The Impact of Family Engagement and Child Welfare Services on Maltreatment Re-reports and Substantiated Re-reports

Recurrent child protection post-investigation services for First Nations children in the province of Quebec

BACKGROUND

The longitudinal trajectory of Indigenous children within child protection (CP) services, including their recurrent involvement, has yet to be documented.

OBJECTIVES

1) To document whether First Nations children were at increased risk of a first recurrence of post-investigation CP services compared to children from the majority group. 2) To identify the characteristics associated with recurrence for First Nations children, and to compare these results to those for children from the majority group.

METHOD

Anonymized CP administrative data (2002-2014; n = 1150) of a region in the province of Quebec were used to conduct Cox proportional hazards modeling, in partnership with an advisory committee.

RESULTS

The risk of recurrence of First Nations children did not significantly differ from the risk for children from the majority group (HR: 0.980, n.s.) while controlling for covariates. Among First Nations children (n = 459), being under two at the case closure (HR: 2.718, p < .05), having received short-term intervention (HR: 5.027, p < .001) and coming from a family already known to the CP agency (HR: 2.023, p < .001) were associated with an increased risk of recurrence.

CONCLUSIONS

The findings highlight the importance of studying First Nations children's trajectories within CP services as a group deserving full attention and for First Nations to be able to design or demand appropriate services responding to their population's needs. A family-based research perspective is recommended to understand better the full family history leading to and in relation to CP services, which could provide more sound practice recommendations.

Reducing Family Violence Through Child Welfare Intervention: A Propensity Score-Matched Study of Fathers for Change

Intimate partner violence (IPV) is prevalent, costly, and detrimental to children's health and development. It often co-occurs with child abuse and neglect. Most children referred to child protective services (CPS) have witnessed IPV and are at increased risk for subsequent exposure, as well as repeat maltreatment. For CPS referred children, there is often a missed opportunity to interrupt family violence and prevent future occurrences. Fathers for Change (F4C) is a family level intervention designed to reduce IPV by improving emotion regulation and reflective functioning in fathers. To date, no study has examined whether F4C is associated with reduced recidivism in families referred to CPS. Using propensity score matching (PSM) to simulate an experimental design, the current study tests the hypothesis that families with fathers who completed F4C will have significantly lower rates of new CPS reports over a 12-month period compared to a PSM sample of families of fathers not referred to F4C. Data were extracted from a state CPS electronic case records system on all accepted child maltreatment reports received between January 1, 2015, and April 30, 2020. PSM was successful in balancing potential confounders (e.g., race, number of prior maltreatment reports, risk level, date of report), resulting in a comparison group approximate to one that could be achieved via a randomized control trial. Logistic regression analyses of 1:1 PSM pairs revealed that control fathers were 2.4 times more likely to have a repeat maltreatment report during the 12-month follow-up period than F4C fathers. These findings suggest that F4C may provide an effective approach for reducing risk of repeat maltreatment among CPS referred children with identified IPV exposure.

Differential Response and the Reduction of Child Maltreatment and Foster Care Services Utilization in the U.S. From 2004 to 2017

By 2014, the majority of U.S. states had implemented differential response (DR), a system policy that seeks to serve families of low-to moderate-risk for child maltreatment through family engagement, diversion from formal child protective services investigations, and service provision. However, the effects of DR programs on child welfare dynamics have yet to be evaluated nationally using causal methods. Using a quasi-experimental study design with data drawn from the National Child Abuse and Neglect Data System from 2004 to 2017, we found states with DR programs had approximately 19% fewer substantiated reports, 25% fewer children substantiated for neglect, and a 17% reduction in foster care services utilization when compared to states without DR programs. We find these estimates to be robust to the opioid epidemic and incarceration rates. Additional research is needed to better characterize DR programs and isolate the effects of DR programs geographically.

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.

Safely Increasing Connection to Community-Based Services: A Study of Multidisciplinary Team Decision Making for Child Welfare Referrals

Initial child welfare screening decisions, traditionally made by an individual worker, determine if a family will receive further intervention by child protective services. A multi-disciplinary team (MDT) decision-making approach for child welfare referrals aims to provide a more thorough assessment of needs and strengths and to connect families to appropriate community-based providers. This study examined 159 child welfare referrals handled by MDTs compared to 331 referrals handled via the traditional screening approach. The study used a pseudo randomization procedure to assign referrals to the study conditions: Referrals logged on 2.5 days of the week were assigned to the treatment group; all others were assigned to the comparison group. Referrals handled by an MDT were more than four times as likely as those not handled by an MDT to be referred to community-based organizations (OR = 4.32, p < .001). There were no statistically significant differences in families' engagement with community-based organizations or child welfare outcomes. MDTs are a promising step in the initial process of connecting families to services, although they did not affect this study's longer-term outcomes.

Neglect subtypes in relation to rereport and foster care entry outcomes

BACKGROUND

There have been mixed findings on whether neglect increases the risk of re-report and foster care entry compared with other child maltreatment types. Studies suggest that child neglect can be broken into subtypes which, in turn, may lead to different child welfare outcomes.

OBJECTIVE

The purpose of this study was to examine whether the re-report and foster care entry outcomes varied by child maltreatment type, specifically the subtypes of neglect.

PARTICIPANTS AND SETTING

Data were derived from a regional longitudinal study with linked CPS and state-level administrative data. Participants (n = 4867) included children with reports of physical abuse, sexual abuse, and six neglect subtypes. Cox regression models were used to assess the probability of recurrence and foster care entry outcomes.

RESULTS

Most neglect subtypes were more likely to be re-reported than physical abuse and sexual abuse, and physical neglect was more likely to be re-reported than lack of supervision (HR = 1.20). Children reported for physical neglect was more likely to be placed in foster care than children with reports of physical abuse and other subtypes of neglect.

CONCLUSIONS

This study provides new insight on whether families with child neglect allegations are at increased risk of re-report or foster care entry outcomes compared with other child maltreatment allegations. Given the significant individual, system, and societal costs of neglect, we hope this study facilitates rigorous investigation of child neglect and the potentially modifiable factors or targets for intervening to prevent the re-report of child maltreatment and foster care entry.

Re-referrals to Child Protective Services for children born to young parents

BACKGROUND

Children of teenage parents are at increased risk for child maltreatment but there is limited information about the risks teenage parenthood poses for maltreatment recurrence after prior Child Protective Service (CPS) involvement.

OBJECTIVE

Determine whether children born to teenage parents are at increased risk of maltreatment re-referral to CPS compared to children born to older parents.

PARTICIPANTS AND SETTING

Children under 6 years with substantiated reports of parental maltreatment between 2002 and 2018 were identified from National Child Abuse and Neglect Data System (NCANDS) data.

METHODS

Youngest known parental age at child's birth, in years, was categorized as <20, 20-24, 25-29, or ≥30 (referent group). The number of re-referrals within 5 years was the outcome of interest. Negative binomial regression analyses assessed whether being born to a teen parent was associated with a greater risk of re-referral.

RESULTS

In a study population of 2,680,961 children, having a teen parent, one aged 20-24 years, or 25-29 years at birth was associated with 19% (95% CI 1.18-1.19), 16% (95% CI 1.16-1.17), and 11% (95% CI 1.11-1.12) greater risk of re-referral compared to having a parent aged 30 years or older adjusting for child age, gender, race-ethnicity, state, and initial maltreatment type.

CONCLUSION

The small, but significant increased risk for re-referral to CPS for child maltreatment in young children with at least one teenage or young parent at the time of birth compared to children with older parents suggests that specifically targeting young parents with appropriate services when initially referred to CPS may help reduce the risk of maltreatment recurrence.

Engaging Families in Voluntary Prevention Services to Reduce Future Child Abuse and Neglect: a Randomized Controlled Trial

Research on secondary prevention is mixed as to whether referrals to evidence-based practices and other community interventions reduce maltreatment recidivism. This evaluation sought to rigorously assess whether a community service-linkage model to evidence-based programs decreased subsequent reports of abuse and neglect among families reported to the child protection system (CPS). Between 2016 and 2018, administrative CPS records were used to identify families with at least one child under 5 years of age recently reported for maltreatment in Orange County, California, but where no follow-up services were mandated. Families were randomized to one of two community outreach and engagement conditions (i.e., targeted provider outreach vs. treatment-as-usual). Re-reporting outcomes were tracked in administrative records for a period of 12 months. A total of 4873 families met eligibility criteria, with 2231 (45.0%) randomized to the intervention arm and 2642 (54.0%) families to the control group. Among families in the intervention group, 811 (36.4%) were successfully contacted by a community provider. Of those families contacted, 145 (18.0%) agreed to participate in voluntary services. Overall, we did not detect any significant difference in re-reporting between our treatment and control groups (P = .433). Likewise, no significant differences in re-reporting were observed when we stratified the treatment group by levels of outreach and service engagement. Findings indicate low levels of successful engagement of families in voluntary services. Notwithstanding the absence of significant findings, this study demonstrates the potential for using community-based RCTs and administrative records to rigorously evaluate secondary prevention programs in the child protection system.

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

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

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.

Differential Response and Children Re-Reported to Child Protective Services: County Data From the National Child Abuse and Neglect Data System (NCANDS)

Child protection systems that implement differential response (DR) systems screen to route referrals to an investigation response (IR) or alternative response (AR). AR responses emphasize family engagement, assessment of family needs, and service linkage. Usually, AR state-level policy does not require child welfare staff to make a maltreatment determination. Jurisdictions implement DR systems differently, leading to variations in the proportion of AR cases, risk levels of cases served, and the ways families access and use services. County data from the National Child Abuse and Neglect Data System were analyzed for six states from 2004 to 2013 that implemented DR. Variation in county-level AR rates were associated with county-level re-report rates using regression models with risk adjustments for socioeconomic and other county characteristics. Counties had 3% fewer re-reports overall for each percentage increase in AR use; higher levels of AR use are related to lower levels of re-reporting. When county AR and IR cases were analyzed separately, increasing rates of AR were associated with lower re-report rates for IR cases, but higher re-report rates for AR cases. Findings for the AR and IR subgroup must be interpreted with caution as a number of technical factors may be driving these results.

Child abuse and neglect re-report rates for young children with developmental delays

The study objective was to examine the likelihood and magnitude of child abuse and neglect (CAN) re-reports for young children (0-71 months) with delays in cognitive, language, and adaptive development, compared to typically developing children. The National Survey of Child and Adolescent Well-Being (NSCAW II), a nationally representative and longitudinal survey, was used to examine CAN re-reports at two follow-up waves, 18- and 36-months post baseline assessments. Logistic regression models were employed to determine the correlation between number of developmental delays and a CAN re-report at waves 2 and 3. Results indicate that children with three or more domains of delays had odds 4.73 times higher than children without developmental delays of re-report to CPS at wave 2 but not at wave 3. In this study, children with multiple developmental delays have elevated rates of CAN re-reports when compared to typically developing children. Allocation of child welfare resources should include strategies for preventing maltreatment risk among children with developmental delays.