Duration in Poverty-Related Programs and Number of Child Maltreatment Reports

Poverty and Health Inequities in Children Investigated by Child Protective Services

The objective of our study was to examine the association between poverty and child health outcomes in school-age children referred to child protective services. We conducted a secondary analysis of children aged 5 to 9 years in the Second National Survey of Child and Adolescent Well-Being, a nationally representative longitudinal observational data set of children referred to protective services for maltreatment (2008-2012). We analyzed the association of poverty, defined as family income below the federal poverty level (FPL), with caregiver report of the child's overall health, primary care, and emergency department visits using Pearson's chi-squared test. Children below FPL compared with children above it had poorer overall health (29.8% vs 18.0%, P = .03). We also conducted a longitudinal multivariable logistic regression analysis and found poverty was associated with the child's poorer overall health at 36 months (odds ratios 2.78, 95% confidence interval 1.55-5.01). Future studies and interventions to improve health in this at-risk population should target poverty.

Has the relationship between community poverty and child maltreatment report rates become stronger or weaker over time?

BACKGROUND

Poverty is among the most powerful predictors of child maltreatment risk and reporting. To date, however, there have been no studies assessing the stability of this relationship over time.

OBJECTIVE

To examine whether the county-level relationship between child poverty rates and child maltreatment report (CMR) rates changed over time in the United States in 2009-2018, overall and across of child age, sex, race/ethnicity, and maltreatment type.

PARTICIPANTS AND SETTING

U.S. Counties in 2009-2018.

METHODS

Linear multilevel models estimated this relationship and its longitudinal change, while controlling for potential confounding variables.

RESULTS

We found that the county-level relationship between child poverty rates and CMR rates had intensified almost linearly from 2009 to 2018. Per one-percentage-point increase in child poverty rates, CMR rates significantly increased by 1.26 per 1000 children in 2009 and by 1.74 per 1000 children in 2018, indicating an almost 40 % increase in the poverty-CMR relationship. This increasing trend was also found within all subgroups of child age and sex. This trend was found among White and Black children, but not among Latino children. This trend was strong among neglect reports, weaker among physical abuse reports, and not found among sexual abuse reports.

CONCLUSIONS

Our findings highlight the continued, perhaps increasing importance of poverty as a predictor of CMR. To the degree that our findings can be replicated, they could be interpreted as supporting an increased emphasis on reducing child maltreatment incidents and reports through poverty amelioration efforts and the provision of material family supports.

Association of Housing Stress With Child Maltreatment: A Systematic Review

Child maltreatment is a significant public health issue in the United States. Understanding key risk factors for child maltreatment is critical to informing effective prevention. Poverty is an established risk factor for child maltreatment. However, recent research indicates that material hardship (i.e., difficulties meeting basic needs) may serve as a more direct measure of the way in which poverty affects daily life. One form of material hardship that is common among families is housing stress. Previous reviews have summarized the existing literature regarding the association of economic insecurity with child maltreatment, but no reviews have synthesized and critically evaluated the literature specific to the association of various types of housing stress with child maltreatment. We conducted a systematic search of multiple electronic databases to identify peer-reviewed studies conducted in the U.S. regarding the association of housing stress with child maltreatment. We identified 21 articles that used nine distinct measures of housing stress including homelessness or eviction, homeless or emergency shelter stays, foreclosure filing, housing instability, inadequate housing, physical housing risk, living doubled-up, housing unaffordability, and composite housing stress indicators. Overall, results from this body of literature indicate that housing stress is associated with an increased likelihood of caregiver or child self-reported maltreatment, child protective services (CPS) reports, investigated and substantiated CPS reports, out-of-home placements, and maltreatment death. Additional theory-driven research is needed to further our understanding of the contribution of specific types of housing stress to risk for specific types of maltreatment.

Neighborhood Contexts and Child Maltreatment Reports Among Families Receiving AFDC/TANF: A Longitudinal and Multilevel Study

Attention to the relationship between neighborhood context and child maltreatment is growing. However, no study exists that considers families' residential moves and neighborhood changes longitudinally. This is particularly relevant to disadvantaged families who move frequently. Our sample includes children who experienced a child maltreatment report (CMR) or an AFDC case in early childhood. We followed up these children from 1995 to 2009 through various administrative databases. We used multilevel logistic growth curve models to estimate the CMR likelihood at each age from 1 to 16. Estimates were limited to ages on AFDC/TANF to trace families' residential addresses based on AFDC/TANF payee records. Our findings highlight the importance of tracing residential neighborhoods in a longitudinal study. While doing so, we identify some possible neighborhood contextual influences. These, however, are small in contribution to overall risk and are less observable among children that are more vulnerable.

Association between Temporary Assistance for Needy Families (TANF) and child maltreatment among a cohort of fragile families

BACKGROUND

Child maltreatment disproportionately affects families experiencing poverty and structural discrimination, including African American (AA) families. The generosity of Temporary Assistance for Needy Families (TANF) may reduce child maltreatment disparities.

OBJECTIVE

Our aim is to understand TANF's impact on the mother's perpetration of child maltreatment and whether the effect differs across AA and White mothers.

PARTICIPANTS AND SETTING

Participants are 2457 primary caregiving mothers participating in waves 3 (2001-2003), 4 (2003-2006), and 5 (2007-2010) of the U.S.-based Fragile Families and Child Wellbeing birth cohort study.

METHODS

We use a difference-in-differences study design to estimate overall and race-specific effects of TANF policies on caregivers' self-report of child neglect and physical and psychological maltreatment measured by the Child-Parent Conflict Tactics Scale. State-level TANF policy exposures include the TANF-to-Poverty Ratio (TPR), maximum cash benefits, time limits, sanctions, diversion payments, and family caps.

RESULTS

A $100 increase in TANF benefits was associated with a reduction of 1.8 reported physical abuse events (Beta = -1.80, 95% CI (-3.29, -0.31)). Imposing a time limit on TANF receipt was associated with an increase of 2.3 reported physical abuse events (Beta = 2.27, 95% CI (0.04, 4.50)). No significant differences were found for AA mothers versus White mothers.

CONCLUSIONS AND RELEVANCE

Increasing TANF cash benefits should be prioritized to reduce poverty-related child maltreatment disparities. TANF time limits should be reconsidered.

Longitudinal Understanding of Child Maltreatment Report Risks

BACKGROUND

Child maltreatment reports (CMR) are both common and strongly associated with various negative outcomes.

OBJECTIVE

To examine CMR risks by child age, early childhood context, current/cumulative economic status (welfare receipt), race, and other risk factors with a longitudinal dataset.

PARTICIPANTS AND SETTING

The CAN sample included 2,111 children having a CMR ≤ age 3, suggestive of a harmful early childhood context. The AFDC sample included 1,923 children having AFDC but no CMR ≤ age 3, suggestive of early childhood protective factors despite poverty.

METHODS

We estimated the CMR likelihood at each age from 1-17 years based on various risk factors while following up children from 1995-2009.

RESULTS

During follow-up, CMR likelihoods were substantially higher for the CAN sample than for the AFDC sample. The age-CMR relationship was strongly negative for the CAN sample (OR = 0.87, 95% CI = 0.86-0.88). This relationship was weaker for the AFDC sample (OR = 0.92, 0.89-0.95) and became non-significant for children who exited welfare. Current welfare receipt remained a strong predictor of CMR likelihoods for both CAN (OR = 2.32, 1.98-2.71) and AFDC (OR = 2.08, 1.61-2.68) samples. Prior welfare receipt moderately increased CMR likelihoods among those not currently on welfare. Controlling for other risk factors, White children had the highest likelihood of CMR. Other child and parent level vulnerabilities also increased CMR risk over time.

CONCLUSIONS

This study highlights the importance of longitudinal analytic approaches and the utility of cross-sector administrative data in improving our ability to understand and predict CMRs over time.

Latent class analysis risk profiles: An effective method to predict a first re-report of maltreatment?

Recurrence of child maltreatment is a significant concern causing substantial individual, family and societal cost. Variable-based approaches to identifying targets for intervention may not reflect the reality that families may experience multiple co-occurring risks. An alternative approach was tested using baseline data from the National Survey of Child and Adolescent Well-being (NSCAW) I and II to develop Latent Class Analysis models of family risk classes using variables derived from prior studies of re-reporting. The samples were collected approximately 10 years apart offering a chance to test how the approach might be impacted by demographic or policy shifts. The association between baseline classes and later re-reports was tested using both samples. A two-class model of high versus low presence of baseline risk resulted that was strongly associated with later likelihood of re-report and results were relatively stable across the two studies. Person-centered approaches may hold promise in the early identification of families that require a more comprehensive array of supports to prevent re-reports of maltreatment.

Risk factors that predict longitudinal patterns of substantiated and unsubstantiated maltreatment reports

BACKGROUND

Substantiated and unsubstantiated reports of maltreatment are associated with similar risk of emotional and behavioral problems. However, substantiation status often determines service provision.

OBJECTIVE

We examined substantiated and unsubstantiated reports to identify patterns of recurrence over a five-year period and identified family risk factors that predicted recurrence patterns.

PARTICIPANTS AND SETTING

We studied a subsample (N = 246,021) of the National Child Abuse and Neglect Data System from 2011-2015.

METHODS

Measures included child, caregiver, and child protective services case characteristics obtained in 2011. We used latent class analysis to identify heterogeneous classes, then entered class membership as the outcome variable in a multinomial logistic regression to identify risk factors.

RESULTS

Four latent classes emerged: (1) initial unsubstantiation and moderate recurrence, (2) initial unsubstantiation and low recurrence, (3) initial substantiation and moderate recurrence, and (4) initial substantiation and low recurrence. Domestic violence (relative risk ratio (RRR) = 2.56, β = 0.94, SE = .02, p < .001), caregiver substance abuse (RRR=2.23, β=0.80, SE=.02, p < .001), and Native Hawaiian/Pacific Islander race (RRR=1.67, β=0.52, SE=.11, p < .001), predicted initial substantiation status but were not meaningful predictors of long-term recurrence. Prior substantiated report and poverty predicted initial substantiation status (report RRR=1.50, β=0.41, SE=.02, p < .001; poverty RRR=1.50, β=0.41, SE=.02, p < .001) and long-term recurrence (report RRR=2.60, β=0.96, SE=.02, p < .001; poverty RRR = 1.35, β=0.30, SE=.02, p < .001). Asian American race predicted low recurrence rates (RRR=2.09, β=0.74, SE=.12, p < .001).

CONCLUSIONS

Similar recurrence patterns between substantiated and unsubstantiated reports emphasize the importance of providing services regardless of substantiation status. Integrating administrative databases may reveal more variables that predict long-term recurrence.

Cumulative Prevalence of Onset and Recurrence of Child Maltreatment Reports

OBJECTIVE

We estimated cumulative probabilities of onset and recurrences of child maltreatment reports from birth to age 11 years. Estimates were provided overall and within subcategories of race/ethnicity, sex, and subtype.

METHOD

We developed synthetic life tables from national Child Protective Services records (2003-2016) and Census data. Although 28 states and the District of Columbia were used for estimates due to data quality, sensitivity analyses suggest that our estimates may be very similar to national estimates, with very minor underestimation.

RESULTS

The probability of having at least "X-number" of maltreatment reports by age 12 years was 32.41% for 1 report, 13.71% for 2 reports, 7.57% for 3 reports, 4.50% for reports, 2.80% for 5 reports, and 1.79% for 6 reports. Children with more prior reports were more likely to have future reports. The risk increased from 42.31% when having 1 prior report to 64.01% when having 5 prior reports. Asian/Pacific Islanders showed exceptionally lower onset and recurring rates than others. Individuals of nonwhite ethnicity (African American/black, Native American, and Hispanic) had higher onset rates than white individuals. Once initially reported, however, white persons had generally slightly higher rates of recurrence than nonwhite persons. Neglect was the most frequent subtype in both onset and recurring reports. No practical difference existed in overall onset and recurring rates by sex.

CONCLUSION

Many United States children experience reported maltreatment, and many experience repeated or chronic maltreatment. The increased risk of recurring with more prior reports suggests preventive efforts for serially reported children. The large racial disparity at the onset stage disappears at the recurring stages, suggesting interventions prior to the onset.

Factor analysis and predictive validity of the Early Risks of Physical Abuse and Neglect Scale (ERPANS): A prospective study in Dutch public youth healthcare

Early detection of child abuse risk factors in families of new-born babies is an important task of the public youth health care system in the Netherlands. The Early Risks of Physical Abuse and Neglect Scale (ERPANS) was originally developed in Belgium as an observation scale for public child healthcare nurses. The present longitudinal study is an independent prospective validation of the ERPANS in a Dutch community sample (N = 1257) of families with a new-born. Results showed a commonality of underlying subsets of items belonging to the 'Disturbed parent-child relationship' and 'Psychological problems' factors, but the factor 'Communication problems' of the original ERPANS could not be replicated. We found that parental psychological problems were a significant predictor of family problems, including involvement of child protection authorities, at an average follow-up of 22 months. Parents who reported feeling unloved by their own parents were at higher risk of reports of serious concern to child protection authorities at 22 months after birth. These findings support the utility of at least a subset of the ERPANS items as a screening tool for child abuse risk in preventive public youth health care for new-born babies. Our research adds to a growing body of evidence which points to the importance of parental mental health problems and adverse childhood experiences as precursors to child abuse risk.

Urban-Rural Residence and Child Physical Abuse Hospitalizations: A National Incidence Study

OBJECTIVE

To determine if child physical abuse hospitalization rates vary across urban-rural regions overall and after accounting for race/ethnicity and poverty demographics.

STUDY DESIGN

This was a retrospective cross-sectional study of black, Hispanic, and non-Hispanic white children <5 years of age living in all US counties. US counties were classified as central metro, fringe/small metro, and rural. Incidence rates were calculated using child physical abuse hospitalization counts from the 2012 Kids' Inpatient Database and population statistics from the 2012 American Community Survey. Counties' race/ethnicity demographics and percent of children living in poverty were used to adjust rates.

RESULTS

We identified 3082 child physical abuse hospitalizations occurring among 18.2 million children. Neither crude nor adjusted overall rates of child physical abuse hospitalizations varied significantly across the urban-rural spectrum. When stratified by race/ethnicity, crude child physical abuse hospitalization rates decreased among black children 29.1% (P = .004) and increased among white children 25.6% (P = .001) from central metro to rural counties. After adjusting for poverty, only rates among black children continued to vary significantly, decreasing 34.8% (P = .001) from central metro to rural counties. Rates were disproportionately higher among black children compared with white children and their disproportionality increased with population density, even after poverty adjustment. Rates among Hispanic children were disproportionately lower compared with white children in nearly all urban-rural categories.

CONCLUSIONS

Our results suggest that urban black children have unique exposures, outside of poverty, increasing their risk for child physical abuse hospitalization. Identifying and addressing these unique urban exposures may aid in reducing black-white disproportionalities in child physical abuse.