Maltreatment following reunification: predictors of subsequent Child Protective Services contact after children return home

Identifying Trajectories of Maltreatment Revictimization and Juvenile Justice Outcome: A Latent Class Analysis of Subtype, Timing, and Chronicity

Continued exposure to abuse or neglect is a strong predictor for immediate and long-term negative developmental outcomes including developmental delays, disabilities, poor school performance, criminal behavior, and mental health issues. The purpose of this study was to identify distinct subgroups of children with repeat victimization based on maltreatment timing, subtype, and chronicity and to examine how the unique subgroups are related to youth's juvenile justice outcome. Using data from Longitudinal Studies of Child Abuse and Neglect, this study included 286 children (47% males, 41% blacks) with more than one report for substantiated maltreatment from birth to age 17. Latent class analysis was employed to identify heterogeneity in the patterns of maltreatment revictimization. Four latent classes emerged: (a) Prevailing Early Neglect (52.6%); (b) Co-occurring Maltreatments in Preschool Age (20.1%); (c) Incremental Neglect with Sexual Abuse in School Age (18.7%); and (d) Co-occurring Maltreatments in School Age (8.6%). Black children were overrepresented in Incremental Neglect with Sexual Abuse in School Age compared to white and other racial groups of children. Ordinal logistic regression analysis indicated that there was no significant difference in the juvenile justice outcome across four subgroups of children with revictimization. Our person-centered investigations of maltreatment subtype, timing, and chronicity highlight the need for precise assessment and prevention strategies based on a more nuanced understanding of various patterns of childhood maltreatment revictimization.

Parental Risk and Protective Factors in Child Maltreatment: A Systematic Review of the Evidence

This study systematically reviews and synthesizes evidence on parental risk and protective factors along with identifying differences in the presence of these factors based on maltreatment type. In all, 68 quantitative, published, empirical studies were included from electronic databases for the systematic review. Quality appraisal did not exclude any studies and data were extracted from all. Results were narratively synthesized using the Risk and Resilience Ecological framework. The findings revealed more risk factors on the micro (individual and family) ecological level compared to mezzo and macro levels. At the micro level, findings mirror results of prior systematic reviews such as parental substance abuse, history of childhood maltreatment, and intimate partner violence (IPV). Social support was the most significant protective factor across all ecological levels and across all maltreatment types except child sexual abuse but differed in definition widely across studies. Physical abuse had the most risk factors unique to this type followed by neglect, and IPV was a common risk factor across all maltreatment types. Fewer studies on emotional abuse, sexual abuse, and protective factors were identified. The findings of this review delineated key parental risk and protective factors at various ecological levels along with associations between distinct factors and types of maltreatment. Interventions working with parents to reduce child maltreatment risk can use these findings to guide development of targeted programs for families based on risk and maltreatment type. For researchers, the findings can guide further investigation in under-researched areas of parental sexual and emotional abuse and protective factors.

Child Protective Services Reports After Reunification: An Examination of the Risk of Being Rereported to Child Protective Services After Returning Home From Foster Care

While a number of studies have examined the risk of reentry after exiting foster care, few studies have examined the risk of rereport to Child Protective Services (CPS) in the United States. Understanding more about rereports may help identify targets for supportive services that prevent reentry and promote safety. This study is the first to use nation-wide linked data to examine the risk of rereport for reunified children. The sample included children reunified after experiencing their first episode in foster care with at least one CPS report prior to care. With a 2000-day observation period, flexible parametric survival models with time varying hazard ratios were used to model the hazard or rereport conditional on prior CPS and foster care characteristics. Over 50% of the sample experienced a rereport after reunification. Results indicate that children entering foster care following a history of multiple CPS reports prior to placement were at substantially increased risk of rereport after returning home. A group of children with shorter stays in care had a high risk of recurrence within the first month, but this was not true over time. Implications for future research as well as permanency planning and addressing the needs of families with chronic reports are discussed.

Reunification trajectories in Quebec: Acknowledging chronic family challenges to support stability

BACKGROUND

While family reunification following out-of-home placement is a goal of child protection policy, complex family needs may not be met at the point that child protection systems reunify families. Permanency legislation creating maximum placement timeframes prompts questions regarding what families need to be supported in stably reunifying following a child's removal from the home.

OBJECTIVE

We aim to identify clinical risk factors salient for initial placements and placements following a child reunifying with their family to inform successful reunification and improve children's stability.

PARTICIPANTS AND SETTING

The study includes a representative sample of children in Quebec with a child protection investigation in 2008 (N = 3051) followed for nine years.

METHODS

Cross-sectional clinical data from the Quebec Incidence Study (QIS) on Evaluated Child Protection Reports (2008) were linked with longitudinal administrative data from 16 provincial child protection agencies. Canadian Census data (2006) were used to create a factorial index measure for poverty. Chi-square automatic interaction detector (CHAID) decision tree analysis was used to compare risk factors salient for initial placements (n = 1120) with post-reunification placements (n = 455).

RESULTS

For the placement sample (n = 1120), significant factors were: attachment issues, caregiver drug use, child's suicidal thoughts, child's self-harming behavior, and academic difficulties. Of the children who reunified with their families (n = 847), over half (n = 455; 54%) returned to out-of-home placements. Certain factors remained significant for placement after reunification: academic difficulties, attachment issues, and caregiver drug use. The CHAID model fit estimates suggest 70.9% (SE = 0.008) accuracy predicting out-of-home placement following child protection investigation and 58.2% (SE = 0.017) accuracy predicting re-placement following family reunification.

CONCLUSIONS

Complex needs among families most likely to experience reunification breakdown indicate potential service gaps. When legislated placement timeframes prompt quick resolution of family challenges, these analyses can contribute to policy discussions regarding clinical family challenges that impact stability.

Family outcomes in alternative response: A multilevel analysis of recurrence

Alternative response (AR) is preventative, family-centered, strengths-based approach within child protective services (CPS). When AR is offered it typically creates a two-track system where low- to moderate-risk families are not subjected to a traditional, fact-finding response that concludes with a determination of child abuse/neglect. One area that continues to concern child welfare administrators and researchers is recurrence, or when a family returns to CPS. Yet, it is unclear whether AR families have the same or different predictors of recurrence than TR families. Using a multilevel analytic approach, the present study followed 17,741 families in one mid-Atlantic state for 18-months post-response to determine what child, family, and county-level predicted a reported re-investigation and a substantiated re-investigation. We found few differences in predictors at the child and family level but found distinct differences at the county level for AR families. Recommendations are provided for policy, practice, and research, including a suggestion for further inquiry on what makes an optimal AR track.

The Centrality of Child Maltreatment to Criminology

Despite sufficient evidence to conclude that maltreatment exposure affects the risk of crime and delinquency, we conclude that the unique effects of child maltreatment on crime and delinquency, and the mechanisms through which those effects operate, remain poorly identified. Key challenges include insufficient attention to the overlap of child maltreatment with various forms of family dysfunction and adversity and a lack of comprehensive measurement of the multiple, often comorbid, forms of child maltreatment. We then consider potential impacts of the child welfare system on the maltreatment-crime link. Because the child welfare system typically provides voluntary, short-term services of unknown quality, it likely neither increases nor reduces risks of delinquency and crime for most children who encounter it. For the comparatively small subset of children experiencing foster care, impacts on delinquency and crime likely vary by the quality of environments within and after their time in care - issues that, to date, have received too little attention.

Behavioral and pharmacological interventions for the prevention and treatment of psychiatric disorders with children exposed to maltreatment

There is a well-established relation between exposure to child maltreatment and the onset and course of multiple, comorbid psychiatric disorders. Given the heterogeneous clinical presentations at the time services are initiated, interventions for children exposed to maltreatment need to be highly effective to curtail the lifelong burden and public health costs attributable to psychiatric disorders. The current review describes the most effective, well-researched, and widely-used behavioral and pharmacological interventions for preventing and treating a range of psychiatric disorders common in children exposed to maltreatment. Detailed descriptions of each intervention, including their target population, indicated age range, hypothesized mechanisms of action, and effectiveness demonstrated through randomized controlled trials research, are presented. Current limitations of these interventions are noted to guide specific directions for future research aiming to optimize both treatment effectiveness and efficiency with children and families exposed to maltreatment. Strategic and programmatic future research can continue the substantial progress that has been made in the prevention and treatment of psychiatric disorders for children exposed to maltreatment.

Moderators and mediators of outcomes of parents with substance use problems: further evaluation of the Parents under Pressure programme

BACKGROUND AND AIMS

Family-focused interventions can improve family functioning when parents have substance use problems. However, there has been little focus upon potential predictors of change and analysis of mechanisms of change. This study aims to identify mediators and moderators of change in a pragmatic, multi-site, randomized controlled trial of the Parents under Pressure (PuP) programme, a family-focused intervention for parents with substance use and other problems, and treatment-as-usual (TAU).

DESIGN

Secondary analysis of data: multi-level modelling was used to investigate moderators of treatment outcome; mediation was tested with cross-lagged models.

SETTING

Community-based family support services in the United Kingdom.

PARTICIPANTS

Parents (n = 100) attending community-based addiction services with children aged 2.5 years or younger.

MEASUREMENTS

Predictors of the primary outcome, child abuse potential, were: baseline child age and gender, composite family risk score, parental substance use and parental emotional dysregulation. Mediation was tested across three time-points with the observed variables parental emotion dysregulation and child abuse potential.

FINDINGS

Increased child age [Z = 2.14, 95% confidence interval (CI) = 0.01, 0.33] at baseline was associated with greater reductions in child abuse potential for PuP programme participants compared with TAU. Poorer parental emotional regulation (Z = 2.48, 95% CI = -2.76, -0.32) was associated with greater reductions in child abuse potential for all participants. Parental substance use (either recent use or primary substance of concern) did not alter any treatment effects on child abuse potential. The mediation analysis showed that PuP produced greater improvements in emotional regulation at post-treatment (P < 0.001) compared with TAU, which predicted lower child abuse potential at 6-month follow up (P < 0.05).

CONCLUSIONS

For UK parents enrolled in a family-focused intervention, baseline measurements of higher child age appear to be associated with greater reductions in child abuse potential at 6-month follow-up in PuP participants compared with treatment as usual (TAU). Poorer parental emotional regulation and, potentially, higher family risk, appears to be associated with greater reductions in child abuse potential at 6-month follow-up in PuP and TAU. Emotional regulation appeared to act as a mediator as improvements in parental emotional regulation post-treatment appeared to be associated with greater reductions in child abuse potential at 6-month follow up. Notably, participation in the PuP programme led to better parental emotional regulation compared with TAU.

Foster care, permanency, and risk of prison entry

Objective

(1) Examine associations of foster care exit type (e.g., reunification with birth family, adoption, guardianship/permanent relative placement, or emancipation from care) with risk of entry into state prison; (2) Examine racial disparities in those associations.

Method

With data on over 10,000 Wisconsin youth who entered foster care in mid- to late-childhood, we present imprisonment rates in young adulthood by race, sex, and foster care exit type. Proportional hazards models with a robust set of covariates compared prison entry rates among the most common exit types-reunification, aging out, and guardianship/permanent relative placement.

Results

Nearly 13% of the sample experienced imprisonment in young adulthood. Compared with emancipated youth, hazard of imprisonment was 1.58-1.96 times higher among reunified youth. Differences were largely unexplained by observed individual, family, or foster care characteristics. Imprisonment rates were similar for emancipated youth and youth exiting to guardianship/permanent relative placement. Hazard of imprisonment for reunified Black youth was twice that of reunified white youth, but racial differences in prison entry were statistically non-significant among emancipated youth.

Conclusion

Efforts to reduce incarceration risk for all youth in foster care are needed. Reunified youth may benefit from services and supports currently provided primarily to emancipated youth.

Tea or Thrush?: A Case of Nonaccidental Oral Injury in an Infant

A 5-month-old girl child patient presented to the emergency department for oral thrush and poor feeding but instead demonstrated concern for abuse after physical exam, as findings were consistent with oral injury. Correct identification of the oral findings as traumatic necessitated navigating language and cultural issues before the mechanism of injury and abuse determination could be made. Exploring the involvement of other caregivers was a crucial piece for investigation of the clinical scenario. The incidence of child abuse and pediatric oral injuries concerning for abuse were reviewed in this case report.

Identifying children at high risk for recurrence child abuse

PURPOSE

To evaluate the characteristics of abused children, families and abusive event and to identify risk factors associated with recurrence of child abuse.

METHODS

Retrospective data from 133 children aged between 2 months to 15 years old who were diagnosed as abuse between year 2002 and 2017. Thirteen items related to characteristics of the child, families, abusive event were selected. These factors were analyzed by multivariate logistic regression model for association with repeated child abuse.

RESULTS

Total of 133 subjects with average age of 5.25 ± 4.65 years old. There were 54 cases (40.60%) reported of repeated abuse. Majority of repeated abuse type in this study was physical abuse (73.68%). Most perpetrators were child's own parents (45.10%). Factors associated with increased risk of repeated abuse were child age 1-5 years old (AOR = 4.95/95%CI = 1.06-23.05), 6-10 years old (AOR = 6.80/95%CI = 1.22-37.91) and perpetrator was child's own parent (AOR = 21.34/95%CI = 3.51-129.72). Three cases of mortality were found with single-visit children and one case in recurrence. Most of death cases were children less than 1-year-old with average age of 7 months. Causes of death were subdural hematoma with skull and ribs fracture.

CONCLUSIONS

Identifying risk factors for repeated child abuse help in recognizing child at risk to provide prompt intervention. This study found two factors associated with higher risk of abuse recurrence: child age 1-10 years old and abusive parents. Children who presented with these risk factors should be recognized and intensively monitored.

Child Maltreatment and Neglect

Emergency medicine clinicians are mandated reporters, legally, which obligates clinicians to report any behavior suspicious for child maltreatment to local authorities. Pediatric patients often present to the emergency department with concern for physical injury and other pervasive complaints. In some cases, these injuries are nonaccidental. To appropriately advocate and protect children from further physical and emotional trauma, it is important for clinicians to recognize the signs and symptoms of child maltreatment and sexual abuse.

The dynamics of two-session interviews with suspected victims of abuse who are reluctant to make allegations

Supportive forensic interviews conducted in accordance with the National Institute of Child Health and Human Development Revised Protocol (RP) help many alleged victims describe abusive experiences. When children remain reluctant to make allegations, the RP guides interviewers to (a) focus on rapport building and nonsuggestive support in a first interview, and (b) plan a second interview to allow continued rapport building before exploring for possible abuse. We explored the dynamics of such two-session RP interviews. Of 204 children who remained reluctant in an initial interview, we focused on 104 who made allegations when re-interviewed a few days later. A structural equation model revealed that interviewer support during the first session predicted children's cooperation during the rapport-building phase of the second session, which, in turn, predicted more spontaneous allegations, which were associated with the interviewers' enhanced use of open-ended questions. Together, these factors mediated the effects of support on children's free recall of forensically important information. This highlighted the importance of emphasizing rapport with reluctant children, confirming that some children may need more time to build rapport even with supportive interviewers.

Recurrent involvement with the Quebec child protection system for reasons of neglect: A longitudinal clinical population study

Studies in several jurisdictions have found that families become recurrently involved with child protection systems most frequently for reasons of neglect. Child protection involvement for reasons of neglect is shown to correlate with various socioeconomic vulnerabilities.

OBJECTIVE

This study, the largest of its kind in Canada, examines when and for whom recurring conditions of neglect were most likely to occur for all children involved with child protection in the province of Quebec over a span of fifteen years.

PARTICIPANTS AND SETTING

Specifically, the study population includes all children whose ongoing child protection intervention in Quebec closed between 2002 and 2017 (N = 76,176).

METHODS

This clinical population study uses a longitudinal research design drawing anonymized clinical administrative data from all of Quebec's child protection jurisdictions spanning 15 years, and Quebec data extracted from the 2011 Canadian National Household Survey to estimate socioeconomic vulnerability.

RESULTS

Of the total population studied, 32.5 % (N = 24,816) experienced a recurrence of maltreatment during the study period, of which more than one third (N = 8707) experienced a recurrence for reasons of neglect.

CONCLUSIONS

Because the association between socioeconomic vulnerability and recurrence of neglect indicates a gap in material and social supports-which child protection systems have neither the mandate nor the resources to fill-we propose additional avenues that we urge policymakers and practitioners to consider in supporting the demonstrated needs of these families.

Family Reunification Decision-Making in Dutch Family Foster Care: A Dual Perspective Approach

Background

An important responsibility of the child welfare system, is taking decisions on the reunification of children with their birth parents after the children have lived in foster families. We currently lack evidence-based knowledge to guide the reunification decision-making process.

Objective

The present study uses concept mapping as an exploratory method, to identify themes that seem to be used by two groups of professionals in their judgement and decision making on reunification.

Method

First, we consulted 78 foster care workers and studied 172 legal cases to examine criteria important for reunification. Next, unique criteria were grouped and rated by 35 foster care workers and also by 12 family judges separately. The data was analysed with multidimensional scaling and cluster analysis which resulted in a concept map for each group of professionals.

Results

Both foster care workers and family judges suggested the following themes in the reunification decision-making process: (a) birth parents’ functioning and parenting abilities, (b) birth parents’ acceptance of support, and (c) the child’s functioning, developmental needs and wishes. Besides parallel themes, both foster care workers and family judges also seem to consider unique themes.

Conclusions

The suggested similarities and differences between the two groups of professionals possibly reflect different professional frameworks. The foster care workers’ considerations seem to have an orientation towards permanency planning while the family judges’ considerations seem to be linked to the legal framework. Gaining insight in the perspective of different groups of professionals involved in the process of reunification, is a small but important step towards reaching consensus through discussion in order to achieve the optimal implementation of the decisions considered in the best interest of children’s future.

Sibling Child Protective Services Involvement Following a Child Maltreatment Fatality

OBJECTIVE

This study examined CPS involvement of children surviving the CMF of a sibling as well as predictors of subsequent CPS reports.

METHOD

Department of Human Services and Child Death Review Board data about children who died from a CMF during 1993-2003 (n = 416) and their siblings in the state of Oklahoma were used to examine CPS involvement and predictors of subsequent CPS reports for surviving siblings.

RESULTS

Surviving siblings of a victim of a CMF experienced substantial CPS involvement; 81% of the original victims had siblings who were subsequently reported to CPS (n = 1,840). Original victim and family characteristics that predicted a greater rate of siblings' subsequent reports to CPS included younger original victim age, greater number of children in the original victim's home, and more previous reports of the original victim to CPS.

DISCUSSION

A large portion of families with a CMF struggle to adequately care for their surviving children. Such families may need additional support after a CMF.

Private vs public child welfare systems: A comparative analysis of national safety outcome performance

BACKGROUND

Ensuring the safety of American children is one of the chief mandates of the U.S. Child Welfare System. Yet system differences, including privatization remain an area of concern for whether safety of children is achieved.

OBJECTIVE

This study examined the effect of privatization policy on the performance of state child welfare systems in terms of achieving national safety outcome standards.

PARTICIPANTS AND SETTING

N₁ = 10 states systems (5 privatized and 5 public systems) with N₂ = 118,761 foster care cases located throughout the U.S.

METHOD

Using data from the Adoption and Foster Care Analysis and Reporting System (AFCARS), safety outcome performance measures were assessed, as were child-/case factors to predict the likelihood of the system types meeting the national safety outcome standards.

RESULTS

Logistic regression models of child, case, and system factors predicting the likelihood state systems met national safety outcome performance standards were statistically significant. Private systems, compared to non-private systems, were found to have lower odds of meeting the safety outcome 1 standard (OR = 0.41, 95% CI = 0.40-0.42), but greater odds of meeting the safety outcome 2 standard (OR = 6.79, 95% CI = 6.56-7.02).

CONCLUSIONS

The implementation of privatization policy in state child welfare/foster care service delivery was found to have mixed results in terms of the national safety outcome standards.

Repeat reports among cases reported for child neglect: A scoping review

BACKGROUND

In the United States (US), child welfare policy prioritizes prevention of future harm (e.g., repeat reports) after a report of maltreatment. The majority of reports include some form of child neglect, but no prior review of the recurrence literature has focused on neglect.

OBJECTIVE

This review sought to help guide future research, policy and practice by summarizing recurrence findings related to child neglect with attention to the broader ecological context in which maltreatment occurs.

PARTICIPANTS

The final review included 34 US studies of maltreatment recurrence. Twenty-eight studies compared child neglect with at least one other form of maltreatment and six studies examined recurrence among neglect cases.

METHODS

Eleven online databases were searched to locate relevant empirical studies. This review attended specifically to contextualizing findings according to other modifiable factors as well as methodological variation. A scoping review approach was used to summarize findings.

RESULTS

Of the 28 studies comparing neglect to other types of maltreatment, 14 found increased risk for neglect, 12 found no association, and two reported a lower risk. When significant, the effect size ranged from 10% to over three times higher risk for neglect. Poverty or material need was the most commonly included control (15 studies), with two thirds finding that lower resource families had higher risk.

CONCLUSION

Methodological variability across studies confounds current ability to guide practice or policy. More research is needed that can replicate and extend findings with comparable samples and model specifications that take into account the regional and policy context.

Ongoing Pediatric Health Care for the Child Who Has Been Maltreated

Pediatricians provide continuous medical care and anticipatory guidance for children who have been reported to state child protection agencies, including tribal child protection agencies, because of suspected child maltreatment. Because families may continue their relationships with their pediatricians after these reports, these primary care providers are in a unique position to recognize and manage the physical, developmental, academic, and emotional consequences of maltreatment and exposure to childhood adversity. Substantial information is available to optimize follow-up medical care of maltreated children. This new clinical report will provide guidance to pediatricians about how they can best oversee and foster the optimal physical health, growth, and development of children who have been maltreated and remain in the care of their biological family or are returned to their care by Child Protective Services agencies. The report describes the pediatrician's role in helping to strengthen families' and caregivers' capabilities and competencies and in promoting and maximizing high-quality services for their families in their community. Pediatricians should refer to other reports and policies from the American Academy of Pediatrics for more information about the emotional and behavioral consequences of child maltreatment and the treatment of these consequences.

Permanency and the Educational and Economic Attainment of Former Foster Children in Early Adulthood

Foster children are at disproportionate risk of adverse outcomes throughout the life course. Public policy prioritizes permanency (exiting foster care through reunification with birth parents, adoption, or legal guardianship) as means of promoting healthy development and wellbeing for foster youth, but little empirical evidence indicates that permanency, including its most preferred form-reunification-promotes positive outcomes. Using multi-system, statewide longitudinal administrative data, we employed logistic and mixed-effects regression to examine educational attainment and earnings among former foster youth in early adulthood. We included a variety of sociodemographic and economic controls to reduce selection bias. We found that youth who did not attain permanency (those who aged out of care) had significantly higher odds of graduating high school and enrolling in college than reunified youth and youth who exited to guardianship, and similar odds as adopted youth. Earnings were similar across groups. Among aged-out (but not reunified) youth, odds of high school graduation and average earnings were higher for those who spent more time in foster care prior to age 18. Notably, some findings were sensitive to the categorization of youth who ran away from care. Overall, results suggest that permanency alone is insufficient to promote foster youths' educational and economic attainment.

Growth patterns of future orientation among maltreated youth: A prospective examination of the emergence of resilience

During adolescence, a positive outlook toward the future (i.e., future orientation) can protect youth from the risks conferred by childhood adversity. Research to date, however, has largely considered future orientation as a static attribute. Developmental systems perspectives suggest that future orientation, when considered across time, will exhibit dynamic trajectories with levels changing in response to the varying balance of risks and resources in youths' environments. Investigating the developmental course and consequences of future orientation is particularly germane to maltreated youth who may benefit from programs that target this protective mechanism. The present study tested hypotheses regarding the developmental course of future orientation, including the association of distinct future orientation trajectories with time-varying risk factors and resources, and the association of continuity and change in future orientation trajectories with young adult psychosocial functioning. Hypotheses were investigated with longitudinal (T1 M_age = 12.22, T2 M_age = 13.52, T3 M_age = 14.79, T4 M_age = 18.54), multireporter data from a nationally representative sample of maltreated youth (N = 1,461). Growth mixture modeling (GMM) identified three classes of growth trajectories in future orientation: high-persistent, low start/increasing, and high start/decreasing. Time-variant and -invariant risk factors and resources differentiated youths' future orientation trajectories. Youth in the high-persistent and low start/increasing trajectories were more likely to attain young adulthood developmental milestones-including independent living skills, social capital, employment, and higher weekly income. This study documents how an important component of resilient adaptation emerges and promotes positive outcomes among highly vulnerable youth. (PsycINFO Database Record

Child maltreatment re-offending in families served by the United States Air Force Family Advocacy Program

The current study examined child maltreatment re-offending in United States Air Force (USAF) families. In a clinical database containing 24,999 child maltreatment incidents perpetrated by 15,042 offenders between the years 1997 and 2013, 13% of offenders maltreated a child on more than one date (i.e., they re-offended). We explored several offender demographic characteristics associated with who re-offended and found that civilians re-offended at a similar rate as active duty members, males re-offended at a similar rate as females, and younger offenders were more likely to re-offend than older offenders. We also explored incident characteristics associated with who re-offended: Re-offending was more likely if the initial maltreatment was neglect or emotional abuse and re-offenders were likely to perpetrate subsequent maltreatment that was the same type and severity as their initial incident. The current data indicate that young offenders and offenders of neglect and emotional maltreatment are the greatest risk of re-offending. These offender and incident characteristics could be used by the USAF to guide their efforts to reduce re-offending.

Les contacts parent-enfant suite au placement en famille substitut : liens avec la stabilité du placement

Cadre de la recherche :Les enfants d’âge préscolaire sont moins susceptibles de retourner dans leur milieu d’origine suite à une mesure de placement et ont généralement des trajectoires de placement plus stables. Or, nous en connaissons peu sur les facteurs associés à la stabilité du placement chez les enfants d’âge préscolaire et plus particulièrement, sur le rôle des contacts parent-enfant sur la trajectoire de placement de ces enfants.

Objectifs :La présente étude examine les liens entre les contacts parent-enfant et trois indices de stabilité de la trajectoire de placement : les perspectives de réunification familiale, la survenue d’un échec de la réunification et le nombre de milieux substituts où l’enfant a été hébergé suite à son placement.

Méthodologie :Cinquante-quatre parents biologiques et 43 parents substituts responsables de jeunes enfants âgés entre 12 et 43 mois sont rencontrés. Les informations liées au contexte socio-démographique et aux modalités de contacts sont recueillies lors d’une entrevue individuelle avec le parent biologique et l’engagement parental est évalué à partir d’une grille d’observation.

Résultats :Les résultats indiquent que les contacts parent-enfant sont associés ou tendent à être associés aux perspectives de réunification familiale et ce, même après avoir contrôlé pour des caractéristiques écologiques potentiellement confondantes. Ces résultats indiquent également qu’au-delà des modalités de contacts, l’engagement du parent biologique envers son enfant contribue aux perspectives de réunification familiale.

Conclusions :Ainsi, les résultats de cette étude confirment le rôle de l’engagement parental suite au placement en famille d’accueil et soutiennent l’élaboration d’interventions favorisant cette composante de la parentalité.

Contribution :Cette étude offre un éclairage pertinent sur les rôles distincts de l’engagement parental et du maintien des contacts parent-enfant sur les perspectives de réunification familiale et soutient les travaux de recherche futurs dans ce domaine.

Permanency and Safety Among Children in Foster Family and Kinship Care: A Scoping Review

Over the past 25 years, kinship care placements have risen dramatically, such that when a child enters into care, child welfare agencies must first attempt to identify safe living arrangements with relatives or individuals known to the child before searching for alternatives. Despite the growing emphasis on kinship care, little is known about its impact on child outcomes in comparison to other placement types (e.g., foster family). Therefore, the aim of this scoping review was to evaluate quantitative research on children in out-of-home care from 2007 to 2014 with regard to the following outcomes: (1) permanency (i.e., reunification, reentry, placement stability, and adoption/guardianship) and (2) safety (e.g., additional reports to child welfare). Based on these objectives, the review identified 54 studies that examined permanency and safety among children in two major placement types, namely foster family and kinship care. Across studies, children in kinship care experienced greater permanency in terms of a lower rate of reentry, greater placement stability, and more guardianship placements in comparison to children living with foster families. Children in kinship care, however, had lower rates of adoption and reunification. The findings also indicated that differences in these variables diminish over time. Findings for safety outcomes were mixed. Study methodological limitations and recommendations for future research are considered.

Maltreatment, family environment, and social risk factors: Determinants of the child welfare to juvenile justice transition among maltreated children and adolescents

This study prospectively examines the transition from the child welfare system into the juvenile justice system among 10,850 maltreated children and adolescents and explores how patterns of risks, including severity and chronicity of maltreatment, adverse family environment, and social risk factors, affect service systems transition. Almost three percent of maltreated children and adolescents had their first juvenile justice adjudication within an average of approximately six years of their initial child protective services investigation (CPS). Social risk factors, including a child's age at index CPS investigation (older), gender (boys), and race/ethnicity (Black and Hispanic) significantly predicted the risk of transition into the juvenile justice system. Recurrence of maltreatment and experiencing at least one incident of neglect over the course of the study period also increased the risk of transition into the juvenile justice system. However, subtypes of maltreatment, including physical, sexual, and other types of abuse did not significantly predict the risk of juvenile justice system transition. Finally, family environment characterized by poverty also significantly increased the risk of juvenile justice system transition. These findings have important implications for developing and tailoring services for maltreated children, particularly those at-risk for transitioning into the juvenile justice system.

Cumulative risk hypothesis: Predicting and preventing child maltreatment recidivism

Although Child Protective Services (CPS) and other child welfare agencies aim to prevent further maltreatment in cases of child abuse and neglect, recidivism is common. Having a better understanding of recidivism predictors could aid in preventing additional instances of maltreatment. A previous study identified two CPS interventions that predicted recidivism: psychotherapy for the parent, which was related to a reduced risk of recidivism, and temporary removal of the child from the parent's custody, which was related to an increased recidivism risk. However, counter to expectations, this previous study did not identify any other specific risk factors related to maltreatment recidivism. For the current study, it was hypothesized that (a) cumulative risk (i.e., the total number of risk factors) would significantly predict maltreatment recidivism above and beyond intervention variables in a sample of CPS case files and that (b) therapy for the parent would be related to a reduced likelihood of recidivism. Because it was believed that the relation between temporary removal of a child from the parent's custody and maltreatment recidivism is explained by cumulative risk, the study also hypothesized that that the relation between temporary removal of the child from the parent's custody and recidivism would be mediated by cumulative risk. After performing a hierarchical logistic regression analysis, the first two hypotheses were supported, and an additional predictor, psychotherapy for the child, also was related to reduced chances of recidivism. However, Hypothesis 3 was not supported, as risk did not significantly mediate the relation between temporary removal and recidivism.

Reunifying abused or neglected children: Decision-making and outcomes

Little is known about decision-making regarding the reunification of children in care, or about the consequences of these decisions for the children concerned. This study compared decision-making and outcomes for 149 maltreated children in seven English authorities (68 reunified, 81 who remained in care). Children were followed up six months after their return home or, for those who were not reunified, six months after the 'effective decision' that they should remain in care. They were followed up again four years (on average) after the return or effective decision. Data were extracted from case files at baseline and six month follow-up and were gathered from surveys of social workers and teachers at final follow-up. The two key predictors of reunification were assessments that parental problems had improved and that risks to the child were not unacceptably high. Two-thirds returned to improved family circumstances, sometimes due to a change in the household they returned to, but others were reunified despite persisting concerns. However 35% re-entered care within six months and 63% re-entered at some point during the four-year follow-up period, often due to recurring abuse or neglect. At final follow-up remaining in care was the strongest predictor of positive outcomes on a range of dimensions, even once children's characteristics and histories were taken into account. Outcomes were especially poor for neglected children who were reunified, irrespective of whether reunification was stable or unstable. Results show the potential of the care system to produce positive outcomes for maltreated children.

Risk factors for child maltreatment recurrence: An updated systematic review

OBJECTIVES

Children who have been maltreated are at increased risk of further maltreatment. Identification of those at highest risk of further maltreatment is a priority for professionals working in child protection services. The current study is intended to consolidate and expand on previous work on recurrence of child maltreatment. It has sought to identify risk factors for maltreatment recurrence in the recent literature in the expectation that this may help in the practical identification of children at risk.

METHODS

We conducted a systematic review of cohort studies published between 2003 and 2009, identifying factors associated with maltreatment recurrence in children. Studies included demonstrated differing levels of substantiation of maltreatment.

RESULTS

Fifteen studies met inclusion criteria but showed significant heterogeneity, varying in setting, recruitment of subjects, types of maltreatment considered and length of follow-up. Previous findings were replicated and expanded in the current study in relation to a range of factors, including rates of maltreatment recurrence, maltreatment types, frequency of previous episodes of maltreatment, child and family considerations, home environment and service provision. Factors were identified irrespective of level of maltreatment substantiation.

CONCLUSION

This study provides further systematic evidence of the existence of a number of factors associated with child maltreatment recurrence. It points to the possibility of practical application of its findings within the wider context of decision making in child protection services, with the ultimate aim of reducing recurrence of maltreatment in individual cases.

Kinship care for the safety, permanency, and well-being of children removed from the home for maltreatment

BACKGROUND

Every year a large number of children around the world are removed from their homes because they are maltreated. Child welfare agencies are responsible for placing these children in out-of-home settings that will facilitate their safety, permanency, and well-being.However, children in out-of-home placements typically display more educational, behavioural, and psychological problems than do their peers, although it is unclear whether this results from the placement itself, the maltreatment that precipitated it, or inadequacies in the child welfare system.

OBJECTIVES

To evaluate the effect of kinship care placement compared to foster care placement on the safety, permanency, and well-being of children removed from the home for maltreatment.

SEARCH METHODS

We searched the following databases for this updated review on 14 March 2011: the Cochrane Central Register of Controlled Trials(CENTRAL),MEDLINE, PsycINFO, CINAHL, Sociological Abstracts, Social Science Citation Index, ERIC, Conference Proceedings Citation Index-Social Science and Humanities, ASSIA, and Dissertation Express. We handsearched relevant social work journals and reference lists of published literature reviews, and contacted authors.

SELECTION CRITERIA

Controlled experimental and quasi-experimental studies, in which children removed from the home for maltreatment and subsequently placed in kinship foster care were compared with children placed in non-kinship foster care for child welfare outcomes in the domains of well-being, permanency, or safety.

DATA COLLECTION AND ANALYSIS

Two review authors independently read the titles and abstracts identified in the searches, and selected appropriate studies. Two review authors assessed the eligibility of each study for the evidence base and then evaluated the methodological quality of the included studies.Lastly, we extracted outcome data and entered them into Review Manager 5 software (RevMan) for meta-analysis with the results presented in written and graphical forms.

MAIN RESULTS

One-hundred-and-two quasi-experimental studies,with 666,615 children are included in this review.The 'Risk of bias' analysis indicates that the evidence base contains studies with unclear risk for selection bias, performance bias, detection bias, reporting bias, and attritionbias, with the highest risk associated with selection bias and the lowest associated with reporting bias. The outcome data suggest that children in kinship foster care experience fewer behavioural problems (standardised mean difference effect size -0.33, 95% confidence interval (CI) -0.49 to -0.17), fewer mental health disorders (odds ratio (OR) 0.51, 95% CI 0.42 to 0.62), better well-being (OR 0.50,95% CI 0.38 to 0.64), and less placement disruption (OR 0.52, 95% CI 0.40 to 0.69) than do children in non-kinship foster care. For permanency, there was no difference on re unification rates, although children in non-kinship foster care were more likely to be adopted(OR 2.52, 95% CI 1.42 to 4.49), while children in kinship foster care were more likely to be in guardianship (OR 0.26, 95% CI 0.17 to 0.40). Lastly, children in non-kinship foster care were more likely to utilise mental health services (OR 1.79, 95% CI 1.35 to 2.37).

AUTHORS' CONCLUSIONS

This review supports the practice of treating kinship care as a viable out-of-home placement option for children removed from the home for maltreatment. However, this conclusion is tempered by the pronounced methodological and design weaknesses of the included studies.

Testing a cascade model of linkage between child abuse and negative mental health among battered women in Japan

This study examined the following hypotheses: (1) a child abuse history (CAH), domestic violence (DV), and child abuse by an intimate partner might have a crucial and specific influence but act differently on women's negative mental health; (2) CAH, DV, child abuse by an intimate partner, and negative mental health might be predictors of maternal child abuse, with complex interactions. A self-administered questionnaire survey was conducted among a sample of mothers (N=304) and their children (N=498) staying in 83 Mother-Child Homes in Japan to assess the women's CAH and DV experiences, along with their current mental health problems, including dissociated, depressed, and traumatic symptoms. A structural equation modeling (SEM) was adapted to test whether a complex theoretical model fits the actual relationship among a set of observed measures. Our model confirmed the linkage with broader aspects of violence within the family such as CAH and DV, focusing on women's mental health problems reported by them. In addition, CAH, DV, child abuse by intimate partner, and maternal mental health might have a crucial and specific but act influence on maternal child abuse.

Identifying the substance abuse treatment needs of caregivers involved with child welfare

Parental substance use significantly increases risk of child maltreatment, but is often under-identified by child protective services. This study examined how agency use of standardized substance use assessments and child welfare investigative caseworker education, experience, and caseload affected caseworkers' identification of parental substance abuse treatment needs. Data are from a national probability sample of permanent, primary caregivers involved with child protective services whose children initially remained at home and whose confidential responses on two validated instruments indicated harmful substance use or dependence. Investigative caseworkers reported use of a formal assessment in over two thirds of cases in which substance use was accurately identified. However, weighted logistic regression indicated that agency provision of standardized assessment instruments was not associated with caseworker identification of caregiver needs. Caseworkers were also less likely to identify substance abuse when their caseloads were high and when caregivers were fathers. Implications for agency practice are discussed.

Preventing the recurrence of maltreatment

In the context of the federal child welfare performance measurement system, recurrence of maltreatment refers to circumstances in which children that have previously been substantiated as victims of abuse or neglect experience another incident of substantiated maltreatment. Multiple episodes of maltreatment can lead to: (1) more serious short and long term negative consequences, (2) entry into the juvenile justice system, and (3) juvenile delinquency. In this literature review the authors summarize the research on child, family, and systemic factors related to maltreatment recurrence and promising practices for improving performance. Promising practices aimed at preventing recurrence of maltreatment include interventions at multiple levels (e.g., the child, caregiver, family, and agency) and include a range of service modalities.

Foster care re-entry: Exploring the role of foster care characteristics, in-home child welfare services and cross-sector services

This study seeks to advance our understanding of how modifiable and non-modifiable factors may impact the likelihood of re-entry into foster care. Children who entered foster care for the first time following at least one report of maltreatment and were then reunified were followed from exit to re-entry, age 18 or the end of the study period using longitudinal administrative data. Risk of re-entry was explored according to a range of modifiable and non-modifiable case and service characteristics. Children removed from homes with parents who had multiple risk factors (e.g., no high school diploma, mental health diagnosis, criminal record, or teen parents) or were receiving AFDC prior to entry were more likely to re-enter. The receipt of in-home child welfare services during or after foster care was associated with reduced risk of re-entry. Having the longest placement with a relative was associated with decreased risk of re-entry. In conclusion, both modifiable and non-modifiable factors are associated with re-entry into foster care. Among modifiable factors, services appear to have a particularly strong relationship to re-entry. Our data also suggest that in-home child welfare services provided during and after foster care may be associated with improved long-term permanency after return home. Given the continued import of caregiver risk factors even among reunified families, services provided to support reunification should include attention to caregiver needs outside parenting.

Trajectories of maltreatment re-reports from ages 4 to 12:: evidence for persistent risk after early exposure

This study identified trajectories of maltreatment re-reports between ages 4 and 12 for children first referred to Child Protective Services (CPS) for maltreatment prior to age 4 and either removed from the home or assessed by a CPS intake worker as moderately or highly likely to be abused/neglected in the future, absent intervention. Participants (n = 501) were children from the Southwest and Northwest sites of the Consortium for Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). During the 8-year follow-up period, 67% of children were re-reported. Growth mixture modeling identified four trajectory classes: No re-report (33%), Continuous re-reports (10%), Intermittent re-reports (37%), and Early re-reports (20%). Membership in classes with relatively more re-reports was predicted by several factors assessed at age 4, including physical abuse; living with a biological/stepparent; caregiver alcohol abuse, depression, and lack of social support; receipt of Aid to Families with Dependent Children (AFDC); and number of children in the home. For a subpopulation of high-risk children first reported in early childhood, risk for maltreatment re-reporting may persist longer than previously documented, continuing 8 to 12 years after the first report.

Factors associated with caregiver stability in permanent placements: a classification tree approach

OBJECTIVE

Identify individual and environmental variables associated with caregiver stability and instability for children in diverse permanent placement types (i.e., reunification, adoption, and long-term foster care/guardianship with relatives or non-relatives), following 5 or more months in out-of-home care prior to age 4 due to substantiated maltreatment.

METHODS

Participants were 285 children from the Southwestern site of Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Caregiver instability was defined as a change in primary caregiver between ages 6 and 8 years. Classification and regression tree (CART) analysis was used to identify the strongest predictors of instability from multiple variables assessed at age 6 with caregiver and child reports within the domains of neighborhood/community characteristics, caregiving environment, caregiver characteristics, and child characteristics.

RESULTS

One out of 7, or 14% of the 285 children experienced caregiver instability in their permanent placement between ages 6 and 8. The strongest predictor of stability was whether the child had been placed in adoptive care. However, for children who were not adopted, a number of contextual factors (e.g., father involvement, expressiveness within the family) and child characteristics (e.g., intellectual functioning, externalizing problem behaviors) predicted stability and instability of permanent placements.

CONCLUSIONS

Current findings suggest that a number of factors should be considered, in addition to placement type, if we are to understand what predicts caregiver stability and find stable permanent placements for children who have entered foster care. These factors include involvement of a father figure, family functioning, and child functioning.

PRACTICE IMPLICATIONS

Adoption was supported as a desired permanent placement in terms of stability, but results suggest that other placement types can also lead to stability. In fact, with attention to providing biological parents, relative, and non-relative caregivers with support and resources (e.g., emotional, financial, and optimizing father involvement or providing a stable adult figure) the likelihood that a child will have a stable caregiver may be increased.