Out-of-Home Care and the Educational Achievement, Attendance, and Suspensions of Maltreated Children: A Propensity-Matched Study

Receipt of parenting, disability, unemployment, and other income support payments in persons aged 16 to 33 years - the associations with child maltreatment

BACKGROUND

Child maltreatment (CM) is a major public health concern with life-long effects. Its impact on income support has rarely been studied.

OBJECTIVE

To examine the association between CM and receipt of income support payments and the budgetary impact for persons 16 to 33 years.

PARTICIPANTS AND SETTING

A South Australian birth cohort, born 1986 to 2004 (n = 339,411).

METHODS

We linked child protection (CP) administrative records with national welfare payment records, ending March 2020. Receipt of income support payments and mean payment amounts were described by CP contact (adjusted for child and family attributes). Budget impact was modelled at the national level.

RESULTS

Adjusted odds ratio (AOR) for receipt of any income support payment was 3.01 (2.95-3.07) for individuals with any CP contact versus no CP contact. Among those receiving any payment, adjusted annualised mean benefit payment was $3754 (US$1446) among individuals with no CP contact, $6262 (US$4,307) in persons with any CP contact, and $9,747 in persons who'd been in OOHC. Cumulative payments modelled from age 16 to 33 years totalled $38,570 (US$26,652) for individuals with no CP contact, and $181,743 (US$125,003) for individuals who'd been in OOHC. Modelled for the Australian population to age 33, the extra cost associated with CP contact added 39 % to the government income support budget.

CONCLUSION

CM is strongly associated with receipt of income support payments. Investment in effective preventive and protective strategies for CP involved children could address this core social determinant of health, while providing budget savings.

Investigating the impact of Out-of-Home Care on early childhood development

BACKGROUND

Early childhood development is influential for life course capability. Children exposed to child maltreatment and at high risk of harm may be removed for their safety, but the effect on child development is uncertain.

OBJECTIVES

To assess developmental vulnerability at school commencement across five developmental domains to ascertain whether removal of children with substantiated maltreatment to foster/kinship care is likely protective, or not, of developmental vulnerabilities.

METHODS

The study drew on linked-data for a South Australian population birth cohort (2003 to 2014) N = 74,751. For children exposed to substantiated child maltreatment meeting study criteria (N = 2011, mean age = 5.7 years, 50.7 % boys), the effect of placement in foster/kinship care (N = 666) on developmental vulnerability was explored using generalized linear models, adjusted for child and family covariates, maltreatment severity and propensity score.

RESULTS

Children placed in care had a reduced risk of developmental vulnerability on the Physical Health and Wellbeing (aRR = 0.73 [0.64, 0.84]), Language and Cognitive Skills (school based) (aRR = 0.79 [0.68, 0.92]), and Communication Skills and General Knowledge (aRR = 0.81 [0.70, 0.94]) domains, compared to children who were not removed. However, these children had increased risk of vulnerability on Social Competence (aRR = 1.14 [1.01, 1.29]) and Emotional Maturity (aRR = 1.20 [1.05, 1.37]) domains.

CONCLUSIONS

These findings suggest placement in out-of-home care supported physical health and wellbeing, communication and cognitive but not social and emotional early childhood development. These results highlighting the need for professional therapeutic support for children in care and better attending to the physical development, communication and cognitive skills in maltreated children remaining at home.

Child protection system involvement in children of incarcerated mothers: A linked data study

BACKGROUND

Women prisoners are a growing portion of the prison population. Health and social outcomes of their children have been studied and found to be poor, but little is known about child protection outcomes.

OBJECTIVES

Ascertain child protection system contact of children exposed to maternal incarceration.

PARTICIPANTS AND SETTING

All children born between 1985 and 2011 exposed to the incarceration of their mothers in a Western Australian correctional facility and a matched comparison group.

METHODS

A matched cohort study using linked administrative data on 2637 mothers entering prison between 1985 and 2015 and their 6680 children. We estimated hazard ratios (HRs) and incidence rate ratios (IRRs) of child protection service (CPS) contact post maternal incarceration (four concern levels), comparing rates for children exposed to maternal incarceration with a matched non-exposed group, adjusting for maternal and child factors.

FINDINGS

Exposure to maternal incarceration increased risk of CPS contact. Unadjusted HRs exposed vs unexposed children were 7.06 (95%CI = 6.49-7.69) for substantiated child maltreatment and 12.89 (95%CI = 11.42-14.55) for out-of-home care (OOHC). Unadjusted IRRs were 6.04 (95%CI = 5.57-6.55) for number of substantiations and 12.47 (95%CI = 10.65-14.59) for number of removals to OOHC. HRs and IRRs were only slightly attenuated in adjusted models.

CONCLUSIONS

Maternal incarceration is a warning flag for a child at high risk of serious child protection concerns. Family-friendly rehabilitative women's prisons, incorporating support for more nurturing mother-child relationships could provide a placed-based public health opportunity for disrupting distressing life trajectories and intergenerational pathways of disadvantage of these vulnerable children and their mothers. This population should be a priority for trauma-informed family support services.

Research Participation of Minor Adolescents in Foster Care

STUDY OBJECTIVE

In this study we evaluated published studies about foster care to: (1) determine the types of data used; (2) describe the degree to which a sexual/reproductive health topic was addressed; and (3) describe the consent process.

DESIGN

Analysis of published literature.

SETTING

PubMed was searched using "foster care" for English articles published between January 1, 2017 and September 4, 2019.

PARTICIPANTS

None.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Articles were coded into 4 data source categories: primary, secondary, peripheral, or perspective data. Articles with a primary data source were coded for participant ages: only 9 years old and younger, 10- to 17-year-olds (minor adolescents), and only 18 years old and older. Articles using a secondary data source were coded for the source of the data registry. All articles were coded for presence of a sexual/reproductive health outcome. The primary data articles that included minor adolescents were coded for the study topic and consent process.

RESULTS

Of the 176 articles about foster care, 72/176 (41%) used primary data, 53/176 (30%) used secondary data, and 51/176 (29%) used peripheral/perspective data. Forty-eight of the primary data articles included minor adolescents. Secondary data sources included few national research surveys. Sexual/reproductive health outcomes were measured in 17 articles, 4 of which used primary data. The consent process for minor adolescents varied and had no consistent pattern across studies.

CONCLUSION

Research on best practices for consent processes and use of registries could be developed to increase research on sexual/reproductive health outcomes among adolescents in foster care.

Research using population-based administration data integrated with longitudinal data in child protection settings: A systematic review

INTRODUCTION

Over the past decade there has been a marked growth in the use of linked population administrative data for child protection research. This is the first systematic review of studies to report on research design and statistical methods used where population-based administrative data is integrated with longitudinal data in child protection settings.

METHODS

The systematic review was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. The electronic databases Medline (Ovid), PsycINFO, Embase, ERIC, and CINAHL were systematically searched in November 2019 to identify all the relevant studies. The protocol for this review was registered and published with Open Science Framework (Registration DOI: 10.17605/OSF.IO/96PX8).

RESULTS

The review identified 30 studies reporting on child maltreatment, mental health, drug and alcohol abuse and education. The quality of almost all studies was strong, however the studies rated poorly on the reporting of data linkage methods. The statistical analysis methods described failed to take into account mediating factors which may have an indirect effect on the outcomes of interest and there was lack of utilisation of multi-level analysis.

CONCLUSION

We recommend reporting of data linkage processes through following recommended and standardised data linkage processes, which can be achieved through greater co-ordination among data providers and researchers.

School Absenteeism Associated With Child Protection System Involvement, Maltreatment Type, and Time in Out-of-Home Care

Greater school absenteeism is associated with numerous negative educational outcomes. We used a retrospective cohort design with linked administrative data on 296,422 children to examine the relationship between school absenteeism and child protection system (CPS) involvement. Children with substantiated maltreatment had 4.1 times more unexplained and problem absences than children with no CPS involvement. In multivariate analyses, children with substantiated maltreatment had significantly greater "chronic" truancy (OR = 3.41) and less "acceptable" levels of absences (OR = 0.74) compared to children with no CPS involvement. Greater absenteeism was seen for children with substantiated neglect and who had their first CPS notification earlier in life. Being in out-of-home care for 3+ years was a protective factor for children who had a CPS notification before age 5. Additional adversities had a strong additive effect with CPS involvement on absenteeism and chronic truancy. This study demonstrates the potential scope for reducing problem absenteeism and helps inform the public debate regarding how the type and timing of CPS involvement might ameliorate or exacerbate harm for children.

Adolescent education outcomes and maltreatment: The role of pre-existing adversity, level of child protection involvement, and school attendance

BACKGROUND

Maltreated children are at high risk for low educational achievement, however few studies have accounted for confounding risk factors that commonly co-occur (including child, family and neighbourhood risk factors) and results have been mixed, particularly for adolescents.

OBJECTIVES

We aimed to 1) examine the relationship between maltreatment and low educational achievement among Year 9 students, taking into account child, family and neighbourhood risk factors; 2) assess subgroup differences in outcomes based on level of child protection involvement and maltreatment type; and 3) identify prevalence and risk factors for low educational achievement.

PARTICIPANTS AND SETTING

A population birth cohort of West Australian children (N = 33,866) who sat national reading achievement tests between 2008 and 2010 was used for the main analysis.

METHODS

Linked administrative data from Departments of Health, Communities (Child Protection and Family Support), Education, and the Disability Services Commission was used to conduct a series of logistic regression analyses.

RESULTS

Maltreatment was significantly associated with low Year 9 achievement, even after accounting for many child, family and neighbourhood risk factors (aOR 1.51, 95 % CI 1.35-1.69). Educational outcomes were consistently poor across subgroups in the child protection system, including those with different levels of child protection involvement and maltreatment types. Other notable risk factors for low achievement included intellectual disability, attendance, parents' level of education, Aboriginality, and being older (indicating possible grade retention).

CONCLUSIONS

Adolescents with a history of maltreatment are at risk for poor educational outcomes and need additional support. Multiple contributing risk factors suggest the need for whole-of-government solutions.