0.82-0.96]; P = .005 for race and spending interaction term).
Conclusions and Relevance
These results raise concerns that benefit programs may add relative advantages for White children compared with Black and Hispanic children and contribute to racial and ethnic disparities in CPS investigations. States’ eligibility criteria and distribution practices should be examined to promote equitable effects on adverse child outcomes.
Adverse childhood experiences, such as abuse and neglect, have been shown to have longstanding negative consequences on a child’s development and outcomes. Studies have noted that there is variation in how youth in child welfare respond to adversity, yet few studies have examined the psychometrics of measures of resilience in this population. In particular, the 14-item Resilience Scale (RS-14) is a widely used instrument yet has not been evaluated for use with adolescents in child welfare populations. The purpose of the study was to describe the levels of resilience reported by adolescent girls involved in the child welfare system and to evaluate the reliability, validity, and factor structure of this scale in this population. Participants were 249 adolescent girls, ages 12–19, who were involved in the child welfare system. Interviews assessed resilience, symptoms of post-traumatic stress, depression, social problem-solving, and demographic variables. Results indicated that levels of resilience among the participants were in the moderate range. The RS-14 demonstrated evidence of good internal consistency and test–retest reliability. Convergent and discriminant validity were established. Confirmatory factor analysis testing a single-factor solution resulted in a weak model fit. A follow-up exploratory factor analysis supported a two-factor solution. Findings suggest this instrument is an appropriate tool for use in child welfare populations.
The framework of reproductive justice recognizes the right to parent one’s children in a healthy and safe environment. Children have a right to be raised by their families and to enjoy profound connections with their network of kin. In some situations, the state steps in and terminates these relations (Ross & Solinger, 2017). Terminations of parental rights were generally rare until the late 1990s. In fiscal year 1990, 12 percent of children in foster care had experienced termination of parental rights (TPR), a statistic that had remained relatively stable in the preceding decade (Robinson, 1995). These numbers rose throughout the 1990s, and in 1997, the year federal legislation passed, the number was recorded at 37,000 (White Stack, 2005), or 7 percent of children in foster care (second author’s calculation using foster care caseload data from Roehrkasse, 2021). The most recent data available (2021) record 65,000 children with full TPR in foster care, or 17 percent of children in foster care (U.S. Children’s Bureau, 2022). These changes have a complex history.
Although the US child welfare system professes to protect and provide for children’s well-being, the reality is that the system is often detrimental to the nation’s most vulnerable children and families. Children under the purview of governmental child welfare agencies manifest some of the worst health outcomes among the US pediatric population. This chapter functions as a case study for the various failures of the US government to uphold its obligations to protect children’s health and well-being, particularly for children from the nation’s most historically oppressed and under-resourced populations, first examining the systemic inequities based on poverty level and race, then discussing the poor health outcomes of children within the system, and finally, exploring the ways in which a rights-based framework, aligned with international law, can help achieve the highest standard of attainable health for children involved with the US child welfare system.
The child welfare system is plagued with an overrepresentation of families and children of color who experience longer and more significant system involvement than their White counterparts. A fundamental goal of implementation science is to integrate research and practice experience to improve the outcomes of those being served. Equitable implementation occurs when equity frameworks are integrated into the strategies of the overall effort. Moving equity into action requires attention to who is involved in deciding what to measure and how to measure it. In such an environment, implementation is anchored by stakeholders, community members, their culture, values, history, and desired outcomes rather than from a singular agency leadership perspective. Equity-anchored implementation requires a participatory approach that includes qualitative and quantitative methods designed to drive continuous quality improvement cycles targeting equity goals and strategies. Th ese cycles promote mutual consultations among community and agency stakeholders to ensure that diverse lived experiences, different forms of knowledge, and different ways of knowing are integrated into planning and strategies. Through this approach, community stakeholders and agency staff partner with organizational leadership to develop and enhance the capacity to assess and use data for equity-based decision-making through modeling, instruction, and coaching. Successful capacity building includes attention to all types of capacity (psychological, behavioral, and structural) at all levels (individual, organization, and community). Th is chapter targets the key considerations, opportunities, and strategies to address racial equity and diversity by applying fundamental tenets of implementation science to child welfare through equity-anchored implementation frameworks.
Maltreatment survivors may be at risk for parenting challenges, although the previous literature is inconsistent, has focused on individual maltreatment forms, and has overlooked posttraumatic stress symptoms (PTSS) and other trauma exposure. The current study, thus, aimed to expand this research in four key ways by (a) examining all five maltreatment forms; (b) controlling for other nonmaltreatment trauma exposure to better isolate the role of maltreatment; (c) investigating maltreatment types and PTSS simultaneously; and (d) exploring novel parenting factors, specifically four types of parenting beliefs and developmental knowledge. Trauma‐exposed parents ( N = 301; M age = 26.49 years, SD = 8.34, range: 18–69 years; 66.8% female; 59.8% White) participated in the study. A path analytic model indicated that, surprisingly, none of the maltreatment types nor cumulative trauma exposure corresponded with parental beliefs related to one's child, self, partner, or social relationships. PTSS, however, were tied to all four parenting belief types as well as developmental knowledge, βs = −.05—.40. Physical and emotional abuse were linked to less accurate developmental knowledge, β = .02, and maladaptive parenting practices, β = .03. Sexual abuse, neglect, and witnessing domestic violence were not associated with any of the parenting factors. Thus, current trauma symptoms are likely a more critical intervention focus than maltreatment experiences, although physical and emotional abuse may also play a role in parenting knowledge and behaviors. These findings also signal the importance of including all five maltreatment forms and PTSS when conducting research on the interaction between trauma and parenting.
Importance
Child maltreatment is a risk factor for poor health throughout the life course. Existing estimates of the proportion of the US population maltreated during childhood are based on retrospective self-reports. Records of officially confirmed maltreatment have been used to produce annual rather than cumulative counts of maltreated individuals.Objective
To estimate the proportion of US children with a report of maltreatment (abuse or neglect) that was indicated or substantiated by Child Protective Services (referred to as confirmed maltreatment) by 18 years of age.Design, Setting, and Participants
The National Child Abuse and Neglect Data System (NCANDS) Child File includes information on all US children with a confirmed report of maltreatment, totaling 5 689 900 children (2004-2011). We developed synthetic cohort life tables to estimate the cumulative prevalence of confirmed childhood maltreatment by 18 years of age.Main Outcomes and Measures
The cumulative prevalence of confirmed child maltreatment by race/ethnicity, sex, and year.Results
At 2011 rates, 12.5% (95% CI, 12.5%-12.6%) of US children will experience a confirmed case of maltreatment by 18 years of age. Girls have a higher cumulative prevalence (13.0% [95% CI, 12.9%-13.0%]) than boys (12.0% [12.0%-12.1%]). Black (20.9% [95% CI, 20.8%-21.1%]), Native American (14.5% [14.2%-14.9%]), and Hispanic (13.0% [12.9%-13.1%]) children have higher prevalences than white (10.7% [10.6%-10.8%]) or Asian/Pacific Islander (3.8% [3.7%-3.8%]) children. The risk for maltreatment is highest in the first few years of life; 2.1% (95% CI, 2.1%-2.1%) of children have confirmed maltreatment by 1 year of age, and 5.8% (5.8%-5.9%), by 5 years of age. Estimates from 2011 were consistent with those from 2004 through 2010.Conclusions and Relevance
Annual rates of confirmed child maltreatment dramatically understate the cumulative number of children confirmed to be maltreated during childhood. Our findings indicate that maltreatment will be confirmed for 1 in 8 US children by 18 years of age, far greater than the 1 in 100 children whose maltreatment is confirmed annually. For black children, the cumulative prevalence is 1 in 5; for Native American children, 1 in 7.
Background
The effectiveness of paraprofessional home-visitations on improving the circumstances of disadvantaged families is unclear. The purpose of this paper is to systematically review the effectiveness of paraprofessional home-visiting programs on developmental and health outcomes of young children from disadvantaged families.
Methods
A comprehensive search of electronic databases (e.g., CINAHL PLUS, Cochrane, EMBASE, MEDLINE) from 1990 through May 2012 was supplemented by reference lists to search for relevant studies. Through the use of reliable tools, studies were assessed in duplicate. English language studies of paraprofessional home-visiting programs assessing specific outcomes for children (0-6 years) from disadvantaged families were eligible for inclusion in the review. Data extraction included the characteristics of the participants, intervention, outcomes and quality of the studies.
Results
Studies that scored 13 or greater out of a total of 15 on the validity tool (n = 21) are the focus of this review. All studies are randomized controlled trials and most were conducted in the United States. Significant improvements to the development and health of young children as a result of a home-visiting program are noted for particular groups. These include: (a) prevention of child abuse in some cases, particularly when the intervention is initiated prenatally; (b) developmental benefits in relation to cognition and problem behaviours, and less consistently with language skills; and (c) reduced incidence of low birth weights and health problems in older children, and increased incidence of appropriate weight gain in early childhood. However, overall home-visiting programs are limited in improving the lives of socially high-risk children who live in disadvantaged families.
Conclusions
Home visitation by paraprofessionals is an intervention that holds promise for socially high-risk families with young children. Initiating the intervention prenatally and increasing the number of visits improves development and health outcomes for particular groups of children. Future studies should consider what dose of the intervention is most beneficial and address retention issues.
To present new estimates of the average lifetime costs per child maltreatment victim and aggregate lifetime costs for all new child maltreatment cases incurred in 2008 using an incidence-based approach.
This study used the best available secondary data to develop cost per case estimates. For each cost category, the paper used attributable costs whenever possible. For those categories that attributable cost data were not available, costs were estimated as the product of incremental effect of child maltreatment on a specific outcome multiplied by the estimated cost associated with that outcome. The estimate of the aggregate lifetime cost of child maltreatment in 2008 was obtained by multiplying per-victim lifetime cost estimates by the estimated cases of new child maltreatment in 2008.
The estimated average lifetime cost per victim of nonfatal child maltreatment is $210,012 in 2010 dollars, including $32,648 in childhood health care costs; $10,530 in adult medical costs; $144,360 in productivity losses; $7,728 in child welfare costs; $6,747 in criminal justice costs; and $7,999 in special education costs. The estimated average lifetime cost per death is $1,272,900, including $14,100 in medical costs and $1,258,800 in productivity losses. The total lifetime economic burden resulting from new cases of fatal and nonfatal child maltreatment in the United States in 2008 is approximately $124 billion. In sensitivity analysis, the total burden is estimated to be as large as $585 billion.
Compared with other health problems, the burden of child maltreatment is substantial, indicating the importance of prevention efforts to address the high prevalence of child maltreatment.
Childhood maltreatment represents a significant risk factor for psychopathology. Recent research has begun to examine both the functional and structural neurobiological correlates of adverse care-giving experiences, including maltreatment, and how these might impact on a child’s psychological and emotional development. The relationship between such experiences and risk for psychopathology has been shown to vary as a function of genetic factors. In this review we begin by providing a brief overview of neuroendocrine findings, which indicate an association between maltreatment and atypical development of the hypothalamic–pituitary–adrenal axis stress response, which may predispose to psychiatric vulnerability in adulthood. We then selectively review the magnetic resonance imaging (MRI) studies that have investigated possible structural and functional brain differences in children and adults who have experienced childhood maltreatment. Differences in the corpus callosum identified by structural MRI have now been reliably reported in children who have experienced abuse, while differences in the hippocampus have been reported in adults with childhood histories of maltreatment. In addition, there is preliminary evidence from functional MRI studies of adults who have experienced childhood maltreatment of amygdala hyperactivity and atypical activation of frontal regions. These functional differences can be partly understood in the context of the information biases observed in event-related potential and behavioral studies of physically abused children. Finally we consider research that has indicated that the effect of environmental adversity may be moderated by genotype, reviewing pertinent studies pointing to gene by environment interactions. We conclude by exploring the extent to which the growing evidence base in relation to neurobiological and genetic research may be relevant to clinical practice and intervention.
This article presents a population-based study of early childhood injury mortality following a nonfatal allegation of maltreatment. Findings are based on a unique data set constructed by establishing child-level linkages between vital birth records, administrative child protective services records, and vital death records. These linked data reflect over 4.3 million children born in California between 1999 and 2006 and provide a longitudinal record of maltreatment allegations and death. Of interest was whether children reported for nonfatal maltreatment subsequently faced a heightened risk of unintentional and intentional injury mortality during the first 5 years of life. Findings indicate that after adjusting for risk factors at birth, children with a prior allegation of maltreatment died from intentional injuries at a rate that was 5.9 times greater than unreported children (95% CI [4.39, 7.81]) and died from unintentional injuries at twice the rate of unreported children (95% CI [1.71, 2.36]). A prior allegation to CPS proved to be the strongest independent risk factor for injury mortality before the age of five.
Cases of child abuse and neglect that involve black children are reported to and substantiated by public child welfare agencies at a rate approximately twice that of cases that involve white children. A range of studies have been performed to assess the degree to which this racial disproportionality is attributable to racial bias in physicians, nurses, and other professionals mandated to report suspected child victimization. The prevailing current explanation posits that the presence of bias among reporters and within the child welfare system has led to the current large overrepresentation of black children. A competing explanation is that overrepresentation of black children is mainly the consequence of increased exposure to risk factors such as poverty.
We tested the competing models by using data drawn from national child welfare and public health sources. We compared racial disproportionality ratios on rates of victimization from official child welfare organizations to rates of key public health outcomes not subject to the same potential biases (eg, general infant mortality).
We found that racial differences in victimization rate data from the official child welfare system are consistent with known differences for other child outcomes. We also found evidence supporting the presence of cultural protective factors for Hispanic children, termed the "Hispanic paradox."
Although our findings do not preclude the possibility of racial bias, these findings suggest that racial bias in reporting and in the child welfare system are not large-scale drivers of racial disproportionality. Our data suggest that reduction of black/white racial disproportionality in the child welfare system can best be achieved by a public health approach to reducing underlying risk factors that affect black families.
Using the National Longitudinal Study of Adolescent Health (Add Health), we estimate the determinants and direction of change in individual racial identification among multiracial and monoracial adolescents as they transition to young adulthood. We find that while many multiracials subsequently identify as monoracials, sizable numbers of monoracials also subsequently become multiracials. Native American-whites appear to have the least stable identification. We find strong support that socioeconomic status, gender, and physical appearance shape the direction of change for multiracials, and that black biracials are especially compelled to identify as monoracial blacks.
The prevention of child maltreatment necessitates a public health approach. In the U.S. Triple P System Population Trial, 18 counties were randomly assigned to either dissemination of the Triple P-Positive Parenting Program system or to the services-as-usual control condition. Dissemination involved Triple P professional training for the existing workforce (over 600 service providers), as well as universal media and communication strategies. Large effect sizes were found for three independently derived population indicators: substantiated child maltreatment, child out-of-home placements, and child maltreatment injuries. This study is the first to randomize geographical areas and show preventive impact on child maltreatment at a population level using evidence-based parenting interventions.
Data from the National Survey of Child and Adolescent Well-being, a national probability study of children and families investigated for child maltreatment, were analyzed to answer the question: Do substantiated and unsubstantiated cases differ in rates of recidivism over 36 months? Recidivism was classified as (a) any re-reports, (b) substantiated re-reports and (c) subsequent foster care placements. Bivariate (survivor functions estimated by the Kaplan-Meier method) and multivariate (Cox regression modeling) analyses were conducted. The results revealed that risk of recidivism was similar regardless of substantiation status of the index investigation. We suggest that the substantiation label be removed from field use. Instead, we suggest that agencies record service needs in the families they serve, and also record whether or not the family meets criteria for referral to the family court. These would be far more practical and meaningful ways to measure child welfare services.
To determine whether child physical maltreatment early in life has long-term effects on psychological, behavioral, and academic problems independent of other characteristics associated with maltreatment.
Prospective longitudinal study with data collected annually from 1987 through 1999.
Randomly selected, community-based samples of 585 children from the ongoing Child Development Project were recruited the summer before children entered kindergarten in 3 geographic sites. Seventy-nine percent continued to participate in grade 11. The initial in-home interviews revealed that 69 children (11.8%) had experienced physical maltreatment prior to kindergarten matriculation.
Adolescent assessment of school grades, standardized test scores, absences, suspensions, aggression, anxiety/depression, other psychological problems, drug use, trouble with police, pregnancy, running away, gang membership, and educational aspirations.
Adolescents maltreated early in life were absent from school more than 1.5 as many days, were less likely to anticipate attending college compared with nonmaltreated adolescents, and had levels of aggression, anxiety/depression, dissociation, posttraumatic stress disorder symptoms, social problems, thought problems, and social withdrawal that were on average more than three quarters of an SD higher than those of their nonmaltreated counterparts. The findings held after controlling for family and child characteristics correlated with maltreatment.
Early physical maltreatment predicts adolescent psychological and behavioral problems, beyond the effects of other factors associated with maltreatment. Undetected early physical maltreatment in community populations represents a major problem worthy of prevention.
Childhood maltreatment has been linked to a variety of changes in brain structure and function and stress-responsive neurobiological systems. Epidemiological studies have documented the impact of childhood maltreatment on health and emotional well-being.
After a brief review of the neurobiology of childhood trauma, we use the Adverse Childhood Experiences (ACE) Study as an epidemiological "case example" of the convergence between epidemiologic and neurobiological evidence of the effects of childhood trauma. The ACE Study included 17,337 adult HMO members and assessed 8 adverse childhood experiences (ACEs) including abuse, witnessing domestic violence, and serious household dysfunction. We used the number of ACEs (ACE score) as a measure of cumulative childhood stress and hypothesized a "dose-response" relationship of the ACE score to 18 selected outcomes and to the total number of these outcomes (comorbidity).
Based upon logistic regression analysis, the risk of every outcome in the affective, somatic, substance abuse, memory, sexual,and aggression-related domains increased in a graded fashion as the ACE score increased (P <0.001). The mean number of comorbid outcomes tripled across the range of the ACE score.
The graded relationship of the ACE score to 18 different outcomes in multiple domains theoretically parallels the cumulative exposure of the developing brain to the stress response with resulting impairment in multiple brain structures and functions.
The purpose of this study was to estimate the prevalence of child maltreatment in the United States and examine its relationship to sociodemographic factors and major adolescent health risks.
The National Longitudinal Study of Adolescent Health is a prospective cohort study following a national sample of adolescents into adulthood. The wave III interview, completed by 15 197 young adults in 2001-2002 (77.4% response rate), included retrospective measures of child maltreatment. We used these measures to estimate the prevalence of self-reported supervision neglect, physical neglect, physical assault, and contact sexual abuse during childhood. Next, we investigated the relationship between sociodemographic characteristics and maltreatment. Finally, we examined the association between child maltreatment and adolescent self-rated health; overweight status; depression; cigarette, alcohol, marijuana, and inhalant use; and violent behavior.
Having been left home alone as a child, indicating possible supervision neglect, was most prevalent (reported by 41.5% of respondents), followed by physical assault (28.4%), physical neglect (11.8%), and contact sexual abuse (4.5%). Each sociodemographic characteristic was associated with > or = 1 type of maltreatment, and race/ethnicity was associated with all 4. Each type of maltreatment was associated with no fewer than 8 of the 10 adolescent health risks examined.
Self-reported childhood maltreatment was common. The likelihood of maltreatment varied across many sociodemographic characteristics. Each type of maltreatment was associated with multiple adolescent health risks.
A previous article published several years ago (Prinz et al. Prevention Science, 10, 1–12, 2009) described the main results of a place-randomized-design study focused on the prevention of child-maltreatment-related outcomes at a population level through the implementation of a multilevel system of parenting and family support (the Triple P—Positive Parenting Program). The current report, prepared at the encouragement of the journal, provides additional details about procedures, measures, and design-related decisions, presents an additional analysis of the main outcome variables, and poses questions about the study and its implications. We also offer guidance about how the field can move forward to build on this line of research. From the outset, the three designated primary child maltreatment outcomes were county-wide rates for substantiated child maltreatment cases, out-of-home placements, and hospital-treated child maltreatment injuries, derived from independent data sources available through administrative archival records. Baseline equivalence between the two intervention conditions was reaffirmed. The additional analysis, which made use of a 5-year baseline (replacing a 1-year baseline) and ANCOVA, yielded large effect sizes for all three outcomes that converged with those from the original analyses. Overall, the study underscored the potential for community-wide parenting and family support to produce population-level preventive impact on child maltreatment. Issues addressed included (1) the need for replication of population-oriented maltreatment prevention strategies like the one tested in this randomized experiment, (2) the need to demonstrate that a parenting-based population approach to maltreatment prevention can also impact children’s adjustment apart from child abuse, and (3) the role of implementation science for achieving greater population reach and maintenance over time.
It is important to estimate the burden of and trends for violence, crime, and abuse in the lives of children.
To provide health care professionals, policy makers, and parents with current estimates of exposure to violence, crime, and abuse across childhood and at different developmental stages.
The National Survey of Children's Exposure to Violence (NatSCEV) includes a representative sample of US telephone numbers from August 28, 2013, to April 30, 2014. Via telephone interviews, information was obtained on 4000 children 0 to 17 years old, with information about exposure to violence, crime, and abuse provided by youth 10 to 17 years old and by caregivers for children 0 to 9 years old.
Exposure to violence, crime, and abuse using the Juvenile Victimization Questionnaire.
In total, 37.3% of youth experienced a physical assault in the study year, and 9.3% of youth experienced an assault-related injury. Two percent of girls experienced sexual assault or sexual abuse in the study year, while the rate was 4.6% for girls 14 to 17 years old. Overall, 15.2% of children and youth experienced maltreatment by a caregiver, including 5.0% who experienced physical abuse. In total, 5.8% witnessed an assault between parents. Only 2 significant rate changes could be detected compared with the last survey in 2011, namely, declines in past-year exposure to dating violence and lifetime exposure to household theft.
Children and youth are exposed to violence, abuse, and crime in varied and extensive ways, which justifies continued monitoring and prevention efforts.
This article constitutes a 20-year update to a previous publication (Pelton, 1994), which showed that there is overwhelming evidence that poverty and low income are strongly related to child abuse and neglect. Subsequent evidence shows that the relationship continues to be strong. In addition, there is further evidence since the 1994 publication that this relation is not substantially due to class bias. Yet it is suggested that class bias does exist within the system. There is also further evidence that decreases in child maltreatment follow increases in material supports, and that job loss bears a complex relationship to child maltreatment. Findings pertaining to racial bias within the child welfare system continue to be mixed, but leave no doubt that racial disproportionalities within the system are overwhelmingly related to racial disproportionalities in the poverty population. There is continuing evidence that children placed in foster care are predominantly from impoverished families, and that changes in the level of material supports are related to risk of placement. It is suggested that the fact that there are nearly one million children in out-of-home placement (foster care and child-welfare involved adoption, combined) is indicative of the continuing dysfunction of the child welfare system, and that the differential response paradigm has not altered this dysfunction. A proposal for a fundamental restructuring of the child welfare system is recommended and restated here. Prospects for such change are briefly discussed. Also, to reduce poverty, a previously proposed universal social dividend and taxation system is briefly discussed and recommended.
The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology . Anda R.F., Felitti V.J., Bremner J.D., Walker J.D., Whitfield C., Perry B.D., Dube S.R. & Giles W.H. ( 2005 ) European Archives of Psychiatry and Clinical Neuroscience , ePub, posted online 29 November 2005 .
Background Childhood maltreatment has been linked to a variety of changes in brain structure and function and stress–responsive neurobiological systems. Epidemiological studies have documented the impact of childhood maltreatment on health and emotional well-being.
Methods After a brief review of the neurobiology of childhood trauma, we use the Adverse Childhood Experiences (ACE) Study as an epidemiological ‘case example’ of the convergence between epidemiological and neurobiological evidence of the effects of childhood trauma. The ACE Study included 17 337 adult HMO (Health Maintenance Organization) members and assessed eight adverse childhood experiences (ACEs) including abuse, witnessing domestic violence, and serious household dysfunction. We used the number of ACEs (ACE score) as a measure of cumulative childhood stress and hypothesized a ‘dose–response’ relationship of the ACE score to 18 selected outcomes and to the total number of these outcomes (comorbidity).
Results Based upon logistic regression analysis, the risk of every outcome in the affective, somatic, substance abuse, memory, sexual, and aggression-related domains increased in a graded fashion as the ACE score increased (P < 0.001). The mean number of comorbid outcomes tripled across the range of the ACE score.
Conclusions The graded relationship of the ACE score to 18 different outcomes in multiple domains theoretically parallels the cumulative exposure of the developing brain to the stress response with resulting impairment in multiple brain structures and functions.
Residential mobility is a process that changes lives and neighborhoods. Efforts to build strong communities are unavoidably caught up with this dynamic but have insufficient understanding of its complexities. To shed light on the underlying forces of residential mobility, this study uses a unique panel survey from the Casey Foundations Making Connections initiative targeting poor neighborhoods in 10 cities. The study classified households in the 10 cities as movers, newcomers, or stayers, and it evaluated the push and pull factors related to their mobility decisions. Cluster analysis revealed discernible types based on life cycle, household economic factors, and neighborhood attachment. The study also investigated the effect of residential mobility on neighborhood composition, finding that neighborhood change was pnmanly due to differences between movers and newcomers rather than changes for stayers. Combining information on the mix of household types with the components of neighborhood change, the study suggests these neighborhoods functioned in quite different ways that are relevant to family well-being and community development.
Child maltreatment is a major social problem. This paper focuses on measuring the relationship between child maltreatment and crime using data from the National Longitudinal Study of Adolescent Health (Add Health). We focus on crime because it is one of the most costly potential outcomes of maltreatment. Our work addresses two main limitations of the existing literature on child maltreatment. First, we use a large national sample, and investigate different types of maltreatment in a unified framework. Second, we pay careful attention to controlling for possible confounders using a variety of statistical methods that make differing assumptions. The results suggest that maltreatment greatly increases the probability of engaging in crime and that the probability increases with the experience of multiple forms of maltreatment.
Substantiation rates have long been the primary variable associated with research into child protective services (CPS) early intervention. Rates of substantiation have been used to criticize the efficiency of CPS screening procedures, to suggest that mandated reporting laws are cumbersome and require revision, and to posit that large numbers of CPS assessments result in high levels of unintended negative consequences for reported families. Substantiation is commonly used in empirical research as a proxy for the appropriateness of CPS referrals. These practices are problematic for several reasons. This article argues that many or most unsubstantiated reports involve either some form of maltreatment or preventive service needs appropriate to CPS intervention, and that using substantiation as a means of gauging the validity of a CPS referral is therefore intrinsically fallacious. A harm/evidence model is presented as an aid to conceptualizing the heterogeneity of unsubstantiated reports. The validity of the model is explored through a review of relevant empirical work. The article concludes with a series of suggestions for future research.
To examine the effectiveness of the Safe Environment for Every Kid (SEEK) model of enhanced pediatric primary care to help reduce child maltreatment in a relatively low-risk population.
A total of 18 pediatric practices were assigned to intervention or control groups, and 1119 mothers of children ages 0 to 5 years were recruited to help evaluate SEEK by completing assessments initially and after 6 and 12 months. Children's medical records and Child Protective Services data were reviewed. The SEEK model included training health professionals to address targeted risk factors (eg, maternal depression), the Parent Screening Questionnaire, parent handouts, and a social worker. Maltreatment was assessed 3 ways: 1) maternal self-report, 2) children's medical records, and 3) Child Protective Services reports.
In the initial and 12-month assessments, SEEK mothers reported less Psychological Aggression than controls (initial effect size = -0.16, 95% confidence interval [95% CI] -0.27, -0.05, P = .006; 12-month effect size = -0.12, 95% CI -0.24, -0.002, P = .047). Similarly, SEEK mothers reported fewer Minor Physical Assaults than controls (initial effect size = -0.16, 95% CI -0.29, -0.03, P = .019; 12-month effect size = -0.14, 95% CI -0.28, -0.005, P = .043). There were trends in the same positive direction at 6 months, albeit not statistically significant. There were few instances of maltreatment documented in the medical records and few Child Protective Services reports.
The SEEK model was associated with reduced maternal Psychological Aggression and Minor Physical Assaults. Although such experiences may not be reported to protective services, ample evidence indicates their potential harm. SEEK offers a promising and practical enhancement of pediatric primary care.
This study presents data from the first large-scale longitudinal study to track the involvement of children reported for maltreatment in both the special education and child welfare systems. A range of state and local administrative databases were combined and cross-sector service histories were established for 7,940 children who had received Aid to Families With Dependent Children between 1993 and 1994. The authors address the following questions: (a) Is maltreatment associated with entry into special education after controlling for other factors? (b) among maltreated children, does maltreatment type or child welfare service use predict special education eligibility? and (c) what is the relationship between maltreatment type and type of educational disability? Results indicate that child maltreatment system involvement generally predates special education entry and is predictive of entry even after controlling for other factors. A range of other associations between factors such as child and maternal characteristics, services received, maltreatment type, and special education classification are detailed.
Chronic maltreatment has been associated with the poorest developmental outcomes, but its effects may depend on the age when the maltreatment began, or be confounded by co-occurring psychosocial risk factors.
We used data from the National Survey of Child and Adolescent Well-Being (NSCAW) to identify four groups of children who varied in the timing, extent, and continuity of their maltreatment from birth to 9 years. Internalizing and externalizing problems, prosocial behavior, and IQ were assessed 21 months, on average, following the most recent maltreatment report.
Children maltreated in multiple developmental periods had more externalizing and internalizing problems and lower IQ scores than children maltreated in only one developmental period. Chronically maltreated children had significantly more family risk factors than children maltreated in one developmental period and these accounted for maltreatment chronicity effects on externalizing and internalizing problems, but not IQ. The timing of maltreatment did not have a unique effect on cognitive or behavioral outcomes, although it did moderate the effect of maltreatment chronicity on prosocial behavior.
There is a need for early intervention to prevent maltreatment from emerging and to provide more mental health and substance use services to caregivers involved with child welfare services.
We assessed the self-reported experience, comfort and competence of primary care pediatricians in evaluating and managing child maltreatment (CM), in rendering opinions regarding the likelihood of CM, and in providing court testimony. We examined pediatricians' need for expert consultation when evaluating possible maltreatment.
A questionnaire was mailed to 520 randomly selected AAP members. Pediatricians were asked how frequently they evaluated and reported children for suspected maltreatment, and whether child abuse pediatricians were available to and used by them. Pediatricians were asked to rate their knowledge, comfort and competence in the management of CM. Demographic information was also gathered. Pediatricians' experience with CM, their comfort, self-reported competence, and need for expert assistance is described. Logistic regression was used to assess factors that predicted pediatricians' sense of competence while controlling for covariates found to be significant in bivariate analyses.
One hundred forty-seven questionnaires were eligible for analysis. The majority of respondents had little experience evaluating and reporting suspected CM, and was interested in having expert consultation. While pediatricians often felt competent in conducting medical exams for suspected maltreatment, they felt less competent in rendering a definitive opinion, and did not generally feel competent to testify in court. Sense of competence was particularly low for sexual abuse. Increased practice experience and more courses in CM led to increased sense of competence in some areas.
Pediatricians acknowledged many limitations to providing care to maltreated children, and expressed interest in subspecialist input.
These findings add additional support to the American Board of Pediatrics' decision to create a Child Abuse Pediatrics subspecialty. The findings also indicate a need to ensure funding for fellowship training programs in this field.
A survey of 10% of federally recognized American Indian tribes and the states in which they are located indicates national data systems receive reports of approximately 61% of data on the abuse or neglect of American Indian children, 42% by states and 19% by counties. The author recommends that American Indians develop culturally sound definitions of abuse and neglect and that the government provide the resources and assistance necessary to develop data tracking and reporting systems on the abuse and neglect of American Indian children.
The purpose of this article is to: (1) illustrate the application of life table methodology to child abuse and neglect report data and (2) demonstrate the use of indicators derived from the life tables for monitoring the risk of child maltreatment within a community.
Computerized records of child maltreatment reports from a large, urban county in Ohio are cumulated for 11 years and linked for each child. Life table methods are used to estimate the probability that children from birth to age 10 will be reported victims of maltreatment by age, race, and urban or suburban residence.
Using life tables, the estimates in the county of this study are that 33.4% of African American children and 11.8% of White children will appear in substantiated or indicated child abuse or neglect report(s) by their 10th birthday. The age-specific probability of a maltreatment report is highest in the first year of life for both groups. The probability of a child being reported for a substantiated or indicated incident of maltreatment before his or her 10th birthday is more than three times higher for city dwellers than for suburbanites in the urban county studied here.
Life table methodology is useful for creating child well-being indicators for communities. Such indicators reveal that a larger portion of the child population is affected by maltreatment reports than would be concluded from examining cross-sectional rates and can be used to identify racial or geographic disparities.
To examine whether children with substantiated maltreatment reports between 4 and 8 years of age differ from children with unsubstantiated reports on any of 10 behavioral and developmental outcomes.
Longitudinal data from 806 children and their adult caregivers collected in four US study sites were pooled and analyzed using Analysis of Variance (ANOVA) and multivariate linear regression.
There were no significant differences between the mean scores of children with unsubstantiated and substantiated maltreatment reports filed between 4 and 8 years of age for any of the 10 behavioral and developmental outcomes. In the multivariate analysis, substantiation status was not significantly associated with any of the 10 outcomes after adjusting for prior functioning, prior maltreatment status, and sociodemographic characteristics. Findings from within-site analyses were generally consistent with the pooled analyses in finding no association between substantiation status and the outcomes examined.
In this high-risk sample, the behavioral and developmental outcomes of 8-year-old children with unsubstantiated and substantiated maltreatment reports filed between ages 4 and 8 were indistinguishable. Future research should attempt to replicate these findings on probability samples that represent the full range of childhood maltreatment risk and with models that control for the impact of social services.
This article presents analyses of longitudinal data to explore whether low-income children who survived a first incident of reported maltreatment were at higher risk of later childhood death compared to a matched comparison group of low-income children without reports of maltreatment (n = 7,433). Compared to the comparison group, children in the maltreatment group had about twice the risk of death before age 18 (0.51% vs. 0.27%). Among children with mal-treatment reports, median time from the first report to subsequent death was 9 months. The majority of deaths among children who were reported for maltreatment could be categorized as preventable (accidents or recurrent maltreatment) as compared to resulting from severe health conditions.
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