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Tzoumakis S, Whitten T, Laurens KR, Dean K, Harris F, Carr VJ, Green MJ. Levels of Involvement with Child Protection Services Associated with Early Adolescent Police Contact as a Victim and Person of Interest. J Interpers Violence 2024; 39:2708-2732. [PMID: 38254307 PMCID: PMC11071604 DOI: 10.1177/08862605231223468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
The relationship between childhood maltreatment and subsequent offending/victimization is well established. However, the magnitude of this relationship for different levels of child protection services (CPS) involvement is poorly understood, due to measurement issues, lack of longitudinal data, and reliance on reports of substantiated maltreatment, which can underestimate the impact of maltreatment. This study examined associations between CPS involvement during childhood (ages 0 to <11 years) and police services contact (as a victim and/or a person of interest) for criminal incidents in early adolescence (11 to ~14 years), differentiated according to levels of CPS involvement (i.e., no risk of significant harm [non-ROSH], unsubstantiated ROSH, substantiated ROSH, and out-of-home care; each examined relative to no CPS contact). Data for 71,465 children were drawn from the New South Wales Child Development Study, an intergenerational, longitudinal investigation that uses administrative records from CPS and police alongside other health, justice, and education data. Multinomial regression analyses were conducted to determine associations between increasing levels of CPS involvement and police contact as a victim only, a person of interest only, and as both victim and person of interest while accounting for covariates (i.e., child's sex, Aboriginal, and/or Torres Strait Islander background, socioeconomic status, maternal age at child's birth, and parental offending history). Children exposed to any of the four levels of CPS involvement had higher odds of police contact, relative to children with no CPS involvement. Odds ratios were higher for contact with police as both a victim and a person of interest, compared to police contact as a victim or a person of interest only. These findings highlight that children with even unsubstantiated CPS reports (i.e., non-ROSH and unsubstantiated ROSH reports) are at heightened risk of police contact compared to children who are unknown to CPS, underlining the need to support all families in contact with CPS.
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Affiliation(s)
- Stacy Tzoumakis
- School of Criminology and Criminal Justice, Griffith University, Southport, QLD, Australia
- Griffith Criminology Institute, Mt Gravatt, QLD, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
| | - Tyson Whitten
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
- Centre for Law and Justice, Charles Sturt University, Port Macquarie, NSW, Australia
| | - Kristin R. Laurens
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia
| | - Kimberlie Dean
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
- Justice Health and Forensic Mental Network, Matraville, NSW, Australia
| | - Felicity Harris
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
| | - Vaughan J. Carr
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
- Department of Psychiatry, Monash University, Melbourne, VIC, Australia
| | - Melissa J. Green
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
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Nakamura Y, Nogami Y, Iwase Y, Hozawa M, Sotome T, Saitoh I, Ohuchi A, Hayasaki H. Dental caries prevalence in children during temporary protective care according to type of abuse. BMC Public Health 2024; 24:1345. [PMID: 38762490 PMCID: PMC11102624 DOI: 10.1186/s12889-024-18833-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 05/13/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND This study investigated the correlation between the prevalence of dental caries and the presence and type of abuse. METHODS Participants were 534 children admitted for care at two child guidance centers (CGCs) in Niigata, Japan. Data pertaining to abuse, including the reason for temporary protective care and the type of abuse, and the oral examination results of the children, were collected. These results were then compared with those of a national survey and analyzed in relation to the presence and type of abuse. RESULTS The odds ratio for decayed teeth was 4.1, indicating a higher risk in children admitted to the CGCs. However, no significant association was found between the presence of decayed, filled, or caries-experienced teeth and the presence of abuse. A significant positive association was observed between dental caries and one type of abuse, indicating a greater prevalence of dental caries in cases of neglect. The findings of this study suggest that the type of abuse, rather than its presence, is associated with dental caries. CONCLUSIONS Our findings suggest that proactive support should be provided to children in problematic nurturing environments, regardless of whether they have been subjected to abuse.
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Affiliation(s)
- Yuki Nakamura
- Division of Pediatric Dentistry, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkochodori, Chuo Ward, Niigata, 951-8514, Japan.
| | - Yukiko Nogami
- Division of Pediatric Dentistry, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkochodori, Chuo Ward, Niigata, 951-8514, Japan
- Department of Oral Health Sciences, Faculty of Health Care Sciences, Takarazuka University of Medical and Health Care, 6-9-38 Nakatsu, Kita Ward, Osaka, 531-0071, Japan
- Department of Pediatric Dentistry, Asahi University School of Dentistry, 1851 Hozumi, Mizuho, Gifu, 501-0296, Japan
| | - Yoko Iwase
- Department of Dentistry for the Disability and Oral Health, Asahi University School of Dentistry, 1851 Hozumi, Mizuho, Gifu, 501-0296, Japan
| | - Mio Hozawa
- Division of Pediatric Dentistry, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkochodori, Chuo Ward, Niigata, 951-8514, Japan
| | - Tetsuya Sotome
- Division of Pediatric Dentistry, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkochodori, Chuo Ward, Niigata, 951-8514, Japan
| | - Issei Saitoh
- Department of Pediatric Dentistry, Asahi University School of Dentistry, 1851 Hozumi, Mizuho, Gifu, 501-0296, Japan
| | - Akitsugu Ohuchi
- Division of Welfare, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkochodori, Chuo Ward, Niigata, 951-8514, Japan
| | - Haruaki Hayasaki
- Division of Pediatric Dentistry, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkochodori, Chuo Ward, Niigata, 951-8514, Japan
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Breeden K, Loiselle C, Hossain J, De Jong AR, Deutsch SA. Factors Impacting Maltreatment Evaluation and Reports to Child Protective Services in Pediatric Substance Exposures. Pediatr Emerg Care 2024; 40:376-381. [PMID: 38206301 DOI: 10.1097/pec.0000000000003115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
OBJECTIVES The objective of this study was to assess demographic, clinical, and psychosocial factors associated with pediatric substance exposures, describe the medical evaluation, and identify factors associated with social work (SW) and hospital-based child protection team (CPT) safety assessments and reports to child protective services (CPS). METHODS We retrospectively reviewed charts of electronic medical records for children ages 0 to 72 months presenting for accidental ingestion evaluated May 1, 2015 to May 1, 2021 at a level 1 pediatric trauma center. Cases of environmental exposures, iatrogenic medication errors, dosing errors, and allergies/adverse reactions were excluded. Data were analyzed using descriptive statistics; χ 2 and multivariable logistic regression analysis assessed factors associated with two primary outcomes of interest, SW/CPT assessment and CPS report. RESULTS Among 773 total cases of substance exposures during the studied time frame, 27% were referred to SW/CPT for further safety assessments and 15.4% were reported to CPS. Being admitted to the hospital, prescription medication or recreational/illegal/illicit substance exposures, and increasing psychosocial risk factors were found to be significantly associated with referrals. Age, race, and insurance status were not found to be associated. Toxicology screening was performed in only 24.7% of cases. Of those eligible for further imaging per hospital protocol, skeletal surveys were obtained in 5.5% of cases and head imaging was obtained in 9% of cases. CONCLUSIONS There is significant variability in pediatric substance exposure assessment practices. Disparities based on demographic characteristics are uncommon. Perceived severity of condition, exposures involving recreational/illegal/illicit substances, and greater prevalence of family psychosocial adversities are associated with higher rates of SW/CPT assessment and CPS reports.
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Affiliation(s)
- Karli Breeden
- From the Department of Pediatrics, Nemours Children's Health, Wilmington, DE and Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Claire Loiselle
- From the Department of Pediatrics, Nemours Children's Health, Wilmington, DE and Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Jobayer Hossain
- Biostatistics Core, Nemours Biomedical Research, Nemours Children's Health, Wilmington, DE
| | - Allan R De Jong
- From the Department of Pediatrics, Nemours Children's Health, Wilmington, DE and Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Stephanie Anne Deutsch
- From the Department of Pediatrics, Nemours Children's Health, Wilmington, DE and Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
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Shapiro JP, Pino EC, Goodridge A, Dholakia A, Nelson K, Hoch A, Kendi S, Boyle TP, Kistin CJ. Disparities in Child Welfare Referrals for Patients Seen in a Pediatric Emergency Department for Unintentional Ingestions. Acad Pediatr 2024; 24:686-691. [PMID: 38253175 DOI: 10.1016/j.acap.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To examine the characteristics of patients visiting the pediatric emergency department (PED) for unintentional ingestions and associations between patient race and ethnicity in referrals to Child Protective Services (CPS) for supervisory neglect. METHODS We conducted a cross-sectional analysis of children <12 years old who presented to the PED between October 2015 and December 2020 for an unintentional ingestion. Patients were identified by searching the electronic health record for diagnosis codes corresponding to unintentional ingestions. Patient demographics, ingestion type, disposition, and referrals to CPS were abstracted by manual chart review. Logistic regression models were used to evaluate associations between patient demographics and visit characteristics with referral to CPS. RESULTS We identified 129 PED encounters for unintentional ingestions that were included for analysis. Overall, 22 patients (17.1%) were referred to CPS for neglect. In the univariate analysis, both ingestion of an illicit drug and arrival to the PED by ambulance were associated with a higher odds of referral to CPS. In the multivariable model adjusted for parent language, ingestion type, and mode of arrival to the PED, Hispanic patients had higher odds of referral to CPS than White patients (adjusted odds ratio (aOR) = 17.2, 95% confidence intervals [1.8-162.3], P = .03). There was not a statistically significant association between Black race and referral to CPS. CONCLUSIONS Referrals to CPS from the PED after unintentional ingestions are common and disproportionally involve Hispanic patients. More research is needed to promote equitable child maltreatment reporting for children presenting to the PED following unintentional ingestions.
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Affiliation(s)
- Joseph P Shapiro
- Department of Pediatrics (JP Shapiro, A Hoch, S Kendi, and TP Boyle), Boston Medical Center & Boston University Chobanian & Avedisian School of Medicine, Boston, Mass.
| | - Elizabeth C Pino
- Department of Emergency Medicine (EC Pino), Boston Medical Center & Boston University Chobanian & Avedisian School of Medicine, Boston, Mass.
| | - Annie Goodridge
- Boston University Questrom School of Business (A Goodridge) & Boston University School of Public Health, Boston, Mass.
| | - Ayesha Dholakia
- Department of Pediatrics (A Dholakia), Boston Medical Center & Boston Children's Hospital, Boston, Mass.
| | - Kerrie Nelson
- Boston University School of Public Health (K Nelson), Crosstown Center 318, Boston, Mass.
| | - Ariel Hoch
- Department of Pediatrics (JP Shapiro, A Hoch, S Kendi, and TP Boyle), Boston Medical Center & Boston University Chobanian & Avedisian School of Medicine, Boston, Mass.
| | - Sadiqa Kendi
- Department of Pediatrics (JP Shapiro, A Hoch, S Kendi, and TP Boyle), Boston Medical Center & Boston University Chobanian & Avedisian School of Medicine, Boston, Mass.
| | - Tehnaz P Boyle
- Department of Pediatrics (JP Shapiro, A Hoch, S Kendi, and TP Boyle), Boston Medical Center & Boston University Chobanian & Avedisian School of Medicine, Boston, Mass.
| | - Caroline J Kistin
- Hassenfeld Child Health and Innovation Institute (CJ Kistin), Department of Health Services, Policy, and Practice Brown University School of Public Health, Providence, RI.
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Barry MJ, Nicholson WK, Silverstein M, Chelmow D, Coker TR, Davis EM, Jaén CR, Krousel-Wood MT, Lee S, Li L, Rao G, Ruiz JM, Stevermer JJ, Tsevat J, Underwood SM, Wiehe S. Primary Care Interventions to Prevent Child Maltreatment: US Preventive Services Task Force Recommendation Statement. JAMA 2024; 331:951-958. [PMID: 38502069 DOI: 10.1001/jama.2024.1869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Importance Child maltreatment, which includes child abuse and neglect, can have profound effects on health, development, survival, and well-being throughout childhood and adulthood. The prevalence of child maltreatment in the US is uncertain and likely underestimated. In 2021, an estimated 600 000 children were identified by Child Protective Services as experiencing abuse or neglect and an estimated 1820 children died of abuse and neglect. Objective The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate benefits and harms of primary care-feasible or referable behavioral counseling interventions to prevent child maltreatment in children and adolescents younger than 18 years without signs or symptoms of maltreatment. Population Children and adolescents younger than 18 years who do not have signs or symptoms of or known exposure to maltreatment. Evidence Assessment The USPSTF concludes that the evidence is insufficient to determine the balance of benefits and harms of primary care interventions to prevent child maltreatment in children and adolescents younger than 18 years without signs or symptoms of or known exposure to maltreatment. Recommendation The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of primary care interventions to prevent child maltreatment. (I statement).
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Affiliation(s)
| | | | | | | | | | - Esa M Davis
- University of Maryland School of Medicine, Baltimore
| | | | | | - Sei Lee
- University of California, San Francisco
| | - Li Li
- University of Virginia, Charlottesville
| | - Goutham Rao
- Case Western Reserve University, Cleveland, Ohio
| | | | | | - Joel Tsevat
- University of Texas Health Science Center, San Antonio
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Viswanathan M, Rains C, Hart LC, Doran E, Sathe N, Hudson K, Ali R, Jonas DE, Chou R, Zolotor AJ. Primary Care Interventions to Prevent Child Maltreatment: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2024; 331:959-971. [PMID: 38502070 DOI: 10.1001/jama.2024.0276] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Importance Child maltreatment is associated with serious negative physical, psychological, and behavioral consequences. Objective To review the evidence on primary care-feasible or referable interventions to prevent child maltreatment to inform the US Preventive Services Task Force. Data Sources PubMed, Cochrane Library, and trial registries through February 2, 2023; references, experts, and surveillance through December 6, 2023. Study Selection English-language, randomized clinical trials of youth through age 18 years (or their caregivers) with no known exposure or signs or symptoms of current or past maltreatment. Data Extraction and Synthesis Two reviewers assessed titles/abstracts, full-text articles, and study quality, and extracted data; when at least 3 similar studies were available, meta-analyses were conducted. Main Outcomes and Measures Directly measured reports of child abuse or neglect (reports to Child Protective Services or removal of the child from the home); proxy measures of abuse or neglect (injury, visits to the emergency department, hospitalization); behavioral, developmental, emotional, mental, or physical health and well-being; mortality; harms. Results Twenty-five trials (N = 14 355 participants) were included; 23 included home visits. Evidence from 11 studies (5311 participants) indicated no differences in likelihood of reports to Child Protective Services within 1 year of intervention completion (pooled odds ratio, 1.03 [95% CI, 0.84-1.27]). Five studies (3336 participants) found no differences in removal of the child from the home within 1 to 3 years of follow-up (pooled risk ratio, 1.06 [95% CI, 0.37-2.99]). The evidence suggested no benefit for emergency department visits in the short term (<2 years) and hospitalizations. The evidence was inconclusive for all other outcomes because of the limited number of trials on each outcome and imprecise results. Among 2 trials reporting harms, neither reported statistically significant differences. Contextual evidence indicated (1) widely varying practices when screening, identifying, and reporting child maltreatment to Child Protective Services, including variations by race or ethnicity; (2) widely varying accuracy of screening instruments; and (3) evidence that child maltreatment interventions may be associated with improvements in some social determinants of health. Conclusion and Relevance The evidence base on interventions feasible in or referable from primary care settings to prevent child maltreatment suggested no benefit or insufficient evidence for direct or proxy measures of child maltreatment. Little information was available about possible harms. Contextual evidence pointed to the potential for bias or inaccuracy in screening, identification, and reporting of child maltreatment but also highlighted the importance of addressing social determinants when intervening to prevent child maltreatment.
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Affiliation(s)
- Meera Viswanathan
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| | - Caroline Rains
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| | - Laura C Hart
- Nationwide Children's Hospital, Columbus, Ohio
- The Ohio State University College of Medicine, Columbus
| | - Emma Doran
- Univerisity of North Carolina at Chapel Hill
| | - Nila Sathe
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| | - Kesha Hudson
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| | - Rania Ali
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| | - Daniel E Jonas
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- The Ohio State University College of Medicine, Columbus
| | - Roger Chou
- Oregon Health & Science University, Portland
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Font SA, Kennedy R, Littleton T. Child protective services involvement and exclusionary school discipline. Child Dev 2023; 94:1625-1641. [PMID: 37161769 PMCID: PMC10636238 DOI: 10.1111/cdev.13941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 01/31/2023] [Accepted: 04/06/2023] [Indexed: 05/11/2023]
Abstract
The study examined the impact of child protective services (CPS) contact on out-of-school suspensions for 49,918 Wisconsin students (followed from ages 5-6 to 14-15; [school years 2010-2019; 74% White; 7% Black; 11% Hispanic; 8% other; 49% female]). A quasi-experimental design comparing recent CPS contact to upcoming (future) CPS contact shows that both recent CPS contact without foster care and future CPS contact predict higher odds of suspension compared with no contact. Higher odds of suspension emerged prior to CPS contact and did not substantially increase during or after CPS contact, suggesting that system-induced stress is not a primary driver of behavioral problems leading to suspension. Foster care reduced the odds of suspension among White children and children in special education.
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Affiliation(s)
- Sarah A. Font
- Pennsylvania State University, State College, Pennsylvania, USA
| | - Reeve Kennedy
- East Carolina University, Greenville, North Carolina, USA
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Segal L, Doidge J, Armfield JM, Gnanamanickam ES, Preen DB, Brown DS, Nguyen H. Association of Child Maltreatment With Risk of Death During Childhood in South Australia. JAMA Netw Open 2021; 4:e2113221. [PMID: 34110393 PMCID: PMC8193432 DOI: 10.1001/jamanetworkopen.2021.13221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IMPORTANCE Child maltreatment is a prominent public health concern affecting 20% to 50% of children worldwide. Consequences for mental and physical health have been reported, but population-level estimates of risk of death during childhood that are adjusted for confounders have not been published to date. OBJECTIVE To estimate the association of documented child protection concerns regarding maltreatment with risk of death from infancy to 16 years of age. DESIGN, SETTING, AND PARTICIPANTS This case-control study was nested in a population birth cohort of 608 547 persons born in South Australia, Australia. Case children were those who died between 1 month and 16 years of age (with the death registered by May 31, 2019). Control children were randomly selected individuals from the same population who were alive at the age at which the case child died, matched 5:1 for age, sex, and Aboriginal status. Data were analyzed from January 2019 to March 2021. EXPOSURE Children were assigned to 1 of 4 child protection concern categories (child protection system notification[s] only, investigation[s] [not substantiated], substantiated maltreatment, and ever placed in out-of-home care) based on administrative data from the South Australia Department for Child Protection or were classified as unexposed. MAIN OUTCOMES AND MEASURES Mortality rate ratios for death before 16 years of age, by child protection concern category, were estimated using conditional logistic regression, adjusted for birth outcomes, maternal attributes, and area-based socioeconomic status. Patterns of cause of death were compared for children with vs without child protection concerns. RESULTS Of 606 665 children included in the study, 1635 were case children (57.9% male [when sex was known]; mean [SD] age, 3.59 [4.56] years) and 8175 were control children (57.7% male; mean [SD] age, 3.59 [4.56] years [age censored at the time of death of the matched control child]). Compared with children with no child protection system contact, adjusted mortality rate ratios among children who died before 16 years of age were 2.69 (95% CI, 2.05-3.54) for children with child protection system notification(s) only; 3.16 (95% CI, 2.25-4.43) for children with investigation(s) (not substantiated); 2.93 (95% CI, 1.95-4.40) with substantiated maltreatment; and 3.79 (95% CI, 2.46-5.85) for children ever placed in out-of-home care. External causes represented 136 of 314 deaths (43.3%) among children with a documented child protection concern and 288 of 1306 deaths (22.1%) among other children. Deaths from assault or self-harm were most overrepresented, accounting for 11.1% of deaths in children with child protection concerns but just 0.8% of deaths among other children. CONCLUSIONS AND RELEVANCE In this case-control study, children with documented child protection concerns, who were known to child protection agencies and were typically seen by clinicians and other service providers, had a higher risk of death compared with children with no child protection service contact. These findings suggest the need for a more comprehensive service response for children with protection concerns.
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Affiliation(s)
- Leonie Segal
- Health Economics and Social Policy Group, Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
| | - James Doidge
- Intensive Care National Audit & Research Centre, London, United Kingdom
| | - Jason M. Armfield
- Health Economics and Social Policy Group, Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
| | - Emmanuel S. Gnanamanickam
- Health Economics and Social Policy Group, Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
| | - David B. Preen
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Derek S. Brown
- Brown School, Institute for Public Health, Washington University in St Louis, St Louis, Missouri
| | - Ha Nguyen
- Health Economics and Social Policy Group, Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
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Putnam-Hornstein E, Ahn E, Prindle J, Magruder J, Webster D, Wildeman C. Cumulative Rates of Child Protection Involvement and Terminations of Parental Rights in a California Birth Cohort, 1999-2017. Am J Public Health 2021; 111:1157-1163. [PMID: 33856882 PMCID: PMC8101595 DOI: 10.2105/ajph.2021.306214] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To document the cumulative childhood risk of different levels of involvement with the child protection system (CPS), including terminations of parental rights (TPRs).Methods. We linked vital records for California's 1999 birth cohort (n = 519 248) to CPS records from 1999 to 2017. We used sociodemographic information captured at birth to estimate differences in the cumulative percentage of children investigated, substantiated, placed in foster care, and with a TPR.Results. Overall, 26.3% of children were investigated for maltreatment, 10.5% were substantiated, 4.3% were placed in foster care, and 1.1% experienced a TPR. Roughly 1 in 2 Black and Native American children were investigated during childhood. Children receiving public insurance experienced CPS involvement at more than twice the rate of children with private insurance.Conclusions. Findings provide a lower-bound estimate of CPS involvement and extend previous research by documenting demographic differences, including in TPRs.Public Health Implications. Conservatively, CPS investigates more than a quarter of children born in California for abuse or neglect. These data reinforce policy questions about the current scope and reach of our modern CPS.
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Affiliation(s)
- Emily Putnam-Hornstein
- Emily Putnam-Hornstein is with the School of Social Work, University of North Carolina at Chapel Hill. Eunhye Ahn and John Prindle are with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles. Joseph Magruder and Daniel Webster are with the School of Social Welfare, University of California, Berkeley. Christopher Wildeman is with the Department of Sociology, Duke University, Durham, NC
| | - Eunhye Ahn
- Emily Putnam-Hornstein is with the School of Social Work, University of North Carolina at Chapel Hill. Eunhye Ahn and John Prindle are with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles. Joseph Magruder and Daniel Webster are with the School of Social Welfare, University of California, Berkeley. Christopher Wildeman is with the Department of Sociology, Duke University, Durham, NC
| | - John Prindle
- Emily Putnam-Hornstein is with the School of Social Work, University of North Carolina at Chapel Hill. Eunhye Ahn and John Prindle are with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles. Joseph Magruder and Daniel Webster are with the School of Social Welfare, University of California, Berkeley. Christopher Wildeman is with the Department of Sociology, Duke University, Durham, NC
| | - Joseph Magruder
- Emily Putnam-Hornstein is with the School of Social Work, University of North Carolina at Chapel Hill. Eunhye Ahn and John Prindle are with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles. Joseph Magruder and Daniel Webster are with the School of Social Welfare, University of California, Berkeley. Christopher Wildeman is with the Department of Sociology, Duke University, Durham, NC
| | - Daniel Webster
- Emily Putnam-Hornstein is with the School of Social Work, University of North Carolina at Chapel Hill. Eunhye Ahn and John Prindle are with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles. Joseph Magruder and Daniel Webster are with the School of Social Welfare, University of California, Berkeley. Christopher Wildeman is with the Department of Sociology, Duke University, Durham, NC
| | - Christopher Wildeman
- Emily Putnam-Hornstein is with the School of Social Work, University of North Carolina at Chapel Hill. Eunhye Ahn and John Prindle are with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles. Joseph Magruder and Daniel Webster are with the School of Social Welfare, University of California, Berkeley. Christopher Wildeman is with the Department of Sociology, Duke University, Durham, NC
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Katz I, Katz C, Andresen S, Bérubé A, Collin-Vezina D, Fallon B, Fouché A, Haffejee S, Masrawa N, Muñoz P, Priolo Filho SR, Tarabulsy G, Truter E, Varela N, Wekerle C. Child maltreatment reports and Child Protection Service responses during COVID-19: Knowledge exchange among Australia, Brazil, Canada, Colombia, Germany, Israel, and South Africa. Child Abuse Negl 2021; 116:105078. [PMID: 33931238 PMCID: PMC8446926 DOI: 10.1016/j.chiabu.2021.105078] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 05/23/2023]
Abstract
BACKGROUND COVID-19 has become a worldwide pandemic impacting child protection services (CPSs) in many countries. With quarantine and social distancing restrictions, school closures, and recreational venues suspended or providing reduced access, the social safety net for violence prevention has been disrupted significantly. Impacts include the concerns of underreporting and increased risk of child abuse and neglect, as well as challenges in operating CPSs and keeping their workforce safe. OBJECTIVE The current discussion paper explored the impact of COVID-19 on child maltreatment reports and CPS responses by comparing countries using available population data. METHOD Information was gathered from researchers in eight countries, including contextual information about the country's demographics and economic situation, key elements of the CPS, and the CPS response to COVID-19. Where available, information about other factors affecting children was also collected. These data informed a discussion about between-country similarities and differences. RESULTS COVID-19 had significant impact on the operation of every CPS, whether in high- income or low-income countries. Most systems encountered some degree of service disruption or change. Risk factors for children appeared to increase while there were often substantial deficits in CPS responses, and in most countries there was at a temporary decrease in CM reports despite the increased risks to children. CONCLUSIONS The initial data presented and discussed among the international teams pointed to the way COVID-19 has hampered CPS responses and the protection of children more generally in most jurisdictions, highlighting that children appear to have been at greater risk for maltreatment during COVID-19.
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Affiliation(s)
- Ilan Katz
- Social Policy Research Centre (SPRC), University of New South Wales, Australia.
| | - Carmit Katz
- Bob Shapell School Tel Aviv University, Israel.
| | - Sabine Andresen
- Social Pedagogy and Family Research at Goethe-University Frankfurt, Germany.
| | - Annie Bérubé
- Department of Psychology and Psychoeducation, University of Quebec in Outaouais, Quebec, Canada.
| | | | - Barbara Fallon
- Faculty of Social Work at the University of Toronto, Canada.
| | - Ansie Fouché
- School of Psychosocial Health, North-West University, COMPRES, South Africa.
| | - Sadiyya Haffejee
- Centre for Social Development in Africa, University of Johannesburg, South Africa.
| | | | - Pablo Muñoz
- Departamento De Psicología, Universidad Nacional De Colombia, United States.
| | | | - George Tarabulsy
- University Center for Research on Youth and Families in Quebec City, Canada.
| | | | - Natalia Varela
- Facultad Ciencias Sociales y Humanas, Universidad Externado De Colombia, United States.
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11
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Kelly P, Adam M, Basu C, Ritchie M, Wilson D, Seymour F. Interviews with health professionals about the National Child Protection Alert System. N Z Med J 2021; 134:35-45. [PMID: 33444305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
AIM The New Zealand National Child Protection Alert System is administered by multidisciplinary teams in every district health board. The aim of this study was to investigate the factors that influence multidisciplinary child protection teams' (MDTs') decisions about whether to place a child protection alert. METHOD Members of the Child Protection Alert System teams were invited to participate in semi-structured interviews. Interview data were coded and grouped into themes using inductive thematic analysis. RESULTS Six themes were identified: the system works well; a wide range of factors are considered in multidisciplinary team decision-making; there are some difficulties with multidisciplinary team meetings; there are problems with the administration of the system across district health boards; there is concern about the potential for the Child Protection Alert System to stigmatise families or cause unjustified responses; improvements can be made to the system. CONCLUSION There is overall support for the National Child Protection Alert System and a consensus that the benefits outweigh any potential risks. There is a need for further improvements to the system, including consistent training, further standardisation and increased accessibility of the information to health professionals, including making information on the system available to primary healthcare.
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Affiliation(s)
- Patrick Kelly
- Paediatrician, Service Clinical Director, Te Puaruruhau (Child Protection Team), Starship Children's Health, Auckland; Department of Paediatrics, Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland
| | - Melissa Adam
- Honours Student, School of Psychology, University of Auckland
| | - Carmen Basu
- Child Protection Research Fellow, Te Puaruruhau (Child Protection Team), Starship Children's Health, Auckland
| | - Miranda Ritchie
- National Violence Intervention Programme Manager, Health Networks Limited
| | - Denise Wilson
- Professor of Māori Health, Co-Director, Taupua Waiora Centre of Māori Health Research, AUT University, Auckland
| | - Fred Seymour
- Emeritus Professor, School of Psychology, University of Auckland
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12
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Fallon B, Lefebvre R, Filippelli J, Joh-Carnella N, Trocmé N, Carradine J, Fluke J. Major findings from the Ontario Incidence Study of Reported Child Abuse and Neglect 2018. Child Abuse Negl 2021; 111:104778. [PMID: 33162106 DOI: 10.1016/j.chiabu.2020.104778] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 05/28/2023]
Abstract
BACKGROUND The Ontario Incidence Study of Reported Child Abuse and Neglect (OIS) is the only source of province-wide statistics on families investigated by child welfare. OBJECTIVE This paper presents key findings from the 2018 cycle of the OIS (OIS-2018) and highlights select policy and practice implications of these findings. PARTICIPANTS AND SETTINGS The OIS-2018 captured information directly from investigating child protection workers about children and families who were the subject of a child protection investigation sampled for inclusion in the study. METHODS The OIS-2018 sample was drawn in three stages: first, a representative sample of child welfare agencies in Ontario was selected, then cases were sampled over a three-month period within selected agencies, and, finally, investigations that met the study criteria were identified from the sampled cases. The data collected for the OIS-2018 were weighted in order to derive provincial, annual incidence estimates. RESULTS An estimated 158,476 child maltreatment-related investigations were conducted in Ontario in 2018. In the majority of investigations, there was no documented physical or emotional harm to the child. The overall incidence of investigations remains unchanged between 2008 and 2018. The only statistically significant difference during this time period is an increase in risk investigations between 2013 and 2018. CONCLUSIONS Data from the OIS gives Ontario child welfare policymakers and practitioners an empirical basis for making evidence-informed decisions. Findings are compared to the United States and Australia.
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Affiliation(s)
- Barbara Fallon
- University of Toronto, Factor-Inwentash Faculty of Social Work, 246 Bloor Street West, Toronto, ON M5S 1V4, Canada.
| | - Rachael Lefebvre
- University of Toronto, Factor-Inwentash Faculty of Social Work, 246 Bloor Street West, Toronto, ON M5S 1V4, Canada
| | - Joanne Filippelli
- University of Toronto, Factor-Inwentash Faculty of Social Work, 246 Bloor Street West, Toronto, ON M5S 1V4, Canada
| | - Nicolette Joh-Carnella
- University of Toronto, Factor-Inwentash Faculty of Social Work, 246 Bloor Street West, Toronto, ON M5S 1V4, Canada
| | - Nico Trocmé
- McGill University, School of Social Work, 3506 Rue University #300, Montréal, QC H3A 2A7, Canada
| | - Jessica Carradine
- University of Toronto, Factor-Inwentash Faculty of Social Work, 246 Bloor Street West, Toronto, ON M5S 1V4, Canada
| | - John Fluke
- University of Colorado, Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, 13123 E. 16th Avenue, Aurora, CO 80045, United States
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Wilke NG, Howard AH, Pop D. Data-informed recommendations for services providers working with vulnerable children and families during the COVID-19 pandemic. Child Abuse Negl 2020; 110:104642. [PMID: 32753231 PMCID: PMC7392096 DOI: 10.1016/j.chiabu.2020.104642] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 05/05/2023]
Abstract
BACKGROUND The COVID-19 pandemic and associated response measures have led to unprecedented challenges for service providers working with vulnerable children and families around the world. OBJECTIVE The goal of the present study was to better understand the impact of the pandemic and associated response measures on vulnerable children and families and provide data-informed recommendations for public and private service providers working with this population. PARTICIPANTS AND SETTING Representatives from 87 non-government organizations (NGOs) providing a variety of direct services (i.e. residential care, family preservation, foster care, etc.) to 454,637 vulnerable children and families in 43 countries completed a brief online survey. METHODS Using a mixed methods design, results examined 1) ways in which children and families have been directly impacted by COVID-19, 2) the impact of the pandemic on services provided by NGOs, 3) government responses and gaps in services for this population during the pandemic, and 4) strategies that have been effective in filling these gaps. RESULTS Data revealed that the pandemic and restrictive measures were associated with increased risk factors for vulnerable children and families, including not having access to vital services. The NGOs experienced government restrictions, decreased financial support, and inability to adequately provide services. Increased communication and supportive activities had a positive impact on both NGO staff and the families they serve. CONCLUSIONS Based on the findings, ten recommendations were made for service providers working with vulnerable children and families during the COVID-19 pandemic.
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Pearson RJ, Jay MA, O'Donnell M, Wijlaars L, Gilbert R. Characterizing newborn and older infant entries into care in England between 2006 and 2014. Child Abuse Negl 2020; 109:104760. [PMID: 33053479 PMCID: PMC7718112 DOI: 10.1016/j.chiabu.2020.104760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The risk of entry to state care during infancy is increasing, both here in England and abroad, with most entering within a week of birth ('newborns'). However, little is known about these infants or of their pathways through care over early childhood. OBJECTIVE To characterize infant entries to care in England. PARTICIPANTS AND SETTING All children in England who first entered care during infancy, between April 2006 and March 2014 (n = 42,000). METHODS We compared sociodemographic and care characteristics for infants entering care over the study period by age at first entry (newborn: <1wks, older infant 1-51wks). Among those who entered before April 2010, we further characterized care over follow-up (i.e. 4 years from first entry) and employed latent class analysis to uncover any common pathways through care. RESULTS Almost 40 % of infants first entered care as a newborn. Most infants first entered care under s 20 arrangements (i.e. out-of-court, 60 % of newborns vs 47 % of older infants). Among infants entering before April 2010, most were adopted over follow-up (60 % vs 37 %), though many were restored to parental care (20 % vs 32 %) or exited care to live with extended family (13 % vs 19 %). One in six infants (17.7 %) had particularly unstable care trajectories over early childhood, typified by three or more placements or failed reunification. CONCLUSIONS Evidence-based strengthening of pre-birth social work support is needed to improve preventive interventions before birth, to more effectively target infant placement into care. Linkages between child protection records and information on parents are needed to inform preventive strategies.
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Affiliation(s)
- Rachel J Pearson
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.
| | - Matthew A Jay
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.
| | - Melissa O'Donnell
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia; Australian Centre for Child Protection, University of South Australia, Adelaide, South Australia, Australia.
| | - Linda Wijlaars
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.
| | - Ruth Gilbert
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.
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15
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Lotspeich SC, Jarrett RT, Epstein RA, Shaffer AM, Gracey K, Cull MJ, Raman R. Incidence and neighborhood-level determinants of child welfare involvement. Child Abuse Negl 2020; 109:104767. [PMID: 33049663 DOI: 10.1016/j.chiabu.2020.104767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/15/2020] [Accepted: 09/28/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Child maltreatment is a global public health issue that has been linked with multiple negative health and life outcomes. OBJECTIVE This study evaluates the association between children placed in out-of-home care and neighborhood-level factors using eight years of administrative data. PARTICIPANTS AND SETTING Between 2011-2018, 33,890 unique instances of child welfare involvement were captured in a department of child and family services database in a southern state in the United States. METHODS Removal addresses were geocoded and linked to the U.S. Census Bureau's American Community Survey to obtain census tract socioeconomic factors. Incidence overall and stratified by individual and neighborhood-level factors was computed. Rate ratios, relative indexes of inequality, and concentration curves quantified disparities in incidence of child welfare involvement by neighborhood-level factors. RESULTS Incidence of children less than 19 years old placed into out-of-home care was 255 per 100,000 person-years (95 % CI: 252, 258). At the individual level, incidence was highest among children <5 and 15-17 years old, comparable between male and female children, and higher among Black children. At the neighborhood level, incidence was highest in census tracts with lower median household incomes, higher percentages of households below poverty or of female-headed or single-parent households, higher unemployment rates, and fewer residents with some college education or health insurance. CONCLUSIONS Incidence of children placed into out-of-home care is disproportionally higher for those who live in disadvantaged communities. Understanding neighborhood-level risk factors that may be linked to child welfare involvement can help inform policy and target prevention efforts.
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Affiliation(s)
| | | | | | | | - Kathy Gracey
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Rameela Raman
- Vanderbilt University Medical Center, Nashville, TN, USA
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Najman JM, Kisely S, Scott JG, Strathearn L, Clavarino A, Williams GM, Middeldorp C, Bernstein D. Agency notification and retrospective self-reports of childhood maltreatment in a 30-Year cohort: Estimating population prevalence from different data sources. Child Abuse Negl 2020; 109:104744. [PMID: 33011350 DOI: 10.1016/j.chiabu.2020.104744] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/10/2020] [Accepted: 09/13/2020] [Indexed: 05/26/2023]
Abstract
BACKGROUND There is little known about how two sources of child maltreatment reports correspond, specifically for emotional, physical, sexual abuse and emotional or physical neglect. OBJECTIVE To compare agency and self-reports of child maltreatment and determine whether they are predicted by similar early life course adverse experiences. Participants Data are taken from a long running birth cohort study (Mater-University of Queensland Study of Pregnancy - MUSP). Mothers (N=7223) were recruited in 1981-83 and their children were followed-up 30 years later (2010-14). In 2000 data from the relevant child protection agency were accessed and linked to the survey data. Setting Consecutive women giving birth to a live singleton baby at a major obstetrical service in Brisbane, Australia were recruited and both mother and child were repeatedly follow-up over a 30 year period. Methods Birth cohort study with data linkage of child protection agency records and self-report survey data (using the Childhood Trauma Questionnaire - CTQ) of childhood maltreatment experiences. We compare reports of emotional, physical and sexual abuse and neglect using agency and self-reports (Cramer's V and kappa). RESULTS Most children who are notified cases of maltreatment subsequently self-report they experienced little or no maltreatment in childhood. Most children who report experiencing severe maltreatment have not previously been notified to the protection agency. Teenage mothers have children who are notified 2.89 (1.52, 5.52) times, self-report 2.01 (1.31, 3.09) times and both notified and self-report 3.61 (2.26, 6.10) times more than their older comparison mothers. CONCLUSIONS Different methods of assessing maltreatment identify different subsets of those children who have experienced maltreatment.
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Affiliation(s)
- Jackob M Najman
- School of Public Health, The University of Queensland, 288 Herston Road, Herston, QLD, 4006, Australia.
| | - Steve Kisely
- Faculty of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia
| | - James G Scott
- Child and Youth Research Group, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD, 4006, Australia
| | - Lane Strathearn
- Stead Family Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Alexandra Clavarino
- School of Public Health, The University of Queensland, 288 Herston Road, Herston, QLD, 4006, Australia
| | - Gail M Williams
- School of Public Health, The University of Queensland, 288 Herston Road, Herston, QLD, 4006, Australia
| | - Christel Middeldorp
- Child Health Research Centre, Centre for Children's Health Research, The University of Queensland, 62 Graham Street, South Brisbane, QLD, 4101, Australia
| | - David Bernstein
- Clinical Psychological Science Department, Faculty of Psychology and Neuroscience, Maastricht University, Univesiteitssingel 40, 6229 ER, Maastrichts, Netherlands
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Garstang J, Debelle G, Anand I, Armstrong J, Botcher E, Chaplin H, Hallett N, Morgans C, Price M, Tan EEH, Tudor E, Taylor J. Effect of COVID-19 lockdown on child protection medical assessments: a retrospective observational study in Birmingham, UK. BMJ Open 2020; 10:e042867. [PMID: 32994262 PMCID: PMC7526028 DOI: 10.1136/bmjopen-2020-042867] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To determine any change in referral patterns and outcomes in children (0-18) referred for child protection medical examination (CPME) during the COVID-19 pandemic compared with previous years. DESIGN Retrospective observational study, analysing routinely collected clinical data from CPME reports in a rapid response to the pandemic lockdown. SETTING Birmingham Community Healthcare NHS Trust, which provides all routine CPME for Birmingham, England, population 1.1 million including 288 000 children. PARTICIPANTS Children aged under 18 years attending CPME during an 18-week period from late February to late June during the years 2018-2020. MAIN OUTCOME MEASURES Numbers of referrals, source of disclosure and outcomes from CPME. RESULTS There were 78 CPME referrals in 2018, 75 in 2019 and 47 in 2020, this was a 39.7% (95% CI 12.4% to 59.0%) reduction in referrals from 2018 to 2020, and a 37.3% (95% CI 8.6% to 57.4%) reduction from 2019 to 2020. There were fewer CPME referrals initiated by school staff in 2020, 12 (26%) compared with 36 (47%) and 38 (52%) in 2018 and 2019, respectively. In all years 75.9% of children were known to social care prior to CPME, and 94% of CPME concluded that there were significant safeguarding concerns. CONCLUSIONS School closure due to COVID-19 may have harmed children as child abuse has remained hidden. There needs to be either mandatory attendance at schools in future or viable alternatives found. There may be a significant increase in safeguarding referrals when schools fully reopen as children disclose the abuse they have experienced at home.
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Affiliation(s)
- Joanna Garstang
- Birmingham Community Healthcare NHS Trust, Birmingham, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Geoff Debelle
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Indu Anand
- Birmingham Community Healthcare NHS Trust, Birmingham, UK
| | - Jane Armstrong
- Birmingham Community Healthcare NHS Trust, Birmingham, UK
| | - Emily Botcher
- Birmingham Community Healthcare NHS Trust, Birmingham, UK
| | - Helen Chaplin
- Birmingham Community Healthcare NHS Trust, Birmingham, UK
| | - Nutmeg Hallett
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Clare Morgans
- Birmingham Community Healthcare NHS Trust, Birmingham, UK
| | - Malcolm Price
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Emily Tudor
- Birmingham Community Healthcare NHS Trust, Birmingham, UK
| | - Julie Taylor
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
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de Vries I, Kafafian M, Goggin K, Bouchard E, Goldfarb S, Farrell A. Enhancing the Identification of Commercial Sexual Exploitation Among a Population of High-Risk Youths Using Predictive Regularization Models. Child Maltreat 2020; 25:318-327. [PMID: 31858831 DOI: 10.1177/1077559519889178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Despite an increasing awareness about the existence and harms of commercial sexual exploitation of children (CSEC), the identification of victims remains a challenge for practitioners, hindering their ability to provide appropriate services. Tools that gauge risk of CSEC support the identification of victims but are underdeveloped because most tools assess risk of CSEC within a general youth population. An understanding of what predicts actual CSEC victimizations among youths at higher risk of CSEC due to experiences of childhood adversities has been left unassessed. Research in this area is limited in part because traditional methods do not allow for an assessment of the unique impact of childhood adversities that tend to co-occur. To address these difficulties, the current study applied predictive regularization methods to identify the most decisive risk items for CSEC. Proximal risk of CSEC was assessed among 317 youths who were referred to a specialized program in the Northeast of the United States due to suspicion of CSEC. With an innovative methodological approach, this study seeks to prompt other scholars to examine risk utilizing novel techniques and provides a foundation for the development of concise tools that assess risk of CSEC among populations of youths at higher levels of risk.
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Affiliation(s)
- Ieke de Vries
- Violence and Justice Research Laboratory, School of Criminology and Criminal Justice, Northeastern University, Boston, MA, USA
| | - Matthew Kafafian
- Violence and Justice Research Laboratory, School of Criminology and Criminal Justice, Northeastern University, Boston, MA, USA
| | - Kelly Goggin
- Violence and Justice Research Laboratory, School of Criminology and Criminal Justice, Northeastern University, Boston, MA, USA
| | | | - Susan Goldfarb
- Children's Advocacy Center of Suffolk County, Boston, MA, USA
| | - Amy Farrell
- Violence and Justice Research Laboratory, School of Criminology and Criminal Justice, Northeastern University, Boston, MA, USA
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Abstract
Families in the child welfare (CW) system who cannot be engaged in services are at high risk of negative outcomes. As motivational interviewing (MI) has been shown to improve engagement in similar contexts. This study aimed to systematically review MI with CW families as well as MI training with CW workers and social work students training to become CW workers. The review used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and searched multiple databases in June 2018. In September 2019, the initial search was repeated with additional searches to identify gray literature. Eight studies described the acquisition of MI among CW workers or student trainees, and 11 studies evaluated the impact of MI on families in CW. MI's impact on some family outcomes, such as engagement in services, was mixed, though MI paired with other evidence-based treatments showed positive effects. With regard to training CW workers and students in MI, differences in training duration, intensity, and modality make conclusions difficult, though trainees generally described MI favorably and some studies showed training increased worker empathy and self-efficacy. Importantly, few published studies have evaluated whether MI-trained CW workers impact out-of-home-care placement, and no studies have evaluated their impact on maltreatment.
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Abstract
The present study is the largest and most rigorous study to date on the effects of being appointed a Court Appointed Special Advocate (CASA) on permanency outcomes of children in foster care. The intent-to-treat study accounts for selection bias by applying inverse probability weighting to logistic and sequential logistic regressions in a large sample of children in foster care in the state of Texas (N = 31,754). Overall, children appointed a CASA have significantly lower odds than children without a CASA of achieving permanency. They have lower odds of being reunified, greater odds of being adopted (if not reunified), and lower odds of being placed in permanent kin guardianship (if not reunified or adopted) than children who are not appointed CASA. This study makes an additional contribution by looking beyond the aggregate effect of CASA on permanency by examining the effect of CASA for different age groups and different types of first placement after removal.
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21
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Nickel NC, Turnbull L, Wall-Wieler E, Au W, Ekuma O, MacWilliam L, Enns JE, Lee JB, McCulloch S, Burchill C, Brownell M. Overlap between child protection services and the youth justice system: protocol for a retrospective population-based cohort study using linked administrative data in Manitoba, Canada. BMJ Open 2020; 10:e034895. [PMID: 32713845 PMCID: PMC7383946 DOI: 10.1136/bmjopen-2019-034895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Children who have a history of involvement in child protection services (CPS) are over-represented in the youth and adult criminal justice systems. There are significant health and socioeconomic implications for individuals involved in either or both CPS and the justice system. Understanding the 'overlap' between these two systems would provide insight into the health and social needs of this population. This protocol describes a research programme on the relationship between the child welfare and the youth justice systems, looking specifically at the population involved in both CPS and the youth justice system. We will examine the characteristics associated with involvement in these systems, justice system trajectories of individuals with a history of CPS involvement and early adult outcomes of children involved in both systems. METHODS AND ANALYSIS Administrative data sets will be linked at the individual level for three cohorts born 1991, 1994 and 1998 in Manitoba, Canada. Involvement in CPS will be categorised as 'placed in out-of-home care', 'received in-home services, but was not placed in care' or 'no involvement'. Involvement in the youth justice system will be examined through contacts with police between ages 12 and 17 that either led to charges or did not proceed. Individual, maternal and neighbourhood characteristics will be examined to identify individuals at greatest risk of involvement in one or both systems. ETHICS AND DISSEMINATION The study was approved by the University of Manitoba Health Research Ethics Board and permission to access data sets has been granted by all data providers. We also received approval for the study from the First Nations Health and Social Secretariat of Manitoba's Health Information Research Governance Committee and the Manitoba Metis Federation. Strategies to disseminate study results will include engagement of stakeholders and policymakers through meetings and workshops, scientific publications and presentations, and social media.
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Affiliation(s)
- Nathan C Nickel
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lorna Turnbull
- Faculty of Law, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Wendy Au
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Okechukwu Ekuma
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leonard MacWilliam
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jennifer Emily Enns
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Janelle Boram Lee
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Scott McCulloch
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Charles Burchill
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marni Brownell
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Brännström L, Forsman H, Vinnerljung B, Almquist YB. Inequalities in educational outcomes in individuals with childhood experience of out-of-home care: What are driving the differences? PLoS One 2020; 15:e0232061. [PMID: 32311003 PMCID: PMC7170256 DOI: 10.1371/journal.pone.0232061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 04/06/2020] [Indexed: 11/30/2022] Open
Abstract
Background Prior research has shown that individuals with experience of out-of-home care (foster family care or residential care) in childhood are educationally disadvantaged compared to their peers. In order to be better equipped to design interventions aimed at improving the educational outcomes of children for whom society has assumed responsibility, this study seeks to further our understanding about which factors that contribute to the educational disparities throughout the life course. Methods Using longitudinal data from a cohort of more than 13,000 Swedes, of which around 7% have childhood experience of out-of-home care, Peters-Belson decomposition is utilized to quantify the extent to which the gap in educational achievement in school (age 16) and midlife educational attainment (age 50) captures differences in the prevalence of factors influencing educational outcomes, and differences in the impacts between these factors. Results We find that the achievement and the attainment gap was around 13% and 9% respectively. These gaps were to a large extent explained by differences in the distribution of predictors. The major explanatory factor for placed children’s lower achievement was a lower average cognitive ability. Yet there were some evidence that the rewards of cognitive ability in these children differed across the life course. While the lower returns of cognitive ability suggest that they were underperforming in compulsory school, the higher returns of cognitive ability on midlife attainment indicate that–given previous underperformance–their attainment at age 50 reflects their cognitive capacity more accurately than their achievement at age 16 do. Conclusion The large influence of the unequal distribution of predictors suggests that policy efforts are needed to promote equity in the distribution of factors contributing to educational achievement and attainment. Since cognitive ability was found to be an important contributory factor, such efforts may include promoting cognitive and intellectual development among children in out-of-home care, preferably starting at a young age.
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Affiliation(s)
- Lars Brännström
- Department of Social Work, Stockholm University, Stockholm, Stockholm, Sweden
- * E-mail:
| | - Hilma Forsman
- Department of Social Work, Stockholm University, Stockholm, Stockholm, Sweden
| | - Bo Vinnerljung
- Department of Social Work, Stockholm University, Stockholm, Stockholm, Sweden
| | - Ylva B. Almquist
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
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Pullmann MD, Roberts N, Parker EM, Mangiaracina KJ, Briner L, Silverman M, Becker JR. Residential instability, running away, and juvenile detention characterizes commercially sexually exploited youth involved in Washington State's child welfare system. Child Abuse Negl 2020; 102:104423. [PMID: 32070933 DOI: 10.1016/j.chiabu.2020.104423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/09/2020] [Accepted: 02/10/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Federal policy in 2015 expanded the definition of "child abuse" to include human trafficking. As a result, child welfare agencies are newly responsible for identifying and providing services for youth in state care who are or at-risk of commercial sexual exploitation. OBJECTIVE To describe the demographics, state-dependent living situations, and juvenile detention usage of state-dependent commercially sexually exploited youth. PARTICIPANTS AND SETTING Eighty-three state-dependent youth (89.2 % female, mean age at identification = 15.5 years, SD = 1.5, Range = 11.7-19.1 years) who were confirmed or strongly suspected of commercial sexual exploitation. METHODS Secondary analysis of lifetime administrative record data from child welfare and juvenile justice systems using descriptive statistics. RESULTS Youth experienced early and frequent contact with the child welfare system. Youth experienced an average of 27 living situation disruptions while in the care of child welfare, with a disruption an average of every 71 days, primarily due to running away. Nearly 9 out of 10 youth had at least one runaway episode, and for these youth, there were an average of 8.6 runaway episodes. Three out of four youth had at least one juvenile detention episode, and for these youth, the average number of detention episodes was 9.2. CONCLUSIONS We provide the context of a cycle of multisystem entanglement, whereby running away may be both a response to and cause of further system involvement and commercial sexual exploitation, and call for evidence-based interventions focused on reducing running away for these youth.
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Affiliation(s)
- Michael D Pullmann
- University of Washington School of Medicine, 6200 74th Street, Building 29, Seattle, WA 98115, United States.
| | - Norene Roberts
- Washington Department of Children, Youth, and Families (DCYF), 500 1st Ave S., Ste 400, Seattle, WA 98104, United States.
| | - Elizabeth M Parker
- University of Washington School of Medicine, 6200 74th Street, Building 29, Seattle, WA 98115, United States
| | - Kelly J Mangiaracina
- King County Superior Court, 1211 East Alder St., Seattle, WA 98122, United States.
| | - Leslie Briner
- YouthCare, 2500 NE 54th St., Seattle, WA 98105, United States.
| | | | - Jeremy R Becker
- University of Washington School of Medicine, 6200 74th Street, Building 29, Seattle, WA 98115, United States
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Font SA, Maguire-Jack K. It's not "Just poverty": Educational, social, and economic functioning among young adults exposed to childhood neglect, abuse, and poverty. Child Abuse Negl 2020; 101:104356. [PMID: 31931322 PMCID: PMC7027312 DOI: 10.1016/j.chiabu.2020.104356] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/10/2019] [Accepted: 01/06/2020] [Indexed: 05/24/2023]
Abstract
BACKGROUND Neglect is the most common allegation in Child Protective Services (CPS) investigations. Researchers and media have questioned whether and how CPS-investigated neglect differs from poverty. Prior studies are limited by self-reported or cross-sectional measures, small samples, and short observation periods. OBJECTIVE (1) To estimate the "added harm" of CPS-investigated neglect, net of poverty exposure (depth and duration), on high school completion, employment and earnings, incarceration, and teen parenthood; (2) To assess whether abuse is a stronger risk factor for adverse outcomes than neglect. PARTICIPANTS AND SETTING 29,154 individuals born in 1993-1996 from Milwaukee County, WI, who either received food assistance or were reported to CPS before age 16. METHOD Using logistic regression with a rich set of social and demographic controls, we compared individuals with CPS-investigated neglect, abuse, or both abuse and neglect in early childhood or adolescence to those who experienced poverty but not CPS involvement. We calculated cumulative measures of poverty duration and poverty depth between ages 0 and 16 for the full sample using public benefit records. RESULTS Outcomes among children with alleged or confirmed neglect were statistically significantly worse in all domains than impoverished children without maltreatment allegations, and similar to children with alleged or confirmed abuse. Effect sizes varied by outcome. CONCLUSIONS Overall, this study suggests that CPS allegations of neglect are distinct from poverty and an important risk factor for adverse outcomes in adulthood.
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Affiliation(s)
- Sarah A Font
- Pennsylvania State University, 612 Oswald Tower, University Park, PA, 16802, United States.
| | - Kathryn Maguire-Jack
- University of Michigan, School of Social Work 1080 S. University Ave, Ann Arbor, MI, 48109, United States.
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Gifford EJ, Evans KE, Eldred Kozecke L, Sloan FA. Mothers and fathers in the criminal justice system and children's child protective services involvement. Child Abuse Negl 2020; 101:104306. [PMID: 32004822 PMCID: PMC7672507 DOI: 10.1016/j.chiabu.2019.104306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 11/17/2019] [Accepted: 11/25/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Parental criminal justice system (CJS) involvement is a marker for child protective services (CPS) involvement. OBJECTIVE To document how parental criminal case processing affects children's CPS involvement. PARTICIPANTS AND SETTING Participants included mothers and fathers with a serious criminal charge (mothers = 78,882; fathers = 165,070) and without any criminal charge (mothers = 962,963; fathers = 743,604) between 2008-2012. Statewide North Carolina records on court proceedings, births, CPS assessments/investigations, and foster care placements were used. METHODS The observational unit was an individual's first charge date of a year. Outcomes were CPS assessment/investigation and foster care entry within six months and alternatively three years following the charge. Key explanatory variables were whether the charges resulted in prosecution, conviction following prosecution, and an active sentence conditional on conviction. An instrumental variables approach was used. RESULTS Parents charged with a criminal offense had higher rates of having a CPS assessment/investigation during the three years preceding the charge than parents who were not charged. Among mothers who were convicted, CPS assessment/investigation increased 8.1 percent (95 % CI: 2.2, 13.9) and 9.5 percent (95 % CI: 1.3, 17.6) 6 months and 3 years following the charge. An active sentence increased CPS assessment/investigations by 21.6 percent (95 % CI: 6.4, 36.7) within 6 months. For fathers, active sentence increased foster care placement by 1.6 percent (95 % CI: 0.24, 2.9) within 6 months of the criminal charge. CONCLUSIONS Changing parental incarceration rates would change CPS caseloads substantially. The criminal justice and CPS systems work with overlapping populations, data and services sharing should be considered a high priority.
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Affiliation(s)
- E J Gifford
- Sanford School of Public Policy, Children's Health and Discovery Initiative, Center for Child and Family Policy, Duke Margolis Center for Health Policy, United States.
| | - K E Evans
- Center for Child and Family Policy, Duke University, United States.
| | - L Eldred Kozecke
- Center for Child and Family Policy, Duke University, United States.
| | - F A Sloan
- Department of Economics, Duke University, United States.
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Abstract
Child sexual abuse (CSA) is associated with a range of negative consequences for victims that are compounded when it recurs. We used the National Child Abuse and Neglect Data System to study a cohort of 42,036 children in 45 U.S. states with sexual abuse reports first confirmed by child protective services (CPS) during 2010 in order to identify children with increased risk for recurrence. A small proportion (3.6%) had a second confirmed sexual abuse report through 2015. In multivariate models, female gender, family hearing and vision problems, other child maltreatment, and other family violence were associated with increased risk of recurrence, while younger children, Hispanic families, and those with substance abuse tended to have less risk. One fourth of recurrence involved the same offender, usually a parent or caretaker. One fourth of cases were referred for any CPS services, which were more likely to be provided for families with poverty, drug or alcohol problems, or other violence. Only substance abuse services significantly reduced recurrence in multivariable models. Those trying to reduce CSA recurrence should recognize that certain case characteristics are associated with greater recurrence, and most CPS services do not significantly reduce CSA recurrence.
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Affiliation(s)
| | - Marissa Ilardi
- New York University School of Medicine, New York, NY, USA
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Abstract
The present research examines child maltreatment allegations (CMAs) in San Diego County, California, exploring spatial patterns of Child Protective Services involvement and multiple, multidimensional measures of neighborhood social vulnerability. Results showed significant patterns of spatial clustering (i.e., hot and cold spots) of CMAs across the county (Moran's I = .316, p < .001). A geographically weighted regression (GWR) was implemented to examine the relationship between CMAs and social vulnerability at the census-tract level, thereby overcoming the deficiencies of global models. Nonstationarity was detected across four indices of vulnerability (socioeconomic status, race/ethnicity, household composition, and health vulnerability) as well as proximity to on-premise alcohol outlets, percentage of residents in each census tract affected by food deserts, and population density, in some cases showing countervailing effects depending on spatial location. A hierarchical clustering was performed on the GWR coefficients to identify spatial regimes, or clusters, across the county. The results yielded six spatial regimes of social vulnerability differentially related to CMA rates. The present study demonstrates the novelty of GWR in combination with a hierarchical cluster analysis for exploring how local contextual processes influence child maltreatment reporting rates across the county.
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Abstract
Recent research has used synthetic cohort life tables to show that having a Child Protective Services investigation, experiencing confirmed maltreatment, and being placed in foster care are more common for American children than would be expected based on daily or annual rates for these events. In this article, we extend this literature by using synthetic cohort life tables and data from the Adoption and Foster Care Analysis and Reporting System to generate the first cumulative prevalence estimates of termination of parental rights. The results provide support for four conclusions. First, according to the 2016 estimate, 1 in 100 U.S. children will experience the termination of parental rights by age 18. Second, the risk of experiencing this event is highest in the first few years of life. Third, risks are highest for Native American and African American children. Nearly 3.0% of Native American children and around 1.5% of African American children will ever experience this event. Finally, there is dramatic variation across states in the risk of experiencing this event and in racial/ethnic inequality in this risk. Taken together, these findings suggest that parental rights termination, which involves the permanent loss of access to children for parents, is far more common than often thought.
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Affiliation(s)
- Christopher Wildeman
- Cornell University, Ithaca, NY, USA
- ROCKWOOL Foundation Research Unit, Copenhagen, Denmark
| | - Frank R. Edwards
- Cornell University, Ithaca, NY, USA
- Rutgers University, Newark, NJ, USA
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Vreeland A, Ebert JS, Kuhn TM, Gracey KA, Shaffer AM, Watson KH, Gruhn MA, Henry L, Dickey L, Siciliano RE, Anderson A, Compas BE. Predictors of placement disruptions in foster care. Child Abuse Negl 2020; 99:104283. [PMID: 31765852 PMCID: PMC7984659 DOI: 10.1016/j.chiabu.2019.104283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/31/2019] [Accepted: 11/11/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Many children who are removed from a dangerous or neglectful home and placed in state custody subsequently experience additional disruptions while in custody, which can compound the effects of ongoing stress and instability. As such, placement stability has been identified as a critical objective and a key indicator of success for children residing in substitutive care. OBJECTIVE To examine the utility of child protective services data in identifying predictors of placement disruption. PARTICIPANTS AND SETTING The current study examined data from youth in Tennessee state custody who had been assessed using the Child and Adolescent Needs and Strengths (CANS) assessment within 30-days of their first, out-of-home placement. The sample included 8,853 youth ages 5-19 years old (M = 13.1; SD = 4.0; 44.8 % female). METHODS Demographics, placement information, and the CANS assessment were collected by the Tennessee Department of Children's Services for all child welfare episodes for children as part of the system's usual standard of care. Bivariate correlation and linear regression models were conducted. RESULTS Multiple risk indices from the CANS appeared to significantly increase risk of placement disruption, including child internalizing and externalizing symptoms, school difficulties, youth affect dysregulation, and child age. CONCLUSIONS The current findings suggest that data collected as part of standard practice by child welfare workers such as the CANS is both feasible and has utility for identifying sources of risk for placement disruptions and to inform possible targets of intervention to enhance placement stability.
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Affiliation(s)
- Allison Vreeland
- Vanderbilt University, Department of Psychology & Human Development, Peabody 552, 230 Appleton Place, Nashville TN, 37203, United States.
| | - John S Ebert
- Vanderbilt University, Department of Psychology & Human Development, Peabody 552, 230 Appleton Place, Nashville TN, 37203, United States
| | - Tarah M Kuhn
- Vanderbilt University, Department of Psychology & Human Development, Peabody 552, 230 Appleton Place, Nashville TN, 37203, United States
| | - Kathy A Gracey
- Vanderbilt University, Department of Psychology & Human Development, Peabody 552, 230 Appleton Place, Nashville TN, 37203, United States
| | - April M Shaffer
- Vanderbilt University, Department of Psychology & Human Development, Peabody 552, 230 Appleton Place, Nashville TN, 37203, United States
| | - Kelly H Watson
- Vanderbilt University, Department of Psychology & Human Development, Peabody 552, 230 Appleton Place, Nashville TN, 37203, United States
| | - Meredith A Gruhn
- Vanderbilt University, Department of Psychology & Human Development, Peabody 552, 230 Appleton Place, Nashville TN, 37203, United States
| | - Lauren Henry
- Vanderbilt University, Department of Psychology & Human Development, Peabody 552, 230 Appleton Place, Nashville TN, 37203, United States
| | - Lindsay Dickey
- Vanderbilt University, Department of Psychology & Human Development, Peabody 552, 230 Appleton Place, Nashville TN, 37203, United States
| | - Rachel E Siciliano
- Vanderbilt University, Department of Psychology & Human Development, Peabody 552, 230 Appleton Place, Nashville TN, 37203, United States
| | - Allegra Anderson
- Vanderbilt University, Department of Psychology & Human Development, Peabody 552, 230 Appleton Place, Nashville TN, 37203, United States
| | - Bruce E Compas
- Vanderbilt University, Department of Psychology & Human Development, Peabody 552, 230 Appleton Place, Nashville TN, 37203, United States
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Zerr AA, Newton RR, Litrownik AJ, McCabe KM, Yeh M. Household composition and maltreatment allegations in the US: Deconstructing the at-risk single mother family. Child Abuse Negl 2019; 97:104123. [PMID: 31473384 DOI: 10.1016/j.chiabu.2019.104123] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 07/22/2019] [Accepted: 07/26/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Previous research has demonstrated the association between child maltreatment and household composition, with increased maltreatment risk generally present in single mother households. However, existing research does not fully examine the complexity and configuration of single mother households. In particular, less is known about important variants of single parent family structures, such as grandparents residing in the home, and the extent to which household compositions change across time. OBJECTIVE The present study examines rates of maltreatment allegations across various household compositions in a sample of single biological mother households. PARTICIPANTS AND SETTING Youth participants (N = 417) were part of the larger multi-site Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) study. METHODS Participants completed longitudinal assessments of household composition and maltreatment allegations from ages 4 to 10. RESULTS The present study illustrates substantial variability in the rate of maltreatment allegations across different types of single mother household compositions. In particular, the presence of non-relatives, especially unrelated males, demonstrated an increased risk for maltreatment allegations in the home. Conversely, single mother homes with two or more adult relatives, especially grandmothers, were at reduced risk for child maltreatment allegations. CONCLUSIONS This study highlights variability in maltreatment allegations among single mother homes, including how maltreatment allegations vary across different household configurations, across child age periods and across different risk levels.
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Affiliation(s)
- Argero A Zerr
- California State University Channel Islands, San Diego State University, Child and Adolescent Services Research Center, United States.
| | - Rae R Newton
- Fielding Graduate University, Child and Adolescent Services Research Center, United States
| | - Alan J Litrownik
- San Diego State University, Child and Adolescent Services Research Center, United States
| | - Kristen M McCabe
- University of San Diego, Child and Adolescent Services Research Center, United States
| | - May Yeh
- San Diego State University, Child and Adolescent Services Research Center, University of California San Diego, United States
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Segal L, Nguyen H, Mansor MM, Gnanamanickam E, Doidge JC, Preen DB, Brown DS, Pearson O, Armfield JM. Lifetime risk of child protection system involvement in South Australia for Aboriginal and non-Aboriginal children, 1986-2017 using linked administrative data. Child Abuse Negl 2019; 97:104145. [PMID: 31465961 DOI: 10.1016/j.chiabu.2019.104145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/15/2019] [Accepted: 08/18/2019] [Indexed: 05/24/2023]
Abstract
BACKGROUND Child protection services exist to reduce potential harms from child maltreatment. Many jurisdictions produce annual data on child protection system (CPS) involvement, leaving a gap in knowledge of lifetime involvement. OBJECTIVE To describe lifetime involvement in CPS, by type of contact. PARTICIPANTS All 608,547 children born in South Australia (SA), Australia between 1986 and 2017. METHODS A retrospective cohort design using linked administrative data to report cumulative incidence of CPS involvement from birth to age <18 (or June30 2017) by Aboriginal status. CPS involvement was categorised into notifications (3 levels), investigations, substantiations and out-of-home care (OOHC). Cumulative incidence curves were derived for 5 birth cohorts. RESULTS Across childhood (to age <18 years), substantiated maltreatment was experienced by 3.2-3.6% of non-Aboriginal and 19-25% of Aboriginal children, 7 times reported annual substantiation rates. For most CPS categories CPS involvement increased until 2010, and was occurring earlier in life. By age 3, 0.5% of non-Aboriginal and 4.5% of Aboriginal children born 1986-1991 were the subject of a substantiation compared with 1.9% and 15% of non-Aboriginal and Aboriginal children, respectively, born 2010-2017. Incidence rates beyond age 3 were similar. OOHC contact was similar across cohorts, with ˜1.5% of non-Aboriginal and 12.7% of Aboriginal children ever-placed in care. CONCLUSIONS Data linkage is an essential tool for understanding life course involvement with the CPS and describing trends not observable from annual snapshots. Such information is critical for burden of disease estimates, informing policy and monitoring CPS performance.
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Affiliation(s)
- Leonie Segal
- Australian Centre for Precision Health, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
| | - Ha Nguyen
- Australian Centre for Precision Health, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Mahayaudin M Mansor
- Australian Centre for Precision Health, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Emmanuel Gnanamanickam
- Australian Centre for Precision Health, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - James C Doidge
- UCL Great Ormond Street Hospital Institute of Child Health, University College London, London, United Kingdom; Intensive Care National Audit and Research Centre, London, United Kingdom
| | - David B Preen
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Derek S Brown
- Brown School, Washington University School of Medicine in St Louis, St. Louis, Missouri, United States
| | - Odette Pearson
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, South Australia, Australia
| | - Jason M Armfield
- Australian Centre for Precision Health, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Beaulieu E, Rajabali F, Zheng A, Pike I. The lifetime costs of pediatric abusive head trauma and a cost-effectiveness analysis of the Period of Purple crying program in British Columbia, Canada. Child Abuse Negl 2019; 97:104133. [PMID: 31473380 DOI: 10.1016/j.chiabu.2019.104133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/24/2019] [Accepted: 08/03/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Abusive head trauma (AHT) is a severe form of child abuse causing devastating outcomes for children and families, but its economic costs in Canada has yet to be determined. The Period of PURPLE crying program (PURPLE) is an AHT prevention program implemented in British Columbia for which success in reducing AHT events was recently reported. OBJECTIVE This study estimated the lifetime costs to society of incidental AHT events and compared the benefits and associated costs of AHT before and after the implementation of the PURPLE program. PARTICIPANTS AND SETTING Children aged 0-24 months old with a definite diagnosis of AHT between 2002 and 2014 in British Columbia were included in this study. METHODS An incidence-based cost-of-illness analysis, using the human capital approach was used to quantify the lifetime costs of AHT events according to their severity (least severe, severe and fatal). A cost-effectiveness analysis of the PURPLE program was conducted from both a societal and a health services' perspectives using decision tree models. RESULTS There were sixty-four AHT events between 2002-2014, resulting in a total cost of $354,359,080 to society. The costs associated with fatal, severe and least severe AHT averaged $7,147,548, $6,057,761 and $1,675,099, respectively. The investment of $5 per newborn through the PURPLE program resulted in a $273.52 and $14.49 per child cost avoidance by society and by the healthcare system. CONCLUSIONS This study provides evidence to policymakers and health practitioners that investing upstream in well-developed AHT prevention programs, such as PURPLE, not only promote child safety and health, but also translates into avoided costs to society.
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Affiliation(s)
- Emilie Beaulieu
- BC Injury Research and Prevention Unit, BC Children's Hospital Research Institute, Address: F508, 4480 Oak St, Vancouver, BC V6H 3V4, Canada; Department of Pediatrics, University of British Columbia, Address: UBC Faculty of Medicine, Rm 2D19 4480 Oak Street, BC Children's Hospital, Vancouver, BC, V6H 3V4, Canada.
| | - Fahra Rajabali
- BC Injury Research and Prevention Unit, BC Children's Hospital Research Institute, Address: F508, 4480 Oak St, Vancouver, BC V6H 3V4, Canada
| | - Alex Zheng
- BC Injury Research and Prevention Unit, BC Children's Hospital Research Institute, Address: F508, 4480 Oak St, Vancouver, BC V6H 3V4, Canada
| | - Ian Pike
- BC Injury Research and Prevention Unit, BC Children's Hospital Research Institute, Address: F508, 4480 Oak St, Vancouver, BC V6H 3V4, Canada; Department of Pediatrics, University of British Columbia, Address: UBC Faculty of Medicine, Rm 2D19 4480 Oak Street, BC Children's Hospital, Vancouver, BC, V6H 3V4, Canada
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Victor BG, Henry C, Gilbert TT, Ryan JP, Perron BE. Child Protective Service Referrals Involving Exposure to Domestic Violence: Prevalence, Associated Maltreatment Types, and Likelihood of Formal Case Openings. Child Maltreat 2019; 24:299-309. [PMID: 31067993 DOI: 10.1177/1077559519843605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Childhood exposure to domestic violence (CEDV) is widely understood as potentially harmful to children. Accordingly, many child welfare systems in the United States construe CEDV as maltreatment when the exposure results in harm or threatened harm to the child. The purpose of the current study was to investigate substantiated child welfare referrals directly related to CEDV to better understand the prevalence and patterns of CEDV-related maltreatment and how child welfare workers respond under the "harm or threatened harm" standard. Data were drawn from 23,704 substantiated referrals between 2009 and 2013 in a large Midwestern child welfare system. Approximately 20% of substantiated referrals were CEDV related. A plurality of CEDV-related referrals included both a male caregiver and female caregiver who were co-substantiated for maltreatment. The most common maltreatment types substantiated for these referrals were neglect based rather than abuse based, and just under a quarter (23%) of CEDV-related referrals were formally opened for services. Referrals involving co-occurring substance abuse were most likely to be opened for services based on predicted probabilities derived from multilevel modeling. Implications for policy and practice are considered.
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Affiliation(s)
| | - Colleen Henry
- 2 Hunter College, City University of New York, New York, NY, USA
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Eastman AL, Foust R, Prindle J, Palmer L, Erlich J, Giannella E, Putnam-Hornstein E. A Descriptive Analysis of the Child Protection Histories of Youth and Young Adults Arrested in California. Child Maltreat 2019; 24:324-329. [PMID: 31142134 DOI: 10.1177/1077559519837667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
In this study, we use population-based linked administrative data to document the full child protective service (CPS) histories of arrested youth and young adults. We extracted records for all individuals aged 24 and under who were arrested in California in 2014 and 2015. These records were probabilistically linked to statewide CPS records dating back to 1998. Overall, 43.4% of those arrested had a history of CPS involvement. Among individuals with uncensored CPS records (born in 1998 or later), 60.2% had past CPS involvement. Findings indicate that youth and young adults booked for a felony offense were more likely to have a history of CPS involvement than those booked for misdemeanors. A multinomial model served to confirm bivariate findings. This study provides further evidence that community concerns of childhood maltreatment were common among criminal justice-involved young adults.
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Affiliation(s)
- Andrea Lane Eastman
- 1 Children's Data Network, University of Southern California, Los Angeles, CA, USA
| | - Regan Foust
- 1 Children's Data Network, University of Southern California, Los Angeles, CA, USA
| | - John Prindle
- 1 Children's Data Network, University of Southern California, Los Angeles, CA, USA
| | - Lindsey Palmer
- 1 Children's Data Network, University of Southern California, Los Angeles, CA, USA
| | - Justin Erlich
- 2 Formerly California Department of Justice, San Francisco, CA, USA
| | - Eric Giannella
- 2 Formerly California Department of Justice, San Francisco, CA, USA
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Greeson JKP, Treglia D, Wolfe DS, Wasch S, Gelles RJ. Child welfare characteristics in a sample of youth involved in commercial sex: An exploratory study. Child Abuse Negl 2019; 94:104038. [PMID: 31181397 DOI: 10.1016/j.chiabu.2019.104038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/04/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Homeless, runaway, and youth exiting foster care are vulnerable to sexual exploitation, but little research has parsed the societal, community, and individual factors that contribute to their risk. OBJECTIVES (1) To estimate child welfare characteristics in a sample of homeless young people who engaged in commercial sex (CS); and (2) To compare young people who were sex trafficked (ST) to those who engaged in some other form of CS. PARTICIPANTS AND SETTING This study includes 98 homeless young people in Philadelphia, PA, Phoenix, AZ, and Washington, DC, who were interviewed for a larger study of ST and endorsed engagement in CS. METHODS We used a non-probability, purposive, maximum variation sampling procedure. Interviews were recorded and responses were simultaneously noted on a standardized interview form. Data were analyzed through means, frequencies, and bivariate tests of association. RESULTS Average age of the full sample of 98 homeless young people was 20.9 years; 48% were female and 50% were Black/African American. Forty-six percent of the full sample was sex trafficked. The full sample and the victims of ST differed significantly in three child welfare characteristics, with the ST group more likely to have been maltreated as children, more likely to have had family involvement with the child welfare system (CWS), and more likely to report higher rates of living someplace other than with their biological parents as children. CONCLUSIONS ST victims differ from those who engaged in other forms of CS in histories of maltreatment, involvement with the CWS, and exposure to residential instability while growing up.
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Affiliation(s)
- Johanna K P Greeson
- University of Pennsylvania, School of Social Policy & Practice, 3701 Locust Walk, Philadelphia, PA 19104, United States; The Field Center for Children's Policy, Practice, & Research, 3815 Walnut Street, Philadelphia, PA 19104, United States.
| | - Daniel Treglia
- University of Pennsylvania, School of Social Policy & Practice, 3701 Locust Walk, Philadelphia, PA 19104, United States.
| | - Debra Schilling Wolfe
- The Field Center for Children's Policy, Practice, & Research, 3815 Walnut Street, Philadelphia, PA 19104, United States.
| | - Sarah Wasch
- The Field Center for Children's Policy, Practice, & Research, 3815 Walnut Street, Philadelphia, PA 19104, United States.
| | - Richard J Gelles
- University of Pennsylvania, School of Social Policy & Practice, 3701 Locust Walk, Philadelphia, PA 19104, United States; The Field Center for Children's Policy, Practice, & Research, 3815 Walnut Street, Philadelphia, PA 19104, United States.
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Dubowitz H, Roesch S, Arria AM, Metzger R, Thompson R, Kotch JB, Lewis T. Timing and chronicity of child neglect and substance use in early adulthood. Child Abuse Negl 2019; 94:104027. [PMID: 31212246 PMCID: PMC6686902 DOI: 10.1016/j.chiabu.2019.104027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 05/10/2019] [Accepted: 05/31/2019] [Indexed: 05/30/2023]
Abstract
BACKGROUND Neglect is the most common form of child maltreatment with consequences that appear to be as serious as for abuse. Despite this, the problem has received less than its due attention. OBJECTIVE To examine the relationship between the timing and chronicity of neglect during childhood and substance use in early adulthood. PARTICIPANTS AND SETTING The sample consisted of a subset of 475 participants from the prospective Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) consortium from five geographic areas around the U.S. METHOD Neglect was assessed using abstracted information from CPS reports (birth-18) and self-reports of neglect (12-18). Participants completed a follow-up online survey (mean age of 24 years) that probed their use of substances. RESULTS The prevalence of substance use during the past year was comparable in this high-risk sample to the general population. Latent class analysis supported the presence of three groups related to the presence and timing of neglect: Chronic Neglect, Late Neglect and Limited Neglect. Late Neglect was the pattern most strongly linked to substance use in early adulthood. CONCLUSIONS High-risk youth experiencing neglect beginning in mid- adolescence are especially vulnerable to later substance use. Those working with such youth and their families can play a valuable role helping ensure their basic needs are adequately met, and recognizing early signs of substance use and abuse.
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Affiliation(s)
- Howard Dubowitz
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, United States.
| | - Scott Roesch
- Department of Psychology, San Diego State University, United States
| | - Amelia M Arria
- Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, United States
| | - Richard Metzger
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, United States
| | - Richard Thompson
- Richard H. Calica Center for Innovation in Children and Family Services, Juvenile Protective Association, United States
| | - Jonathan B Kotch
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States
| | - Terri Lewis
- Department of Pediatrics, University of Colorado School of Medicine, United States
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Maclean MJ, Sims SA, O'Donnell M. Role of pre-existing adversity and child maltreatment on mental health outcomes for children involved in child protection: population-based data linkage study. BMJ Open 2019; 9:e029675. [PMID: 31362970 PMCID: PMC6678009 DOI: 10.1136/bmjopen-2019-029675] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To determine mental health outcomes for children with a history of child protection system involvement, accounting for pre-existing adversity, and to examine variation in risk across diagnostic groupings and child protection subgroups. DESIGN A longitudinal, population-based record-linkage study. PARTICIPANTS All children in Western Australia (WA) with birth records between 1990 and 2009. OUTCOME MEASURES Mental health diagnoses, mental health contacts and any mental health event ascertained from International Classification of Diseases codes within WA's Hospital Morbidity Data Collection and Mental Health Information System from birth until 2013. RESULTS Compared with children without child protection contact, children with substantiated maltreatment had higher prevalence of mental health events (37.4% vs 5.9%) and diagnoses (20% vs 3.6%). After adjusting for background risks, all maltreatment types were associated with an almost twofold to almost threefold increased hazard for mental health events. Multivariate analysis also showed mental health events were elevated across all child protection groups, ranging from HR: 3.54 (95% CI 3.28 to 3.82) for children who had entered care to HR: 2.31 (95% CI 2.18 to 2.46) for unsubstantiated allegations. Maternal mental health, aboriginality, young maternal age and living in socially disadvantaged neighbourhoods were all associated with an increased likelihood of mental health events. The increase varied across diagnostic categories, with particularly increased risk for personality disorder, and frequent comorbidity of mental health and substance abuse disorders. CONCLUSIONS Young people who have been involved in the child protection system are at increased risk for mental health events and diagnoses. These findings emphasise the importance of services and supports to improve mental health outcomes in this vulnerable population. Adversities in childhood along with genetic or environmental vulnerabilities resulting from maternal mental health issues also contribute to young people's mental health outcomes, suggesting a role for broader social supports and early intervention services in addition to targeted mental health programmes.
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Affiliation(s)
- Miriam Jennifer Maclean
- Linked Analytics and Social Policy, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Scott Anthony Sims
- Linked Analytics and Social Policy, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Melissa O'Donnell
- Linked Analytics and Social Policy, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Centre for Child Health Research, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia
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Rossen L, Tzoumakis S, Kariuki M, Laurens KR, Butler M, Chilvers M, Harris F, Carr VJ, Green MJ. Timing of the first report and highest level of child protection response in association with early developmental vulnerabilities in an Australian population cohort. Child Abuse Negl 2019; 93:1-12. [PMID: 31026680 DOI: 10.1016/j.chiabu.2019.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 02/16/2019] [Accepted: 04/08/2019] [Indexed: 05/24/2023]
Abstract
BACKGROUND Childhood maltreatment is associated with early childhood developmental vulnerabilities. However, the extent to which higher levels of child protection responses confer benefit to developmental competencies, and the impact of earlier timing of first reports in relation to early childhood vulnerability remains unclear. OBJECTIVE We examined associations between early developmental vulnerabilities and (1) the highest level of child protection response (where OOHC was deemed the highest response among other types of reports/responses), and (2) the developmental timing of the first child protection report. PARTICIPANTS AND SETTING Participants included 67,027 children from the New South Wales Child Development Study, of whom 10,944 were reported to child protection services up to age 5 years. METHODS A series of Multinomial Logistic Regressions were conducted to examine focal associations. RESULTS Children with substantiated maltreatment reports showed the strongest odds of vulnerability on three or more developmental domains (adjusted OR = 4.90; 95% CI = 4.13-5.80); children placed in OOHC showed slightly better physical, cognitive and communication competencies (adjusted ORs from 1.83 to 2.65) than those with substantiated reports that did not result in OOHC placements (adjusted OR from 2.77 to 3.67), when each group was compared to children with no child protection reports. Children with first maltreatment reports occurring in the first 18 months of life showed the strongest likelihood of developmental vulnerabilities on three or more developmental domains (adjusted OR = 3.56; 95% CI = 3.15-4.01) relative to children with no child protection reports. CONCLUSION Earlier reports of maltreatment may signal the need for targeted remediation of early developmental competencies to mitigate early developmental difficulties.
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Affiliation(s)
- Larissa Rossen
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Stacy Tzoumakis
- School of Social Sciences, University of New South Wales, Sydney, Australia
| | - Maina Kariuki
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Kristin R Laurens
- School of Psychiatry, University of New South Wales, Sydney, Australia; School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| | - Merran Butler
- NSW Department of Family and Community Services, NSW, Australia
| | | | - Felicity Harris
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Vaughan J Carr
- School of Psychiatry, University of New South Wales, Sydney, Australia; Neuroscience Research Australia, Sydney, Australia; Department of Psychiatry, Monash University, Melbourne, Australia
| | - Melissa J Green
- School of Psychiatry, University of New South Wales, Sydney, Australia; Neuroscience Research Australia, Sydney, Australia.
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Crowley DM, Connell CM, Jones D, Donovan MW. Considering the child welfare system burden from opioid misuse: research priorities for estimating public costs. Am J Manag Care 2019; 25:S256-S263. [PMID: 31361428 PMCID: PMC7895335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The negative impact of opioids on those who misuse them has been widely documented. Despite significant spillover effects in the form of elevated rates of child maltreatment and child welfare system (CWS) involvement for children affected by parental opioid misuse, the public costs of opioid misuse to the CWS remain largely undocumented. This work seeks to understand the value and limitations of public data in estimating the costs of the opioid epidemic on the CWS. National data from federal sources are combined with best estimates of the association between opioid misuse and child services system utilization. The limitations of this work are explored, and future research priorities are outlined. Ultimately, this work illustrates the need to (1) improve data quality related to parental opioid misuse and CWS linkages; (2) better estimate the number of children and families coming into contact with the CWS as a result of parental opioid misuse; (3) improve predictions of CWS trajectories, including investigation, service provision, and foster care entry among this population; and (4) better estimate the CWS costs associated with patterns of system involvement resulting from parental opioid misuse. This information is crucial to ensuring the production of high-quality system involvement and cost projections related to the opioid crisis.
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Cleek EA, Johnson NL, Sheets LK. Interdisciplinary collaboration needed in obtaining high-quality medical information in child abuse investigations. Child Abuse Negl 2019; 92:167-178. [PMID: 30999166 PMCID: PMC6513678 DOI: 10.1016/j.chiabu.2019.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/03/2019] [Accepted: 02/23/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Despite reporting legislation, healthcare providers (HCPs) do not always report and collaborate in cases of suspected child abuse. Recognizing this leaves children at risk, the Wisconsin Child Abuse Network (WI CAN) sought to understand barriers to mandated reporting and collaboration with child abuse investigators. OBJECTIVE The purpose of the study was to investigate barriers for professionals in providing and obtaining high-quality medical information in child abuse investigations. PARTICIPANTS AND SETTING Participants included five discipline-specific focus groups: HCPs, child protective services (CPS), law enforcement, lawyers, and judges. All professionals had been directly involved in Wisconsin child abuse cases. METHODS This qualitative study consisted of discipline-specific focus groups, directed by open-ended interview questions. Data analysis was completed through the narrative inquiry methodology. RESULTS Barriers to providing and obtaining high-quality medical information in child abuse investigations were both discipline-specific and universal amongst all groups. Discipline-specific barriers included: HCPs' discomfort with uncertainty; CPS' perception of disrespect and mistrust by HCPs; law enforcement's concerns with HCPs' overstepping professional boundaries; lawyers' concern of HCPs' discomfort with court proceedings; and judges' perception of a lack of understanding between all disciplines. Universal barriers included: value of high-quality medical information in child abuse investigations, burden of time and money; unequal resources between counties; a need for protocols, and a need for interdisciplinary collaboration. CONCLUSION Findings from this study suggest several ways to address identified barriers. Possible interventions include equalizing resources between urban and rural counties (specifically financial resources and access to child abuse experts); protocolizing reporting and investigations; and, increasing interprofessional education.
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Affiliation(s)
| | - Norah L Johnson
- Marquette University, 530 N. 16th St. Milwaukee, WI, 53233, USA
| | - Lynn K Sheets
- Medical College of Wisconsin, 8701 W. Watertown Plank Rd., Wauwatosa, WI, 53226, USA
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Tonmyr L, Shields M, Asokumar A, Hovdestad W, Laurin J, Mukhi S, Burnside L. Can coders abstract child maltreatment variables from child welfare administrative data and case narratives for public health surveillance in Canada? Child Abuse Negl 2019; 92:77-84. [PMID: 30933833 DOI: 10.1016/j.chiabu.2019.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 03/17/2019] [Accepted: 03/21/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Public health surveillance is essential to inform programs that aim to eradicate child maltreatment (CM) and to provide services to children and families. However, collection of CM data imposes a burden on child welfare workers (CWWs). This study assesses the feasibility of hiring coders to abstract the required information from administrative records and case narratives. METHODS Based on a convenience sample of child welfare data from Manitoba, Canada, two coders abstracted information on 181 alleged CM cases. The coders completed a short web-based questionnaire for each case to identify which of five types of CM had been investigated, level of substantiation for each type, and risk of future CM. The CWWs responsible for each case completed the same questionnaire. Percentages of the occurrence of CM by the three sources were compared. The validity of the coders' classifications was assessed by calculating sensitivity, specificity, and positive and negative predictive values, against the CWWs' classifications as the "gold standard." Cohen's kappa was also calculated. RESULTS The coders' classifications of physical abuse, sexual abuse and neglect generally matched those of CWWs; for exposure to intimate partner violence, agreement was weak for one coder. Coding of emotional maltreatment and risk investigations could not be evaluated. CONCLUSION Results were promising. Abstraction was not time-consuming. Differences between coders and CWWs can be largely explained by the administrative data system, child welfare practice, and legislation. Further investigation is required to determine if additional training could improve coders' classifications of CM.
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Affiliation(s)
- Lil Tonmyr
- Public Health Agency of Canada, 785 Carling Ave, AL 6807B, Ottawa, ON, K1A 0K9, Canada.
| | - Margot Shields
- Public Health Agency of Canada, 785 Carling Ave, AL 6807B, Ottawa, ON, K1A 0K9, Canada
| | - Ajani Asokumar
- Department of Neuroscience, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada
| | - Wendy Hovdestad
- Public Health Agency of Canada, 785 Carling Ave, AL 6807B, Ottawa, ON, K1A 0K9, Canada
| | - Jessica Laurin
- Public Health Agency of Canada, 785 Carling Ave, AL 6807B, Ottawa, ON, K1A 0K9, Canada
| | - Shamir Mukhi
- Canadian Network for Public Health Intelligence, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Linda Burnside
- Birch Wellness Centre, 34 Carlton St, Winnipeg, MB, R3C 1N9, Canada
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Abstract
The current study investigates the role of race and county characteristics in substantiation and out-of-home placement decisions in the United States. Using multilevel models, we analyzed data from counties in the United States available through the National Child Abuse and Neglect Data Systems and Adoption and Foster Care Analysis and Reporting System to investigate the interactions between children's race and the context in which they live. Our sample consisted exclusively of children whose cases had been investigated; therefore, we were able to focus on the role played by race and county characteristics in substantiation and out-of-home placement decisions made by Child Protective Services, net of the heightened risk factors (or potential biases) that lead to disparate rates of reporting. Adjusting for state and county of investigation, Black, American Indian/Alaskan Native, and multiracial children were more likely than White (non-Hispanic) children to be substantiated or placed out of home, whereas Asian children were less likely to be substantiated or placed out of home. Notably, differences across groups are far smaller in magnitude when demographic and geographic differences are taken into account. Higher county-level poverty, percentages of Black residents, and juvenile arrest rates were associated with lower odds of substantiation and out-of-home placement among investigated children, whereas an elevated percentage of single-headed households was associated with higher odds of both outcomes. We also found that living in a rural county was associated with greater odds of substantiation but lower odds of out-of-home placement. Important differences by race were found for these associations. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Sarah A Font
- Department of Sociology and Criminology, The Pennsylvania State University
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Fluke JD, Harlaar N, Brown B, Heisler K, Merkel-Holguin L, Darnell A. Differential Response and Children Re-Reported to Child Protective Services: County Data From the National Child Abuse and Neglect Data System (NCANDS). Child Maltreat 2019; 24:127-136. [PMID: 30522344 DOI: 10.1177/1077559518816381] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Child protection systems that implement differential response (DR) systems screen to route referrals to an investigation response (IR) or alternative response (AR). AR responses emphasize family engagement, assessment of family needs, and service linkage. Usually, AR state-level policy does not require child welfare staff to make a maltreatment determination. Jurisdictions implement DR systems differently, leading to variations in the proportion of AR cases, risk levels of cases served, and the ways families access and use services. County data from the National Child Abuse and Neglect Data System were analyzed for six states from 2004 to 2013 that implemented DR. Variation in county-level AR rates were associated with county-level re-report rates using regression models with risk adjustments for socioeconomic and other county characteristics. Counties had 3% fewer re-reports overall for each percentage increase in AR use; higher levels of AR use are related to lower levels of re-reporting. When county AR and IR cases were analyzed separately, increasing rates of AR were associated with lower re-report rates for IR cases, but higher re-report rates for AR cases. Findings for the AR and IR subgroup must be interpreted with caution as a number of technical factors may be driving these results.
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Affiliation(s)
- John D Fluke
- 1 Department of Pediatrics, The Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nicole Harlaar
- 1 Department of Pediatrics, The Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado School of Medicine, Aurora, CO, USA
| | - Brett Brown
- 2 U.S. Department of Health and Human Services, Administration for Children and Families, Office of Planning, Research, and Evaluation, Washington, DC, USA
| | - Kurt Heisler
- 3 Kurt Heisler Consulting, LLC, Alexandria, VA, USA
| | - Lisa Merkel-Holguin
- 1 Department of Pediatrics, The Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado School of Medicine, Aurora, CO, USA
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Fong K. Neighborhood inequality in the prevalence of reported and substantiated child maltreatment. Child Abuse Negl 2019; 90:13-21. [PMID: 30716651 DOI: 10.1016/j.chiabu.2019.01.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 01/06/2019] [Accepted: 01/21/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Prior research documents spatial concentration in the incidence of child maltreatment reported to and confirmed by Child Protective Services (CPS), but without estimates of the prevalence of such reports, the extent of CPS contact in different communities is unknown. OBJECTIVE To estimate the prevalence of CPS reports during early childhood and substantiated investigations during childhood for children living in different types of neighborhoods. PARTICIPANTS AND SETTING Children who experienced CPS reports and substantiated investigations in Connecticut. METHODS This study uses synthetic cohort life tables to estimate the cumulative risk of CPS reports before age five and substantiated CPS investigations before age 18, by neighborhood poverty rate and neighborhood racial composition. RESULTS The analysis reveals substantial stratification in the prevalence of CPS contact by the demographic characteristics of children's residential neighborhoods. For example, while 7% of children in low-poverty neighborhoods (under 10% poor) experience a substantiated CPS investigation at some point during childhood at 2014 and 2015 rates, this risk more than doubles to 17% for their peers in moderate-poverty neighborhoods (10-20% poor) and more than triples to 26% for their peers in high-poverty neighborhoods (over 20% poor). Similar trends emerge when examining CPS reports in early childhood as well as when comparing neighborhoods with different proportions of White residents. CONCLUSIONS CPS reports and substantiated investigations are a widespread and disproportionately experienced life event for children in poor neighborhoods and children in non-White neighborhoods.
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Affiliation(s)
- Kelley Fong
- Department of Sociology, Harvard University, 33 Kirkland St., Cambridge, MA, 02138, USA.
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Kokaliari ED, Roy AW, Taylor J. African American perspectives on racial disparities in child removals. Child Abuse Negl 2019; 90:139-148. [PMID: 30780009 DOI: 10.1016/j.chiabu.2018.12.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 12/13/2018] [Accepted: 12/21/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND African American children are overrepresented in foster care at twice to three times the rate of white children. Scholars argue that racism and oppression underlie disproportionality (Križ & Skivenes, 2011). OBJECTIVE This study explored disproportionality as seen through the eyes of African American parents in the child welfare system. The aim was to understand why African American families are over-represented in child custody statistics and to improve family and parenting support for African American communities. PARTICIPANTS & SETTING Participants included twenty-one African Americans--12 women and 9 men, two of whom were foster parents and 19 of whom were parents involved with child welfare services. All participants reside in two impoverished areas in southern United States. Focus groups were used to collect data and were conducted at a community center. METHODS The method of analysis was constant comparison analysis (Strauss) and thematic analysis of the focus group discussions in the context of institutional policy. FINDINGS Six themes (profound lack of trust; overwhelming trauma; severe and persistent poverty; health and mental health; socio-economic conditions; and sense of social isolation were identified, along with three participant suggestions to improve child welfare services (family support services, economic revival, and better communication). CONCLUSIONS In the current study we note the strong link between poverty, child maltreatment, and child removal and conclude with an exploration of practice and policy implications with recommendations for a way forward. The need for culturally competent and trauma informed child welfare services is also discussed.
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Affiliation(s)
- Effrosyni D Kokaliari
- School of Social Work Springfield College, 263 Alden Street, Springfield 01109 MA, United States.
| | - Ann W Roy
- School of Social Work Springfield College, 263 Alden Street, Springfield 01109 MA, United States
| | - Joyce Taylor
- School of Social Work Springfield College, 263 Alden Street, Springfield 01109 MA, United States
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Nwabuzor Ogbonnaya I, Keeney AJ, Villodas MT. The role of co-occurring intimate partner violence, alcohol use, drug use, and depressive symptoms on disciplinary practices of mothers involved with child welfare. Child Abuse Negl 2019; 90:76-87. [PMID: 30769190 DOI: 10.1016/j.chiabu.2019.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 01/22/2019] [Accepted: 02/04/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Evidence suggests intimate partner violence (IPV), substance use, and depression adversely affect the disciplinary practices of caregivers involved with child welfare; however, it remains uncertain whether the combined effects of these conditions are syndemic. OBJECTIVE The purpose of this study was to examine the (1) associations between IPV, problematic drug use, problematic alcohol use, and depressive symptoms and self-reported disciplinary practices among a sample of mothers with child welfare contact; and (2) effect of co-occurrence of these conditions on child disciplinary practices. PARTICIPANTS AND SETTING We used data from the second cohort of the National Survey of Child and Adolescent Well-Being (NSCAW II). The analysis focused on 965 biological mothers with children who were subjects of child abuse/neglect investigations between February 2008 and April 2009 in the United States. METHOD We conducted multiple linear regression analyses. RESULTS Our findings showed that IPV (B = .28; 95% CI = [.04, .53]) and depressive symptoms (B = .27; 95% CI = [.03, .52]) were independently associated with psychologically aggressive disciplinary practices. Also, IPV was independently associated with physically aggressive disciplinary practices (B = .64; 95% CI = [.18, 1.11]); and IPV (B = .21; 95% CI = [.06, .35]) and depressive symptoms (B = .22; 95% CI = [.07, .37]) were independently associated with neglectful parenting strategies. A significant effect was found for the interaction between problematic drug use and depressive symptoms with physically aggressive practices as the outcome. As the number of conditions caregivers had increased, so did their propensity for self-reporting each of the disciplinary practices (p < .05). CONCLUSIONS The findings highlight the need for using a more holistic/multidisciplinary approach to child maltreatment prevention research, policy, and intervention.
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Affiliation(s)
| | - Annie J Keeney
- School of Social Work, San Diego State University, United States
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O'Donnell M, Taplin S, Marriott R, Lima F, Stanley FJ. Infant removals: The need to address the over-representation of Aboriginal infants and community concerns of another 'stolen generation'. Child Abuse Negl 2019; 90:88-98. [PMID: 30769191 DOI: 10.1016/j.chiabu.2019.01.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 11/14/2018] [Accepted: 01/23/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The removal of a child from their parents is traumatising, particularly in Aboriginal communities where a history of child removals has led to intergenerational trauma. This study will determine where disparities in child protection involvement exist among Aboriginal and non-Aboriginal children and characteristics associated with infant removals. Challenges faced by child protection and other agencies, and opportunities for overcoming these, are discussed. METHODS Data from both the Australian Institute of Health and Welfare and linked Western Australian government data was used to examine disparities between Aboriginal and non-Aboriginal children in the child protection and out-of-home care system. RESULTS Nationally, Aboriginal children are ten times more likely to be placed in out-of-home care than non-Aboriginal children and this disparity starts in infancy. Infants were removed from parents with high levels of risk. Aboriginal infants were at increased risk of being removed from women with substance-use problems and had greater proportions removed from remote, disadvantaged communities than were non-Aboriginal infants. CONCLUSIONS Aboriginal infants have a high rate of removal. Although there are many complexities to be understood and challenges to overcome, there are also potential strategies. The disparity between Aboriginal and non-Aboriginal infant removals needs to be seen as a priority requiring urgent action to prevent further intergenerational trauma.
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Affiliation(s)
- Melissa O'Donnell
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia. Melissa.O'
| | - Stephanie Taplin
- Institute of Child Protection Studies, Australian Catholic University, Canberra, Australia
| | | | - Fernando Lima
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Fiona J Stanley
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
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Kelly P, Thompson JMD, Rungan S, Ameratunga S, Jelleyman T, Percival T, Elder H, Mitchell EA. Do data from child protective services and the police enhance modelling of perinatal risk for paediatric abusive head trauma? A retrospective case-control study. BMJ Open 2019; 9:e024199. [PMID: 30826760 PMCID: PMC6429859 DOI: 10.1136/bmjopen-2018-024199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES First, to investigate whether there is a relationship between a family being known to child protective services or police at the time of birth and the risk of abusive head trauma (AHT, formerly known as shaken baby syndrome). Second, to investigate whether data from child protective services or police improve a predictive risk model derived from health records. DESIGN Retrospective case control study of child protective service and police records. SETTING Nine maternity hospitals. PARTICIPANTS 142 consecutive cases of AHT admitted to a tertiary children's hospital from 1991 to 2010 and born in one of the nine participating maternity hospitals. 550 controls matched by the date and hospital of birth. OUTCOME MEASURE Abusive head trauma. RESULTS There is a relationship between families known to child protective services or police and the risk of AHT. Notification to child protective services: univariable OR 7.24 (95% CI 4.70 to 11.14). Involvement with youth justice: univariable OR 8.94 (95% CI 4.71 to 16.95). Police call-out for partner violence: univariable OR 3.85 (95% CI 2.51 to 5.91). Other violence offence: univariable OR 2.73 (95% CI 1.69 to 4.40). Drug offence: univariable OR 2.82 (95% CI 1.63 to 4.89). However, in multi-variable analysis with data from perinatal health records, notification to child protective services was the only one of these variables to remain in the final model (OR 4.84; 95% CI 2.61 to 8.97) and had little effect on overall predictive power. The area under the receiver operating characteristic curve was 89.5% (95% CI 86.6 to 92.5) using variables from health data alone and 90.9% (95% CI 88.0 to 93.7) when notification was added. CONCLUSIONS Family involvement with child protective services or police is associated with increased risk of AHT. However, accessing such data at the time of birth would add little predictive power to a risk model derived from routine health information.
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Affiliation(s)
- Patrick Kelly
- Te Puaruruhau, Starship Children’s Health, Auckland, New Zealand
- Paediatrics: Child and Youth Health, University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - John M D Thompson
- Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Santuri Rungan
- Community Child Health, Sydney Children’s Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia
| | - Shanthi Ameratunga
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Timothy Jelleyman
- Department of Paediatrics, Waitemata District Health Board, Takapuna, New Zealand
| | - Teuila Percival
- Paediatrics: Child and Youth Health, University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
- Kidz First Children’s Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Hinemoa Elder
- School of Graduate Studies, Te Whare Wānanga o Awanuiārangi, Auckland, New Zealand
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Abstract
PURPOSE The Children in Need Census (CIN) is a case-based administrative dataset on children referred to social care services in England. CIN includes information on the 'needs' of children, and whether they received social care support. Local and national government bodies in England currently use CIN for evaluation purposes. Data are accessible to researchers under certain conditions, allowing researchers to investigate the health implications of adverse childhood experiences. However, CIN suffers from lack of metadata, meaning it can be challenging for researchers to process and interpret data, particularly if researchers are unfamiliar with the English children's social care system. To address this issue, we provide the background to CIN and describe the available data from 2008 to 2016. PARTICIPANTS CIN is derived from case records held by English local authorities on all children referred to children's social care for a 'needs assessment', regardless of whether they are eventually assessed as 'in need of social care support'. Local authorities submit these case records to the UK Department for Education for collation. CIN holds information on an estimated 2.76 million children from October 2008 to March 2016. Since 2013/2014, just under 900 000 children have been recorded in the CIN annually, equivalent to around 8% of children in England (annual prevalence). Approximately, 650 000 children enter or renter the dataset each year, equivalent to 5% of children in England (annual incidence). DATA SUMMARY Of the estimated 2.76 million children in the data, 50% are male and 47% female. 45% are referred to children's social care services due to abuse or neglect. 10.7% of children in CIN went onto a child protection plan, meaning they were judged to be (at risk of) suffering significant harm. FUTURE PLANS CIN data collection is annual and ongoing. Data from the most recent census period typically become available for researchers in the following Spring.
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Affiliation(s)
- Emily H Emmott
- Department of Anthropology, University College London, London, UK
| | - Matthew A Jay
- UCL Legal Epidemiology Group, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jenny Woodman
- Thomas Coram Research Unit, Department of Social Science, UCL Institute of Education, University College London, London, UK
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Konijnendijk AAJ, Boere-Boonekamp MM, Haasnoot ME, Need A. Professionals' preferences and experiences with inter-organizational consultation to assess suspicions of child abuse and neglect. Child Abuse Negl 2019; 88:58-70. [PMID: 30447503 DOI: 10.1016/j.chiabu.2018.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 09/17/2018] [Accepted: 10/23/2018] [Indexed: 06/09/2023]
Abstract
This study addresses the following questions in cases of suspected child abuse and neglect (CAN) in children up to four years of age: 1) How many professionals intend to seek inter-organizational consultation? 2) What types of organizations do professionals prefer to consult? and 3) What factors can be identified as facilitator(s) or barrier(s) regarding inter-organizational consultation, based on professionals' experiences? Professionals working with children in 101 organizations in a medium-sized Dutch city were invited to fill in an online questionnaire. The questionnaire included a vignette about a suspected case. Quantitative, qualitative, and social network analysis approaches were used to analyze the data. Seventy-eight questionnaires were available for analysis. Fifty-five respondents (71%) intended to seek inter-organizational consultation. Ten different organization types were mentioned. The most frequently mentioned organization was preventive child healthcare. In total, 82 text fragments from 39 participants were available to analyze barriers and facilitators to inter-organizational consultation, 60 fragments that entailed a facilitator and 22 fragments that entailed a barrier. The text fragments were subdivided into twelve factors. The three factors that were most often identified as a facilitator were 'support', 'undertaking action', and 'regard'. Barriers were found in relation to all twelve factors. No specific barrier(s) stood out. This study demonstrated that most professionals are inclined to seek inter-organizational consultation when they suspect CAN. They are especially likely to seek consultation from preventive child health care organizations. Their experiences mainly revealed facilitators and few barriers. The implications for research and practice are also discussed.
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Affiliation(s)
- Annemieke A J Konijnendijk
- Departments of Health Technology and Services Research, and Public Administration, Institute of Innovation and Governance Studies, University of Twente, Enschede, the Netherlands.
| | - Magda M Boere-Boonekamp
- Department of Health Technology and Services Research, Institute of Innovation and Governance Studies, University of Twente, Enschede, the Netherlands
| | - Maria E Haasnoot
- Department of Preventive Child Healthcare, Municipal Health Service GGD Twente, Enschede, the Netherlands
| | - Ariana Need
- Department of Public Administration, Institute of Innovation and Governance Studies, University of Twente, Enschede, the Netherlands
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