Differences and disparities over time: Black and White families investigated by Ontario's child welfare system

Identifying newborn discharge to child protective services: Comparing discharge codes from birth hospitalization records and child protection case files

PURPOSE

Newborn removal by North America's child protective services (CPS) disproportionately impacts Indigenous and Black families, yet its implications for population health inequities are not well understood. To guide this as a domain for future research, we measured validity of birth hospitalization discharge codes categorizing newborns discharged to CPS.

METHODS

Using data from 309,260 births in Manitoba, Canada, we compared data on newborns discharged to CPS from hospital discharge codes with the presumed gold standard of custody status from CPS case reports in overall population and separately by First Nations status (categorization used in Canada for Indigenous peoples who are members of a First Nation).

RESULTS

Of 309,260 newborns, 4562 (1.48%) were in CPS custody at hospital discharge according to CPS case reports and 2678 (0.87%) were coded by hospitals as discharged to CPS. Sensitivity of discharge codes was low (47.8%), however codes were highly specific (99.8%) with a positive predictive value (PPV) of 81.4%, and a negative predictive value (NPV) of 99.2%. Sensitivity, PPV and specificity were equal for all newborns but NPV was lower for First Nations newborns.

CONCLUSIONS

Canadian hospital discharge records underestimate newborn discharge to CPS, with no difference in misclassication based on First Nations status.

Examining the role of child welfare worker characteristics and the substantiation decision

BACKGROUND

The role of child welfare workers is twofold, to promote the safety of children and youth and to address their wellbeing. This provincially legislated mandate requires child welfare workers to make decisions across the child welfare service continuum. After a report of child maltreatment is investigated, workers are required to assess the veracity of the allegation through the substantiation decision and to determine whether the child has been victimized, which may impact on families' future involvement with services. Little is known whether or how individual worker characteristics impact the substantiation decision.

OBJECTIVE AND METHODS

This study estimated the degree of variation across caseworker characteristics in the substantiation decision through secondary data analysis of the Ontario Incidence Study of Reported Child Abuse and Neglect (OIS, 2018). We explored how the substantiation decision varied across clinical and caseworker characteristics, using both simple and multilevel logistic regression models.

RESULTS

Findings suggest that primarily clinical characteristics predicted the substantiation decision, however, worker years of child welfare experience also predicted substantiation, such that more experienced workers were significantly more likely to substantiate than less experienced workers (est = 0.02, SE = 0.01, p < .10). The Intraclass Correlation Coefficient (35 %) suggests differences among child welfare workers' substantiation decision, they are however, characteristics not measured in this study.

CONCLUSIONS

Further research to assess the differential nature of child welfare worker characteristics and their role in decision-making is required.

Patterns for Child Protective Service Referrals in a Pediatric Burn Cohort

BACKGROUND

Pediatric non-accidental trauma often necessitates the involvement of protective services. However, the subjectivity and lack of standardization of referral infrastructure may result in some discrepancies between referral patterns and instances of child abuse.

METHODS

An institutional retrospective chart review was conducted between 2015 and 2021, in which all cases of patients under the age of 14 who suffered a burn injury and received a child protective service (CPS) consult were reviewed. Baseline demographics and characteristics were defined. Multivariate analysis was utilized to identify predictors of CPS involvement, while the regression analysis was employed to parse associations between burn injuries and CPS involvement.

RESULTS

Between July 2015 and December 2021, 340 patients (median age two years, IQR: 1-6 years) under the age of 14 who experienced a burn injury were evaluated. Forty-four (12.9%) of the patients' cases received a CPS referral, of which three (0.9%) resulted in a CPS intervention. The most common mechanism of burn within the cohort was scald (241 patients, 70.9%). The median total body surface area (TBSA) was 3.0% (IQR: 1.0%-6.0%), and 76 (22.4%) suffered a high TBSA (>75th percentile). Caucasian race (p < 0.001) and scald mechanisms (p = 0.014) were associated with higher TBSA. When considering how such injuries translated to CPS referrals, increasing age was found to be associated with a decreased likelihood of CPS involvement. Meanwhile, the Black race (p = 0.027) and increasing area deprivation index (ADI) (p = 0.038) were associated with CPS involvement. Those with CPS involvement experienced a greater length of hospital stay (p = 0.001). Black race and intensive care unit level of care were found to be positive predictors of CPS involvement. In total, three (6.82%) of the 44 cases with CPS involvement were found to be substantiated. The three children who required CPS intervention were discharged to foster care settings.

CONCLUSION

Hospitalized pediatric burn injuries must be investigated due to concern of child abuse, yet external factors such as race and socioeconomic status may play a role in the involvement of CPS. Such referrals may not always be substantiated and could lead to further injurious sequelae for children and their families.

State Child Maltreatment Policies and Disparities in Substantiation: A Study of State-Administered Child Welfare Systems in the U.S

Although several studies have examined child and family factors associated with substantiation, less research has explored the role of state child maltreatment policies in substantiating cases of alleged maltreatment. In parallel, there is growing pressure to reduce racial/ethnic disproportionality and disparities across the span of a child welfare case. We examined the relationship between state child maltreatment policies and substantiation, with child race/ethnicity as a moderator of this relationship. Data came from the 2019 National Child Abuse and Neglect Data System (NCANDS) and the State Child Abuse and Neglect (SCAN) Policy Database. Using a series of multi-level binary logistic models, we calculated the odds of substantiation based on child characteristics (e.g., child age, number of types of alleged maltreatment) and state policies (e.g., state definitions of maltreatment that include exposure to domestic violence, harsh punishment). Approximately 17% of the variance in substantiation occurs between states. Although we did not find a direct effect of state policy on substantiation, there were significant interaction terms, in that inclusion of exposure to domestic violence, harsh punishment, or educational neglect in state policy was more strongly associated with substantiation for children of color than white children. Implications for policy and research are explored.

The absence of language: A critical race discourse analysis of Ontario's child welfare legislation and the impacts on Black families

BACKGROUND

The research pertaining to racial disparities for Black families in child welfare is relatively limited in Canada. Recent research reveals that the overrepresentation of Black families in Canadian child welfare systems typically begins at the reporting or investigation stage and continues throughout the child welfare service and decision-making continuum. This research is occurring against the backdrop of increasing public acknowledgement of Canada's historic anti-Black policy-making and institutional relationships to Black communities. Though there is increased awareness about anti-Black racism, there has been limited exploration of the connection between anti-Black racism in child welfare legislation and how this policy generates disparities for Black families in both child welfare involvement and outcomes - this paper seeks to fill this gap in knowledge.

OBJECTIVE

The objective of this paper is to explore the entrenchment of anti-Black racism within the child welfare system by critically assessing the language and absence of language within the guiding legislative and implementation policies.

METHODS

Utilizing a critical race discourse analysis method, this study explores the entrenchment of anti-Black racism within the Ontario child welfare system by critically assessing the language and absence of language within the guiding legislative policies that shape practice for Black children, youth, and families.

RESULTS

The findings revealed that though the legislation does not explicitly address anti-Black racism, there were instances where the legislation indicated that race and culture may be considered in responding to children and families. The lack of specificity, particularly in the Duty to Report, has the potential to contribute to disparate reporting and decision-making for Black families.

CONCLUSIONS

Policy makers should acknowledge the history of anti-Black racism that informed the development of the legislation in Ontario and move towards tackling systemic injustices that disproportionately affect Black families. More explicit language will shape future policies and practices to ensure that the impact of anti-Black racism is considered across the child welfare continuum.

Reasons for admission to service and overrepresentation of Black youth in the child welfare system in Ontario, Canada: Does race matter?

BACKGROUND

In studies exploring racial disparities in the Canadian child welfare systems, evidence is still lacking on the reasons for admission of children to service.

OBJECTIVE

This study investigates the reasons for admission to service in Ontario child welfare based on racial identities.

METHODS

We analyzed three-time points (2018, 2019, and 2020) of the Ontario Looking After Children (OnLAC) project. The sample included 4036 children (M_age = 14.30, SD = 2.21; 39.22 % girls). Univariate and multiple random-effects (REs) logistic regressions were performed to analyze the admission to service according to racial identities.

RESULTS

The results showed that the most frequent reason for admission to service was caregiver capacity in 2018 (56.02 %), 2019 (57.76 %), and 2020 (55.49 %). The results revealed few differences between racial groups on the reasons for their admission to service. There were more differences between racial groups in 2019 and 2020. The three-year cohort analyses showed that Black youth were less likely to have admission to service due to harm by omission (AOR = 0.41, 95%CI 0.18-0.93, z = -2.14, p < .05) and emotional harm (AOR = 0.40, 95%CI 0.17-0.92, z = -2.12, p < .05) than other racial groups. Results from the multiple random-effects logistic regression showed that in 2019 (AOR = 1.83, 95%CI 1.28-2.62, z = 3.32, p < .01) and 2020 (AOR = 2.13, 95%CI 1.41-3.21, z = 3.58, p < .01), youth were particularly at risk of having been admitted to service for caregiver capacity.

CONCLUSIONS

The present study reveals a comprehensive description of the reasons for admission in child welfare in Ontario according to racial identities. Implications for research, prevention, and intervention are discussed.

Development of the Successful Transitions Assessment Tool (STAT) for Crossover Youth (COY): Youth voice and expert feedback with a Delphi approach

BACKGROUND

Crossover youth (COY) are involved with child welfare and/or the justice system and experience multifaceted challenges in their transition into adulthood. A literature review identified eight critical indicators of successful transitions for COY and the absence of a validated comprehensive assessment that is youth informed and culturally sensitive.

OBJECTIVE

To develop a Successful Transitions Assessment Tool (STAT) that is informed by research, Critical Race Theory, and subject matter experts.

PARTICIPANTS AND SETTING

Field experts were approached to review the initial STAT, developed from literature findings, using the Delphi approach; 13 experts completed the first round and nine completed the second round. Child welfare youth participated in a focus group and youth justice youth completed interviews; 10 youth aged 16 to 24 provided feedback.

METHODS

A two-round Delphi study with experts used a survey link. The focus groups and interviews with youth experts were conducted virtually. Expert rankings in the examined areas were aggregated and qualitative data were thematically analyzed.

RESULTS

Responding experts in both rounds of the Delphi process ranked the STAT highly, achieving scores of 16.8 and 16.4 of 20 possible points, respectively (consensus >80 %). No additional rounds were deemed necessary. All suggested tool clarifications were incorporated. Additional questions were added based on suggestions relevant to the eight critical domains.

CONCLUSIONS

This innovative study created a single, brief, yet comprehensive assessment tool of eight key domains for successful transitions out of care settings, informed by experts through the Delphi approach and youth themselves.

Risk of Future Maltreatment: Examining Whether Worker Characteristics Predict Their Perception

Child welfare workers aim to promote the well-being and safety of children and are the link between the child welfare system and families. Families served by the child welfare system should expect similar service based on clinical factors, not based on their caseworker's characteristics. Using secondary data analyses of the most recent Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2008) and multilevel modeling, this study examines whether child welfare worker characteristics, such as education level and field, age, and experience predict their perception of the risk of future maltreatment. A total of 1729 case-level investigations and 419 child welfare workers were included in this study. Several one-level logistic regression and two-level logistic regression analyses were run. The best-fit model suggests that caseworkers with a Master's degree, more than 2 years of experience, and more than 18 cases were significantly more likely to perceive risk of future maltreatment. Further, the interaction between degree level and age also significantly predicted the perception of risk of future maltreatment. Results suggest that the perception of risk of future maltreatment may be influenced by caseworker factors, thus service to families may differ based on caseworker characteristics.

Nationwide Management of Trauma in Child Abuse: Exploring the Racial, Ethnic, and Socioeconomic Disparities

OBJECTIVE

Child abuse is a major cause of childhood injury, morbidity, and death. There is a paucity of data on the practice of abuse interventions among this vulnerable population. The aim of our study was to identify the factors associated with interventions for child abuse on a national scale.

METHODS

Retrospective analysis of 2017-2018 ACS-TQIP. All children presenting with suspected/confirmed child abuse and an abuse report filed were included. Patients with missing information regarding abuse interventions were excluded. Outcomes were abuse investigations initiated among those with abuse reports, and change-of-caregiver at discharge among survivors with an investigation initiated. Multivariable regression analyses were performed.

RESULTS

7,774 child abuse victims with an abuse report were identified. Mean age was 5±5yrs, 4,221(54%) patients were White, 2,297(30%) Black, 1,543(20%) Hispanic, and 5,298(68%) had government-insurance. Most common mechanism was blunt(63%),followed by burns(10%),and penetrating(10%). Median ISS was 5[1-12]. Most common form of abuse was physical(92%), followed by neglect(6%),sexual(3%),and psychological(0.1%). Most common perpetrator of abuse was care provider/teacher(49.5%),followed by member of immediate family(30.5%),or member of the extended/step/foster family(20.0%). 6,377(82%) abuse investigations were initiated for those with abuse reports. Of these, 1,967(33%) resulted in change-of-caregiver. Black children were more likely to have abuse investigated, and Black and Hispanic children were more likely to experience change-of-caregiver after investigations, while privately-insured children were less likely to experience both (Table 3).

CONCLUSION

Significant racial, ethnic, and socioeconomic disparities exist in the nationwide management of child abuse. Further studies are strongly warranted to understand contributing factors and possible strategies to address them.

LEVEL OF EVIDENCE

III Therapeutic/Care Management.

Racial sensitivity training: An inadequate solution to systemic racial disparities in child protection systems

Calls continue for staff training as an instrumental response to racially based differences in rates of child protection system interactions and outcomes. These recommendations echo a reliance on implicit bias and diversity training (referred to broadly as "anti-bias and racial sensitivity training") across disciplines of social and human services in the United States as a feasible and politically expedient solution to racial disparities. But focusing on anti-bias training to address racial disparities in child protection systems will almost certainly fail to achieve desired objectives for at least three reasons: (a) there is no evidence that implicit bias or racial sensitivity trainings change behavior; (b) personnel training initiatives misapply an individual behavioral solution to an institutional and structural problem; and (c) an emphasis on internal training initiatives distracts and reduces the accountability of other systems of care better positioned to produce change. We conclude that if the goal is to reduce racial disparities, systemic innovations and broader policy reforms both internal and external to the child protection system are needed. Training will not meaningfully shift the downstream effects of structural racism.

Racial/ethnic and gender disparities in child protection decision-making: What role do stereotypes play?

BACKGROUND

A wide range of studies have revealed racial/ethnic and gender disparities in child protection decision-making.

OBJECTIVE

This study investigated whether disparities are mediated by stereotypes that professionals may hold, by applying the Stereotype Content Model (SCM) which suggests that stereotypes are formed by perceptions of sociability, morality, and competence.

PARTICIPANTS AND SETTING

258 professionals (133 current staff and 125 trainees) from Colorado participated in the study.

METHODS

The study applied a 2 × 3 randomized experimental vignette design. Participants read a case in which the gender of the parent responsible for maltreatment (mother or father) and race/ethnicity of the family (white, Black, or Latinx) varied.

RESULTS

A SEM model (CFI = .94, RMSEA = .05) with free parameters for trainees and current staff was estimated. No significant association between stereotypes and race/ethnicity and gender appeared. However, evidence for disparities emerged. In the trainee group, scores to decide for a supervision order were higher for white fathers, Black mothers, Latinx mothers, and Latinx fathers (β = 0.18 to 0.25) compared to white mothers. Current staff provided larger risk scores for Black mothers and both Latinx parents (β = 0.20 to 0.22) compared to the white mother, resulting in increased inclinations to decide for a supervision order (β = 0.26). Lastly, negative perceptions of morality increased supervision order scores (β = -0.55 to -0.36).

CONCLUSIONS

Evidence for disparities in decision-making appeared, but the study could not confirm that these disparities were mediated by stereotypes. Furthermore, perceptions of morality seemed to impact decision-making processes.

Addressing the overrepresentation of Black children in Ontario's child welfare system: insights from child welfare workers and community service providers

BACKGROUND

The overrepresentation Black children experience in the child welfare system is well documented in the United States, but such studies are now emerging in Canada. In Ontario, there are few studies that address this issue concerning Black families.

OBJECTIVE

This study is to explore the insights of child welfare workers and community service providers on how to potentially address Black children's overrepresentation in Ontario's child welfare system.

PARTICIPANTS AND SETTING

Twenty-one child welfare workers from two child welfare organizations in Ontario that serves many Black families and thirteen community service providers in Toronto participated in the study.

METHODS

Six focus groups were conducted with thirty-four participants. Audio recording from each of the focus groups was manually transcribed verbatim. We utilized constant comparison analysis to analyse the transcribed data.

RESULTS

Potential solutions to overrepresentation that emerged from the focus group discussions included viewing Black families as experts of their own lives; increasing workforce diversity; educating referral sources and Black families on child welfare practices; subjecting referral sources to detailed questioning; stopping harmful record keeping on families; providing cultural sensitivity training and education; partnering with community organizations; and providing mentorship opportunities.

CONCLUSIONS

The findings from this study emphasize the need for changes related to child welfare assessment tools, workforce development, and shifts in system orientation to address systemic racism and Black children's overrepresentation in the child welfare system.

Understanding the overrepresentation of Black children in Ontario's child welfare system: Perspectives from child welfare workers and community service providers

BACKGROUND

The overrepresentation of Black children in the child welfare system is a social problem that has received longstanding attention in the United States, but has recently received increasing attention in Canada.

OBJECTIVE

This qualitative study explores the findings of two quantitative studies (Antwi-Boasiako et al., 2020, 2021) in order to interpret them through the perspectives of child welfare workers and community service providers. The aim is to gain a deeper understanding on the potential factors that contribute to the overrepresentation of Black children in Ontario's child welfare system.

PARTICIPANTS AND SETTING

The study involved twenty-one child welfare workers from two child welfare organizations in Ontario serving lots of Black families and thirteen community service providers in Toronto.

METHODS

Six focus groups were completed with thirty-four participants. Each of the focus groups was audio recorded and manually transcribed verbatim. Constant comparison analysis was used to analyze the transcribed data.

RESULTS

Themes that emerged from the study include the following concerns: racism and bias from referral sources; racism and bias from child welfare workers; lack of cultural sensitivity; lack of workforce diversity/training; lack of culturally appropriate resources; assessment tools; duty to report; fear of liability; lack of collaboration; and poverty.

CONCLUSIONS

The results from this study reinforce the need to shift practice that acknowledges Black families as valuable stakeholders and experts of their own lives and involves them in the development and implementation of policies and practices that affect them.

Major findings from the Ontario Incidence Study of Reported Child Abuse and Neglect 2018

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.