Explaining Risk Factors for Successful Family Supervision Orders: Families with Intellectual Disabilities in Child Protection in the Netherlands

Families with mild to borderline intellectual disabilities (MBID) are overrepresented in child protection, and are at higher risk for long and unsuccessful family supervision orders (FSOs). This is worrisome, as many children apparently are exposed to unsafe parenting situations for longer periods of time. Therefore, the present study examined which child and parental factors and child maltreatment are related to the duration and success of an FSO in families with MBID in the Netherlands. Casefile data were analysed of 140 children with an ended FSO. Results from binary logistic regression analyses showed that in families with MBID, young children, children with psychiatric problems, and children with MBID were at higher risk for a longer duration of FSOs. Furthermore, young children, children with MBID and children who were sexually abused had a lower chance of a successful FSO. Unexpectedly, children who witnessed domestic violence or whose parents were divorced, had a higher chance of a successful FSO. The discussion focuses on implications of these results for treatment and care of families with MBID from the perspective of child protection.

Interrater reliability of the violence risk assessment checklist for youth: a case vignette study

BACKGROUND

Facilities providing health- and social services for youth are commonly faced with the need for assessment and management of violent behavior. These providers often experience shortage of resources, compromising the feasibility of conducting comprehensive violence risk assessments. The Violence Risk Assessment Checklist for Youth aged 12-18 (V-RISK-Y) is a 12-item violence risk screening instrument developed to rapidly identify youth at high risk for violent behavior in situations requiring expedient evaluation of violence risk. The V-RISK-Y instrument was piloted in acute psychiatric units for youth, yielding positive results of predictive validity. The aim of the present study was to assess the interrater reliability of V-RISK-Y in child and adolescent psychiatric units and acute child protective services institutions.

METHODS

A case vignette study design was utilized to assess interrater reliability of V-RISK-Y. Staff at youth facilities (N = 163) in Norway and Sweden scored V-RISK-Y for three vignettes, and interrater reliability was assessed with the intraclass correlation coefficient (ICC).

RESULTS

Results indicate good interrater reliability for the sum score and Low-Moderate-High risk level appraisal across staff from the different facilities and professions. For single items, interrater reliability ranged from poor to excellent.

CONCLUSIONS

This study is an important step in establishing the psychometric properties of V-RISK-Y. Findings support the structured professional judgment tradition the instrument is based on, with high agreement on the overall risk assessment. This study had a case vignette design, and the next step is to assess the reliability and validity of V-RISK-Y in naturalistic settings.

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.

Estimating the incidence of substance exposed newborns with child welfare system involvement

BACKGROUND

Prenatal substance use can have negative health consequences for both mother and child and may also increase the likelihood of child welfare involvement. The rate of newborns with substance exposure has increased dramatically. As of 2016, federal law requires notification of all infants to child welfare agencies so that a plan of safe care can be developed and referrals to services can be offered.

OBJECTIVE

Child welfare agencies have not historically collected consistent, systematic data identifying substance exposed newborns. We utilized a unique strategy to identify substance exposed newborns with child welfare involvement.

PARTICIPANTS & SETTING

We used data from the National Child Abuse & Detection System (NCANDS) which captures N = 3,189,034 unique child protective services investigations for children under the age of 1 between 2004 and 2017.

METHODS

We calculated the incidence of substance exposed newborns investigated by child welfare agencies and compared with other administrative data on prenatal substance exposure. We also analyzed this rate by infant demographic characteristics (race/ethnicity, sex, rurality).

RESULTS

Between 2004 and 2017, approximately 13 % of infants reported to child protective services were likely reported because of substance exposure at birth, and the rate of substance exposed newborns with child welfare involvement increased from 3.79 to 12.90 per 1000 births, an increase of 240 %, over this period.

CONCLUSIONS

Understanding the extent of the substance use crisis for child welfare involvement is important for policymakers to support children and families.

'There's a will, but not a way': Norwegian GPs' experiences of collaboration with child welfare services - a grounded theory study

BACKGROUND

Adverse childhood experiences can have immediate effects on a child's wellbeing and health and may also result in disorders and illness in adult life. General practitioners are in a good position to identify and support vulnerable children and parents and to collaborate with other agencies such as child welfare services. There is a need for better integration of relevant services. The aim of this study is to explore GPs' experiences of the collaboration process with child welfare services.

METHOD

This is a qualitative grounded theory study, with data consisting of ten semi-structured interviews with general practitioners across Norway.

RESULTS

The doctors' main concern was: 'There's a will, but not a way'. Three subordinate stages of the collaboration process were identified: (I) Familiar territory, with a whole-person approach to care by the doctor. (II) Unfamiliar territory, when child welfare becomes involved. Here, a one-way window of information and a closed door to dialogue perpetuate the doctors' lack of knowledge about child welfare services and uncertainty about what is happening to their patients. (III) Fragmented territory, where doctors experience lost opportunities to help and missing pieces in the patient's history.

CONCLUSION

General practitioners are willing to contribute to a collaborative process with child welfare, but this is hampered by factors such as poor information flow and opportunities for dialogue, and limited knowledge of the partner. This implies lost opportunities for doctors to help families and contribute their knowledge and potential actions to a child welfare case. It can also impede whole-person care and lead to fragmentation of patient pathways. To counteract this, electronic two-way communication could enable a collaborative process and relationships that enhance coordination between the parties. Making space for all parties and their individual roles was considered important to create a positive collaborative environment.

Does a child maltreatment report source predict differences in immediate and subsequent report outcomes?

BACKGROUND

Mandated reporting policies, a core response to the identification of child maltreatment, are widely debated. Currently, there are calls to abolish or scale back these policies to include only certain professionals. These calls warrant evaluation of whether there are any differences in child welfare outcomes based on report source.

OBJECTIVE

To determine if the initial report source predicts immediate and long-term risk of re-referral, substantiation, and placement.

PARTICIPANTS AND SETTING

We used yearly National Child Abuse and Neglect Data System (NCANDS) hotline report and placement data. Children (0-14y) with a first ever hotline report in 2012-2014 were followed for three years. The final sample included 2,101,397 children from 32 states.

METHODS

We use descriptive and bivariate statistics to show initial report outcomes by reporter source type and logistic regression models to evaluate the effect of report source on immediate and subsequent report outcomes.

RESULTS

Professional sources varied in levels of substantiation and placement, with law enforcement, medical, and social service sources showing much higher rates. Reports from professional sources have higher odds of initial report substantiation and foster care entry, and slightly lower odds of later re-report than nonprofessional sources. We found no differences between professional and nonprofessional sources in subsequent foster care entry.

CONCLUSIONS

Reports from professional, nonprofessional, and unclassified sources have varying levels of risk in some of their short- and long-term outcomes. To the degree that child protective services embrace a long-term preventative role, reports by nonprofessional report sources may provide opportunities for prevention.

Medical child abuse: Medical history and red flags in French adolescents

BACKGROUND

Medical child abuse (MCA; or Munchausen syndrome by proxy) is a severe form of adult and medical maltreatment of children. Currently, few data on MCA in adolescents exist.

OBJECTIVE

To describe the clinical characteristics and medical history of children and adolescents aged 10 to 18 years with suspected or confirmed MCA in the pediatric hospital setting.

METHODS

We included patients aged 10 to 18 years who were seen in five tertiary care hospitals in the Paris area and identified by physician recall such as suspected MCA between 2015 and 2021.

RESULTS

We included 29 adolescents; the mean (SD) age was 12.9 (10.8-15.0) years at suspected diagnosis. Medical wandering was common, with a mean of 23 (12.8-33.2) alleged symptoms and 33 (9.2-56.8) specialized consultations in a mean of six different hospitals. The mean number of emergency visits was 11.8 (0-25.9) and radiologic exams 24.3 (5-43.6). Overall, 62 % (18/29) of the adolescents had an underlying organic pathology. The impact of MCA on quality of life was major, with a high rate of school dropout (96 %). The mean delay to the suspected diagnosis was 5.8 (2.6-9) years, and even when recognized, it was rarely the subject of a social or judiciary report (only 42 % of adolescents). In total, 50 % of the adolescents subsequently exhibited Munchausen syndrome.

CONCLUSION

Adolescent MCA is poorly known among the medical profession. Increasing awareness, education and knowledge of risk factors could contribute to better care.

Learning from child welfare staff experiences during the pandemic: Practices to maintain and discontinue

BACKGROUND

The COVID-19 pandemic led to multiple changes in the ways child welfare agencies operate. Child protection agencies had to make rapid changes that impacted where and how staff operate. Minimal research has examined child welfare workers' views of these practices.

OBJECTIVE

This qualitative study seeks to understand CPS workers' perspectives regarding practices utilized during the pandemic. Staff provided input into practices they found beneficial and hope to see maintained and those they hope to see discontinued.

PARTICIPANTS AND SETTING

The full study involved 267 staff members from 50 agencies across Ohio; this study examines qualitative data from 100 staff members who responded to two open ended survey questions.

METHODS

This qualitative study used thematic analysis to analyze two open ended questions from a survey sent to all the child welfare agencies in Ohio.

RESULTS

Thematic analysis of practices staff hoped to continue after the pandemic resulted in five themes: Nontraditional Site and Schedule, Remote Meetings, Safety Protocols, Communication and Support, and Helping Children and Families. Thematic analysis or practices staff hoped would end after the pandemic resulted in six themes: Masking, Virtual Meetings, Mandated Work Location, Unreasonable Policies, Overloading and Overwhelming Staff, and Separation from Coworkers.

CONCLUSIONS

Study results fill a gap in the research by asking CPS staff about their experiences and recommendations after practicing during COVID-19 restrictions. The most common recommendation from staff was to continue offering a nontraditional site and schedule. This study highlights the importance of soliciting and learning from staff perspectives.

Portrait of sleep in preschoolers involved with Child Protective Services and from the community

OBJECTIVES

The objectives of this exploratory study were: 1) to draw a portrait of sleep, using actigraphic sleep measures, sleep diaries and a validated sleep questionnaire in preschoolers (3- to 5-year-olds) involved with Child Protective Services (CPS) and to compare it with preschoolers from the community, not involved with CPS and 2) to verify whether the sleep differences between the two groups persisted after adjusting for covariates (sociodemographic and child characteristics).

METHODS

A total of 92 preschoolers aged from 3 to 5 years (49,5 ± 7,0 months) participated in the study (n = 22 preschoolers involved with CPS and n = 70 preschoolers from the community). Actigraphic sleep parameters were recorded using the child's non-dominant wrist over 72 h during weekdays and sleep diaries were filled out by parents (for nighttime) and childcare specialists (for daytime). Parents filled out the Child Sleep Habits Questionnaires (CSHQ) to measure their perception of their child's sleep. Chi-square tests, ANOVAs, and linear regressions were used to analyze the data and adjust for covariates (sociodemographic and child characteristics).

RESULTS

Preschoolers involved with CPS took longer to fall asleep and signaled significantly fewer nighttime awakenings to their parents compared to the group of preschoolers from the community. These significant effects were still present after adjusting for covariates (sociodemographic and child characteristics).

CONCLUSIONS

Understanding the underpinnings of these sleep differences by exploring their possible links with daytime cortisol production, sleep ecology and parent-child attachment are interesting avenues for future research.

Intergenerational transmission of child protective services involvement: Exploring the role of ACEs and domestic violence among families who receive home visiting services

BACKGROUND

Adverse childhood experiences (ACEs) are associated with negative outcomes over the life course and across generations, including domestic violence (DV) and child maltreatment. However, no studies have examined the connection between parents' ACEs and their child's risk of child protective services (CPS) involvement or possible mechanisms of transmission.

OBJECTIVE

In addition to describing the prevalence and correlates of CPS involvement, our primary aims are to test whether parental adversity in childhood is associated with CPS involvement and whether DV victimization mediates the ACE-CPS association.

PARTICIPANTS AND SETTING

The sample included 3039 primary caregivers and 3343 children served by home visiting programs in Wisconsin between 2014 and 2019.

METHODS

Using matched home visiting and CPS records, we generated prevalence estimates of screened-in CPS reports and assessed bivariate associations between CPS involvement and ACEs, DV, and household demographics. We then conducted a two-stage path analysis to test the association between ACEs and CPS involvement and whether DV mediated the ACE-CPS association.

RESULTS

Overall, 22.8 % of caregivers had a screened-in report. Prevalence rates were higher among women who endured ACEs and DV, and they varied by demographic characteristics. ACEs were directly linked to DV and CPS involvement, and there was an indirect pathway linking ACEs to CPS involvement through DV exposure.

CONCLUSIONS

Home visiting programs serve families that frequently interact with the child welfare system. By enhancing the trauma-responsive potential of these interventions, it may be possible to interrupt intergenerational mechanisms that contribute to child abuse and neglect and CPS involvement.

A qualitative analysis of child protection professionals' challenges during the COVID-19 pandemic

PURPOSE

Child Protection Professionals (CPPs) play a key role in providing insights into the child protection system and how it can best support children's right to personal security, particularly during trying times like the COVID-19 pandemic. Qualitative research provides one potential tool to tap into this knowledge and awareness. This research thus expanded earlier qualitative work on CPPs' perceptions of the impact of COVID-19 on their work, including potential struggles and barriers, into the context of a developing country.

METHODS

A total of 309 CPPs from all five regions in Brazil answered demographics, pandemic-related resilient behaviors, and open-ended questions regarding their profession during the pandemic.

RESULTS

Data went through a three-step process of analysis: (1) pre-analysis; (2) category creation; and (3) coding of responses. Five categories emerged from the analysis: the Pandemic's Impact on CPPs' Work; the Impact of the Pandemic on CPP-Involved Families; Occupational Concerns during the Pandemic; Politics and the Pandemic; and Vulnerability due to the Pandemic.

CONCLUSIONS

Our qualitative analyses showed the pandemic resulted in increased challenges for CPPs across several fronts within their workplace. Although each of these categories is discussed separately, they all influenced one another. This highlights the need to continue efforts to support CPPs.

Understanding the Effects of COVID-19 on Child Maltreatment Reporting Among Rural Versus Urban Communities in the United States

The onset of the coronavirus disease 2019 (COVID-19) pandemic impacted child protective services (CPS) reporting systems in the United States. It may have also led to widened gaps between rural and urban communities in child maltreatment (CM) report rates due to decreased interaction between children and mandated reporters especially in urban jurisdictions. Using data from the National Child Abuse and Neglect Data System, this study tests the hypothesis that during the onset of the COVID-19 pandemic, the decrease in CM reports made to CPS in urban counties was more pronounced than in rural counties. Reports of CM received by CPS offices between January 6, 2020 and June 28, 2020 were aggregated to per-county-per-week-per-10,000 children maltreatment report rates. We used changepoint analyses to analyze the inter- and intra-region incidence rate ratios among rural and urban counties. Moreover, we used multilevel random effects models to generate regression coefficients for the associations between rates of children with a maltreatment report, COVID-19 occurrence, rural-urban designation, and maltreatment risk factors. During the study period, rates of children with a maltreatment report among urban counties decreased more dramatically when compared with rural counties. Our findings persisted even with the inclusion of control variables associated with maltreatment risk factors. Social distancing restrictions may have had the unintended consequence of decreasing the visibility of at-risk children in urban counties more so than in rural counties. Considering geography is critical to continue to protect children during the COVID-19 pandemic and as we prepare for future disasters.

Child protective services contact and youth outcomes

BACKGROUND

Few studies have investigated whether Child Protective Services (CPS) contact influences child wellbeing, independent of underlying maltreatment and not considered as a proxy for such maltreatment.

OBJECTIVE

The present study estimates the association between CPS contact and child delinquency, education, substance use, and mental health and development.

PARTICIPANTS AND SETTING

The study used data from the Fragile Families and Child Wellbeing Study, a longitudinal birth cohort study of children born in 20 US cities. Study outcomes were based on age-15 interviews with the focal children and their caregivers with sample sizes ranging from 2088 to 2327 across outcomes.

METHODS

The relationship between CPS contact and child wellbeing was estimated using the propensity score method of inverse probability of treatment weighting.

RESULTS

CPS contact was associated with an 88% increase in the probability of smoking (p = .010), a 29 % increase in externalizing behavior (p < .001), a 27% increase in internalizing behavior (p = .001), a 18 % increase in the probability of being expelled (p = .32), a 7.5 % increase in a depression (p = .002), a 6.9 % increase in anxiety (p = .002), a 6.2 % reduction in happiness (p = .008), a 6.0 % increase in impulsivity (p < .001), and a 5.5 % increase in school troubles (p < .001).

CONCLUSIONS

Despite a federal mandate to improve child wellbeing, we found no evidence that contact with the child welfare system improves child outcomes. Rather, CPS contact was associated with worse mental health and developmental outcomes.

Child welfare workers satisfaction and wellbeing during the COVID-19 pandemic: Perspectives of agency staff in Ohio

BACKGROUND

The COVID-19 pandemic has impacted the lives of children and families, created additional stressors, and increased risks for maltreatment. The pandemic has changed the way child welfare agencies operate, requiring changes to policies and practice. Minimal research has considered the effects of the COVID-19 pandemic on child welfare workers wellbeing and job satisfaction.

OBJECTIVE

This mixed-methods research study seeks to understand CPS staff satisfaction, variables impacting satisfaction, and challenges that increased since the pandemic began for child welfare workers in Ohio.

PARTICIPANTS AND SETTING

A sample of staff members (n = 267) from 50 CPS agencies across Ohio participated in the study.

METHODS

This mixed-methods study used logistic regression, chi square analyses, and thematic analysis to analyze the data from a survey sent to child welfare agencies in Ohio.

RESULTS

Caring for minor children, primary role at work, and years in child welfare were significantly associated with job satisfaction. Those working in foster care/placement, adoption/permanency, family support/visitation, kinship were 7.57 times more likely than those doing intake/investigation work to be satisfied with their job (p = .007). Thematic analysis of staff issues that increased during the pandemic resulted in six themes: Stress and Anxiety, Feeling Overwhelmed, Burnout, All, Motivation, and Isolation and Disconnection.

CONCLUSIONS

The COVID-19 pandemic has created additional stressors for child welfare staff. Practice implications are discussed to help increase job satisfaction, staff wellbeing, and mitigate turnover.

Exploring the health of child protection workers: A call to action

Background: This exploratory study determined if a relationship exists between secondary traumatic stress (STS) related to health status, health outcomes, and health practices among child protection workers in a Southern state. Methods: This study used a cross-sectional survey research design that included a non-probability sample of child protection workers (N=196). Data were collected face-to-face and online between April 2018 and November 2019 from multiple county agencies. A self-administered questionnaire was completed focused on various health behaviors, outcomes, and workplace perceptions. Results: Results of the zero-order correlations suggest that higher levels of STS were significantly associated with not having visited a doctor for a routine checkup (r=-0.17, P=0.04), more trips to see a doctor (r=0.16, P=0.01), and increased number of visits to emergency room (ER) (r=0.20, P=0.01). Lower levels of STS were associated with better self-rated health (SRH) (r=-0.32, P≤0.001), higher perceptions of health promotion at work (r=-0.29, P≤0.001), frequent exercise (r=-0.21, P=0.01), and by avoiding salt (r=-0.20, P≤0.031). T-test results suggest that workers who did not have children (µ=45.85, SD=14.02, P=0.01) and non-Hispanic white workers (µ=51.79, SD=11.62, P≤0.001) reported significantly higher STS levels than workers who had children (µ=39.73, SD=14.58) and self-identified as Black (µ=39.01, SD=14.38). Conclusion: Findings show that increased interpersonal trauma was linked to unhealthy eating, general physical health problems, and health care utilization. If not addressed, both STS and poor health and health outcomes can have unfavorable employee outcomes, such as poor service delivery.

"Ganja Mamas": Online discussions about cannabis use in pregnancy

BACKGROUND

Nearly 5 % of pregnant women in the United States use cannabis. However, expecting mothers often do not seek counsel from their healthcare providers about prenatal cannabis use due to stigma and legal ramifications. Instead, cannabis-using pregnant women turn to each other to learn. Online message boards have become a safe place for parents to seek answers anonymously in real-time. The objective of this study was to examine the information-seeking/giving behaviors of cannabis-using pregnant women on an online community forum.

METHODS

We extracted 151 original messages and 1260 corresponding comments posted over a 7-day period from Whattoexpect.com's "Ganja Mamas" forum. We iteratively developed a codebook with 16 categories to reflect information-seeking behavior. N = 131 unique forum members posted questions for comment.

RESULTS

Approximately half, 46.56 %, reported their geographic location (24 states), and 40.46 % reported gestational age. The top topics for which members sought out information were testing, state-specific questions, postpartum, child protective services (CPS), hospital-specific questions, birth announcements, methods of cannabis use, quitting, breastfeeding/pumping, pregnancy symptoms, mental health, general health and pregnancy, and quantity of cannabis use. The second phase of analysis was based on members' responses. Clustered codes indicated how the respondents were using the forum: (1) interviewing and geographic location, (2) knowledge, experience, and reassurance, (3) congratulations and relief, and (4) concealing cannabis use and symptoms.

CONCLUSIONS

Our results demonstrate that mothers on an online cannabis forum are seeking information about location-specific experiences pertaining mostly to testing and child protective services. Additionally, mothers are responding by geographic-specific interviewing, and are expressing relief and reassurance in response to members' experiences.

Child maltreatment reporting during the initial weeks of COVID-19 in the US: Findings from NCANDS

BACKGROUND

After the national COVID-19 emergency declaration in the U.S. in March 2020, child welfare agencies observed large reductions in maltreatment reporting.

OBJECTIVE

To quantify the impact of the COVID-19 pandemic on child maltreatment reporting nationally to inform policy for future emergencies.

PARTICIPANTS AND SETTING

Administrative data from the National Child Abuse and Neglect Data System (NCANDS) for 48 states for federal fiscal years (FFYs) 2017 through 2020.

METHODS

Analyses focused on reports to child protective services (CPS) between weeks 12 and 24 of calendar years 2017 through 2020 (mid-March through mid-June). Report sources of screened in and substantiated reports were compared with those during the prior year. Likelihood of a report being substantiated in 2020 compared with 2019 based on report source was calculated using odds ratios.

RESULTS

In 2020, CPS screened in 39 % fewer reports than during the same period in 2019 and the proportion of reports substantiated increased from 18 to 22 %. Reports from all report sources decreased, especially from education personnel (90 % decrease) and child daycare providers (65 % decrease). The odds for substantiation were significantly higher during 2020 than in 2019 for reports from all but three sources.

CONCLUSION

During the initial weeks following the national COVID-19 emergency declaration, the number of reports to CPS declined sharply at the national level and across all states, primarily in association with a large reduction in referrals from education sentinels. Explanations for the increase in percent of substantiation in the context of reduction of reports are considered.

Careful: An administrative child welfare and electronic health records linked dataset

Between 2012 and 2017, N = 2814 youth between the ages of 4 and 20 were in child protective services (CPS) custody in Hamilton County, Ohio, and placed in out-of-home care. Child welfare administrative records were extracted and linked to electronic health records for all encounters at Cincinnati Children's Hospital Medical Center, with n = 2787 (99.1%) of records successfully linked prior to de-identifying the data for research purposes. Child welfare administrative data fields in the dataset include demographics, dates of entry into and exit from protective custody and out-of-home care, reasons for entry into custody, dates of placement changes, reasons for placement changes, and types of placement (e.g., foster home, kinship home, group home, residential treatment, independent living). Electronic health records (EHR) data fields include demographics, all inpatient and outpatient encounters with medications, diagnoses, screening results, laboratory test results, flowsheet data, and problem list entries. Data have been coded to capture broader categories of health needs and encounter details, medications, and other health concerns. Due to the high representation of children in CPS custody and out-of-home care who are also represented in the EHR data, this dataset provides a comprehensive view of the medical needs and health concerns for school-aged children in CPS custody in an entire county. As a result, these data can be useful for understanding the emergence of global and specific health concerns, frequency of healthcare use, and placement stability for all youth in CPS custody in this community, accounting for variation due to other health and child welfare factors. These data are likely generalizable to other mid-sized urban communities where academic medical centers provide healthcare for children in CPS custody. De-identified data may be made available to other researchers with approved data transfer agreements between academic institutions in place.

Flourishing mental health among adults with child welfare contact during childhood: Findings from a nationally representative Canadian survey

This study investigated the prevalence of and factors associated with complete mental health (CMH) among a nationally representative sample of Canadians who had contact with child welfare services before age 16. CMH was defined as (1) the absence of suicidality, mental illness, and substance abuse or dependence in the preceding year; (2) happiness or life satisfaction almost every day in the preceding month, and; (3) social and psychological well-being almost every day in the preceding month. Data came from the 2012 Canadian Community Health Survey - Mental Health. A subsample of 732 adults with child welfare contact during childhood was analyzed using bivariate chi-square analyses and multivariate logistic regression models. Overall, 63.5% of adults with child welfare contact during childhood were in CMH. Those with a post-secondary degree, who were married, who had a confidant, and who used religion or spirituality to cope with daily challenges were more likely to be in CMH. The odds of CMH were higher among those without chronic pain, functional limitations, and a history of depression, anxiety, or substance abuse or dependence. The results of this study indicate significant resiliency among adults following contact with child welfare services during childhood. Implications for appropriate interventions are discussed.

Social determinants of health and Hirschsprung-associated enterocolitis

BACKGROUND

Hirschsprung-associated enterocolitis (HAEC) is the most common cause of morbidity and mortality in patients with Hirschsprung disease (HD). The objective of this study was to examine the association of social determinants of health (SDOH) with HAEC.

METHODS

A review of patients who underwent primary pull through for HD at our institution from 2014 to 2021 was performed. Clinical, surgical, and SDOH data were collected. HAEC was defined by an international scoring system. Categorical variables were analyzed via Fisher's exact tests and continuous variables with Mood's median tests.

RESULTS

One hundred patients were identified with 29 patients (29%) having at least one episode of HAEC during a median follow-up of 31 months (IQR: 11.7-55.7). Children who utilized public transportation for clinic visits, had one or more missed appointments, had any reported safety concerns, were involved with Child Protective Services, had parents/guardians who were not married, lived with people other than their immediate family, or had mothers who reported drug use or lack of prenatal care were found to have a higher likelihood of developing HAEC (p<0.04 for all). Age at HD diagnosis, age at pull through, operative approach, length of aganglionic colon, and Trisomy 21 were not significant predictors of HAEC.

CONCLUSIONS

In our series of 100 patients undergoing primary pull through, there was a significant correlation of HAEC with several social determinants of health elements while anatomical and clinical factors were not associated with HAEC. Attention to social determinants of health and identifying high-risk patients may serve to prevent morbidity and mortality from HAEC.

LEVEL OF EVIDENCE

III.

The extent of violence inflicted on adolescent Aboriginal girls in the Northern Territory

Background

Australian Aboriginal and Torres Strait Islander women are at very high risk of violence but there is little evidence about the age at which their higher exposure to violence commences. The aim of this study was to investigate violence inflicted on Aboriginal girls during childhood and adolescence, relative to Aboriginal boys and non-Aboriginal girls.

Methods

This was a retrospective cohort study using de-identified administrative data for NT residents aged 0-17 years. This study used linked hospital and child protection data to investigate hospitalization for injury caused by assault and substantiated child maltreatment involving violence (physical and sexual abuse).

Results

The incidence of assault hospitalization and substantiated physical/sexual abuse was much higher for Aboriginal than non-Aboriginal adolescents but similar for girls and boys to about age ten, then increased much more for Aboriginal girls than boys. In the 14-17 age-group, assault hospitalization incidence was 125% higher for Aboriginal girls than boys but 56% lower for non-Aboriginal girls than boys. 4.6% of Aboriginal girls were hospitalized (30.9% more than once) for assault between twelfth and eighteenth birthdays, compared to 3.4% of Aboriginal boys and 0.3% of non-Aboriginal girls. The incidence of assault hospitalization during adolescence was over three times higher for Aboriginal children who had substantiated child maltreatment during childhood.

Conclusion

The very high levels of violence suffered by Aboriginal women commence in the pre-teen years. Non-Aboriginal girls are ‘protected’ from the rising levels of violence that boys experience as they progress through adolescence, but Aboriginal girls are not afforded such protection.

One year into COVID-19: What have we learned about child maltreatment reports and child protective service responses?

BACKGROUND

A year has passed since COVID-19 began disrupting systems. Although children are not considered a risk population for the virus, there is accumulating knowledge regarding children's escalating risk for maltreatment during the pandemic.

OBJECTIVE

The current study is part of a larger initiative using an international platform to examine child maltreatment (CM) reports and child protective service (CPS) responses in various countries. The first data collection, which included a comparison between eight countries after the pandemic's first wave (March-June 2020), illustrated a worrisome picture regarding children's wellbeing. The current study presents the second wave of data across 12 regions via population data (Australia [New South Wales], Brazil, United States [California, Pennsylvania], Colombia, England, Germany, Israel, Japan, Canada [Ontario, Quebec], South Africa).

METHOD

Regional information was gathered, including demographics, economic situation, and CPS responses to COVID-19. A descriptive analysis was conducted to provide an overview of the phenomenon.

RESULTS

Across all of the countries, COVID-19 had a substantial negative impact on the operation of CPSs and the children and families they serve by disrupting in-person services. One year into the COVID-19 pandemic, new reports of CM varied across the regions.¹ In some, the impact of COVID-19 on CPS was low to moderate, while in others, more significant changes created multiple challenges for CPS services.

CONCLUSIONS

COVID-19 created a barrier for CPS to access and protect children. The dramatic variance between the regions demonstrated how social, economic and structural contexts impact both CM reports and CPS responses.

"You have to take this medication, but then you get punished for taking it:" lack of agency, choice, and fear of medications to treat opioid use disorder across the perinatal period

INTRODUCTION

Medications to treat opioid use disorder (MOUD) during pregnancy and in the postpartum period remain underutilized. A need exists to enhance our understanding of modifiable factors, facilitators, and barriers to MOUD utilization and adherence in the perinatal period to improve maternal and child outcomes.

METHODS

The study conducted semi-structured qualitative interviews with recently pregnant people with opioid use disorder (OUD) to explore experiences as a pregnant and/or parenting person with OUD, perceptions of enabling factors and barriers to treatment utilization, incentivizing factors for maintaining adherence, and acceptability of ongoing supports to sustain treatment adherence. The study team used constant comparative methods to analyze transcripts and develop the codebook. The team double coded the transcripts, with an overall kappa coefficient of 0.88.

RESULTS

The study team interviewed twenty-six women on average 10.1 months after delivery. All women had some prior experience using MOUD. Four unique themes emerged as barriers to medication utilization and adherence in the perinatal period: 1) Lack of agency and autonomy surrounding medication decisions because pregnancy or parenting status affected treatment adherence; 2) Hesitancy to use MOUD to minimize risk of newborn withdrawal; 3) Concern about increased scrutiny and potential loss of custody due to mandated child protective services reporting for opioid-exposure at delivery in Massachusetts; and 4) Perception that treatment environments, particularly methadone clinics, did not provide gender-responsive or equitable care, and standardized, inflexible visit regulations were particularly difficult to comply with in the early postpartum period.

CONCLUSIONS

Women with OUD experienced a double bind when making perinatal treatment decisions, describing pressure to use MOUD with negative consequences after delivery. Key areas for possible intervention emerged from interviews. These areas include improving uptake of shared decision-making to increase patient autonomy and agency, particularly among those in the earliest stages of recovery during pregnancy; ongoing education around perinatal MOUD safety and efficacy; detangling MOUD and neonatal withdrawal signs from mandated child protective services reporting; and improving gender-responsive and equitable care in substance use disorder treatment programs, including incorporating the utilization of home visiting services for dosing assessments and administration in the early postpartum period.

The power of the future: Intergenerational income mobility and child maltreatment in the United States

BACKGROUND

Recent research has shown that the likelihood of children experiencing intergenerational, upward income mobility depends on the community in which they are raised. Whether parents consider their children's economic chances in their parenting decisions, however, is not well understood.

OBJECTIVE

To examine the relationship between county-level income mobility-distinct from income inequality and poverty-and child maltreatment.

PARTICIPANTS AND SETTING

Administrative data from the National Child Abuse and Neglect Data System: Child File for 2406 counties were merged with measures of intergenerational income mobility from Chetty et al. (2014a), including the probability that a child born in the bottom quintile of the national income distribution reaches the top quintile by age thirty.

METHODS

Weighted least squares analyses were used to empirically estimate the relationship between intergenerational income mobility and child maltreatment report rates. Maltreatment reports were also divided into subgroups by age and metropolitan status.

RESULTS

Counties where children have a greater chance of moving up the income ladder have lower child maltreatment report rates, independent from income inequality and poverty rates. This relationship is consistent across all child ages (0-17). The relationship between upward income mobility and substantiated child maltreatment is also negatively correlated among non-metropolitan counties.

CONCLUSIONS

Children experience a lower risk for maltreatment if they are more likely to move up the income ladder in adulthood. Macroeconomic factors and policies that reduce income inequality and enhance economic mobility are likely to prevent child maltreatment.

The impact of the COVID-19 pandemic on child protective services caseworkers and administrators

BACKGROUND

The COVID-19 pandemic has impacted children and young people experiencing child abuse and neglect. Child Protective Services (CPS) has played an important role in supporting children and families during the COVID-19 pandemic. Few studies to-date have evaluated the impact of the pandemic on CPS caseworkers and administrators in the United States.

OBJECTIVES

We conducted interviews to explore CPS caseworkers' and administrators' experiences working and serving families during the pandemic.

METHODS

Participants were U.S.-based CPS caseworkers and administrators. We conducted semi-structured virtual interviews with participants and used an inductive thematic analysis approach.

RESULTS

We conducted 37 interviews. Participants discussed how the COVID-19 pandemic has changed the way they conduct investigations and provide services to families in the CPS system. Several services were adapted to occur virtually, providing challenges and unique opportunities. Participants also described the personal barriers they faced during the pandemic, including working remotely, experiencing burnout, and challenges obtaining personal protective equipment. Finally, participants shared creative solutions they engaged in to support children and families during the COVID-19 pandemic, including expanding collaborations with other community-based organizations.

DISCUSSION

This study suggests the important role that CPS has played during the pandemic and challenges individual CPS workers felt, in terms of both experiencing burnout and difficulty obtaining personalized protective equipment. Inclusion of the CPS system in emergency preparedness planning for future pandemics or natural disasters will ensure continuation of these vital services.

Health care provider decision-making around prenatal substance use reporting

BACKGROUND

Recent research has found that harms related to alcohol and/or drug (AOD) use during pregnancy are not limited to those associated with use itself; harms also result from policies and health care practices adopted in response, including reporting to Child Protective Services (CPS). This study sought to understand factors that influence health care providers' reporting practices.

METHODS

We conducted 37 semi-structured interviews with hospital-based obstetricians/gynecologists, family medicine physicians, and emergency department physicians, focused on experiences with reporting pregnant/birthing people with AOD to government authorities. We deductively applied an implementation science framework, the Theoretical Domains Framework (TDF) to identify the relevant domains and then inductively coded within domains to identify sub-themes.

RESULTS

Most participants saw reporting as someone else's job, primarily social workers. While a few participants associated reporting with increased connection to services, many participants expressed awareness of negative consequences associated with reporting. Nonetheless, participants were much more concerned about potential harms to the baby associated with not reporting and expressed considerable anxiety about these harms occurring if a report was not made. While a few participants described making reporting decisions themselves, most described interpersonal, hospital-level, and state policy-level factors that constrained their decision-making.

CONCLUSIONS

Many of the factors that influence physician decision-making in reporting pregnant/birthing people who use AOD to CPS are outside the control of individual physicians and require social, structural, and policy changes. Those that are individual-focused involve intense emotions and thus are unlikely to be influenced by solely didactic cognitive-focused trainings.

A Venn diagram of vulnerability: The convergence of pediatric palliative care and child maltreatment a narrative review, and a focus on communication

Child maltreatment and end-of-life care independently represent two of the most emotion-laden and uncomfortable aspects of pediatric patient care. Their overlap can be uniquely distressing. This review explores ethical and legal principles in such cases and provides practical advice for clinicians. The review focuses on three archetypal scenarios of overlap: life-limiting illness in a child for whom parental rights have been terminated; life-threatening injury under CPS investigation; and complex end-of-life care which may warrant CPS involvement. While each scenario presents unique challenges, one consistent theme is the centrality of effective communication. This includes empathic communication with families and thoughtful communication with providers and community stakeholders. In almost all cases, everyone genuinely wants to do what is in the best interest of the child in these unthinkable circumstances. Transparent and collaborative communication can ensure that broad perspectives are considered to ensure that each child gets the best possible care in a manner adherent with ethical and legal standards, as they apply to each case.

Factors contributing to level and type of child welfare involvement following prenatal substance exposure: A scoping review

BACKGROUND

An understanding of factors contributing to variation in child welfare outcomes in cases of prenatal substance exposure (PSE) can help identify gaps in research and practice and guide state and agency policy.

OBJECTIVE

To summarize the evidence base and identify critical gaps in the literature, we conducted a scoping review regarding individual- and institutional-level factors associated with child welfare decision-marking across the service continuum and caregivers' perceptions of child welfare involvement in cases of PSE.

PARTICIPANTS AND SETTING

The sample included peer-reviewed studies based in the United States.

METHODS

We conducted a comprehensive search of four databases for studies investigating 1) sociodemographic, behavioral, policy, or other factors contributing to variation in child welfare outcomes and 2) maternal, family, or provider perceptions of the child welfare process in cases of PSE. We followed an established methodological framework for conducting scoping reviews.

RESULTS

Of the 23 articles included in the review, 20 explored variation in decision-making across the child welfare services continuum and three examined caregivers' perceptions of child welfare involvement. At the institutional level, provider characteristics, such as agency capacity, were linked to specific child welfare outcomes including reports and removals. At the individual level, factors such as socioeconomic status, race, and substance type were also associated with outcomes across the service continuum.

CONCLUSIONS

Child welfare agencies use an unsystematic approach in addressing PSE, contributing to a variation in child welfare outcomes and potentially allowing for bias. This review highlights a need for increased resources and guidance for caseworkers.

Predictive model for intra-familial child maltreatment re-reports and recurrence in South Korea: Analysis of national child protection services case records

BACKGROUND

Child maltreatment recurrence has a significant negative impact on child well-being and may indicate low effectiveness of child protection services (CPS). In South Korea, 10.4% of child maltreatment cases in 2016 had previous CPS involvement. Identifying and understanding significant predictors of child maltreatment re-reports and recurrence has been a critical task in maltreatment research. However, this task has rarely been attempted in South Korea.

OBJECTIVE

This study aimed to examine child maltreatment re-reports and recurrence among children involved in CPS in Korea, identify correlates of child maltreatment re-reports and recurrence with predictors, and explore the consistency or inconsistency of correlates between re-reports and recurrence.

METHODS

The present study analyzed 5349 case records from the National Child Maltreatment Data System, which included information collected by Korean CPS regarding maltreatment, child, parent or perpetrator, and service characteristics.

RESULTS

Results showed that the recurrence rate was 5.9% over the two-year period. In contrast to previous studies, neglect was not found to be a significant predictor of recurrence. Perpetrators' problem-solving skills and survival stress, as well as children's disability status, were significant predictors of recurrence. Receiving welfare assistance was a significant predictor of re-reports (AOL = 1.42, p < 0.01) but not a significant predictor of recurrence.

CONCLUSION

Compared to other empirical studies conducted in several countries, we found similarities and differences regarding predictors of child maltreatment re-reports and recurrences. The results reiterate the importance of family intervention to prevent maltreatment recurrence.

The accrual of parent reported adverse childhood experiences following a child protective services investigation: A prospective approach

INTRODUCTION

Most studies on adverse childhood experiences (ACEs) have largely employed retrospective measures from adults, eschewing prospective measures in child samples. In this paper, we tracked the accrual of ACEs during childhood in a sample of children left in-home following a Child Protection Services investigation.

METHODS

Data from three waves of the 2010 National Survey of Child and Adolescent Well-Being were used (n = 1880). ACEs included 5 forms of child maltreatment and parental domestic violence, mental health problems, substance or alcohol abuse, separation, and arrest. At each wave, parents reported child ACE exposure for the previous year. ACE accrual over three years was traced as mean scores, discrete events, and compounding risk. OLS regression predicted accrual of ACEs over time controlling for important covariates.

RESULTS

At baseline, children experienced an average of 2.2 ACEs, which increased by 3.2 by W3 (5.4 total ACEs). The predicted number of ACEs over time increased by 0.58 with each increase of 1 ACE at baseline (t = 11.74, p < .001). As compound risk, children with 0 ACE at baseline accrued an additional 1.7 by W3, while those experiencing 6 ACEs at baseline accrued 5.9 by W3. Children who experienced emotional neglect and psychological aggression accumulated a greater number of ACEs.

CONCLUSION

The average number of ACEs for in-home children increased precipitously over 3 years, and higher ACE scores at baseline were associated with greater accumulation. This indicates that retrospective measurements may not convey the unremitting nature of ACE accrual.

Diverse trauma profiles of youth in group care settings: A cluster analysis

BACKGROUND

Many adolescents in group care have experienced higher rates of traumatic event exposure, behavior problems, and severe trauma sequelae compared to those outside of group care. Yet, little research has examined from a person-centered perspective their diverse trauma profiles and corresponding service needs.

OBJECTIVE

This exploratory study aimed to examine the heterogeneity of trauma-related profiles among youth in group care to highlight potential distinct service needs among subgroups.

METHOD

Data from the Maltreatment and Adolescent Pathways Study identified 96 randomly selected youth (14-17 years) in Canadian group care settings who completed a battery of self-report measures. Cluster analysis was employed to reveal common patterns of maltreatment and trauma symptoms among subgroups, further described and validated by externalizing behaviors (substance use, risky sexual behavior), internalizing symptoms (global mental health, anger), and personal/parental demographic factors.

RESULTS

Four distinct clusters emerged: (1) no/low maltreatment, low trauma; (2) moderate physical and emotional abuse, moderate trauma; (3) moderate-severe maltreatment, low trauma; and (4) severe maltreatment, high trauma. Clusters 1, 2, and 4 reflected 'dose-response' relationships between maltreatment and trauma symptoms; Cluster 3 was characterized as 'resilient'. Females were highly over-represented in Cluster 4, echoing previous research.

CONCLUSIONS

Findings align with previous research confirming high incidence of maltreatment, internalizing, and externalizing problems among youth in group care, but extends to emphasize the importance of providing trauma-informed services tailored to their variable, complex presentations. Limitations and suggestions for group care settings to provide this wide range of services at program and individual levels are discussed.

The cost of child abuse and neglect in France: The case of children in placement before their fourth birthday

BACKGROUND

Despite the high prevalence of child abuse and neglect and its consequences on health, very few studies have evaluated the trajectories of children in placement in France, and there are no cost studies available.

OBJECTIVE

To estimate the cost of abuse and neglect in children in placement before their 4th birthday in France.

PARTICIPANTS AND SETTING

A cohort of children in placement before their 4th birthday in a single nursery between February 1994 and June 2001 was followed from birth until they left care.

METHODS

Child protective services (CPS), health, health and social, and judiciary services utilization was derived from a qualitative analysis of the children's files and valued with their unit costs in 2013 euros from the societal perspective. Total costs and mean annual cost per child followed by CPS were calculated overall, by cost category, and by status at admission to the nursery.

RESULTS

129 children were included. Mean age at first admission was 1.9 years (SD = 1.3). The mean length of follow-up by CPS was 14.3 years (SD = 5.0). Mean annual cost per child was estimated at €53,265 (SD = 42,077), with CPS costs representing 78% of costs. 80% of health care costs were due to psychiatric care. Children with no identified psychosocial risk factors had significantly higher psychiatric care costs and health and social care costs than pre-term children and children with identified psychosocial risk factors.

CONCLUSION

More research should be carried out to address early and comprehensively the multiple needs of children followed by CPS in the short- and long-term.

A population-based case control study of suicide among youth reported for abuse and neglect

BACKGROUND

Research has indicated an association between child abuse and adolescent suicide. Little population-based information exists, however, about the nature of maltreatment experiences or interactions with the child protection system (CPS).

OBJECTIVE

To examine child maltreatment characteristics and system-level responses associated with risk of adolescent suicide.

PARTICIPANTS AND SETTING

Linked vital death records and CPS records were used to identify the population of adolescents who died by suicide in California between 2010 and 2017 and who had a history of at least one report to CPS prior to death.

METHOD

A case control design was used, with cases defined as a suicide of an adolescent with a history of CPS involvement. Using CPS records, living controls were then matched to cases based on year of birth, sex, race and ethnicity, and age of first child maltreatment allegation. A conditional logistic regression model was used to estimate the adjusted odds of adolescent suicide across various CPS and maltreatment characteristics.

RESULTS

Recent CPS involvement, allegations of physical abuse, and allegations of sexual abuse emerged as significant risk factors for death by suicide. No differences in suicide risk were observed between youth with unsubstantiated or substantiated allegations.

CONCLUSIONS

Suicide risk appears to be more closely tied to specific maltreatment experiences than to substantiation or placement into foster care. As adolescent suicide rates rise, better a understanding of risk factors among already vulnerable populations of youth is critical.

Child Welfare Services Response to COVID-19: Addressing Face-to-Face Contacts

During the onset of the COVID-19 pandemic, child welfare case managers faced contradictions in their responsibility to make regular in-person contact with children and families to promote safety, permanency, and well-being while following public health directives to avoid social contact in order to curb COVID-19 infections. In response, federal guidance was issued regarding the use of technology to maintain mandated contacts with children in foster care. States had to make decisions about how to handle other contact types. This study reviewed documentation of state child welfare agency practices regarding face-to-face contact between case managers and child-welfare involved families between March 2020 and May 2020. Using a point-in-time search to obtain publicly accessible documents related to caseworker face-to-face contact and COVID-19, data was located for 49 states and the District of Columbia (n = 50). Documents were analyzed in NVIVO 12 using document analysis. Within the context of face-to-face interactions by child welfare case managers, documents were analyzed in six themes based on the types of services provided to children and families: (1) investigations, (2) family preservation, (3) family team meetings, (4) foster care, (5) adoption, and (6) general child welfare. State decisions about how to manage these contacts varied. In several states case managers were directed to document both virtual and in-person contacts during this time as face-to-face; which may impact future evaluations of child welfare systems during COVID-19. Findings highlight a range of strategies used by state child welfare systems. By reviewing previous practice and hearing what other states are doing, child welfare service agencies have the potential to evaluate appropriately, strengthen their plans and address disparate impacts.

"A good mother": Impact of motherhood identity on women's substance use and engagement in treatment across the lifespan

BACKGROUND

Women are underrepresented in substance use disorder (SUD) treatment. Interpersonal and structural factors affect women's access to SUD treatment, but limited research evaluates how motherhood is a potential barrier and facilitator to engagement in SUD treatment. We focus on women from young to middle adulthood, and capture women's identities as mothers, caretakers, and grandmothers, outside of pregnancy and the postpartum period.

METHODS

Study staff conducted twenty qualitative interviews with women in SUD treatment to assess experiences with SUD treatment, in which motherhood emerged as a key theme. Twelve women then participated in four focus groups centered on motherhood. The study audio-recorded and transcribed interviews, and two independent authors analyzed interviews, followed by group consensus.

RESULTS

Most women identified their children and responsibilities as mothers and caretakers as important motivators to accessing SUD treatment. Motherhood was also a barrier to treatment, in that women feared losing child custody by disclosing substance use and few residential programs accommodate women with children. Multiple women expressed guilt about their substance use, sensing that it contributed to perceived abandonment or separation from their children. Reunification was important to SUD recovery.

CONCLUSION

Women with SUD who are mothers experience specific barriers to treatment engagement and recovery. Women need SUD treatment programs that address these interpersonal and structural factors across the lifespan.

Clinical evaluation and management of children with suspected physical abuse

Evaluating and managing children with suspected physical abuse is challenging. Few single injuries are pathognomonic for abuse and, as a result, child abuse is easily missed. As such, a healthy bit of skepticism is needed to recognize and protect abused children. The medical history and clinical presentation should guide evaluation. Medical providers must consider the differential diagnosis, epidemiology of injuries, and child development to inform the assessment. In this review, we address evidence-based recommendations to inform child physical abuse evaluations. We also discuss the role of medical providers in communicating with families, mandated reporting and interpreting medical information for investigative agencies and other non-medical colleagues entrusted with protecting children.

Earlier Contact with Child Protection Services Among Children of Parents With Criminal Convictions and Mental Disorders

Parental history of offending and/or mental illness are risk factors for child maltreatment. However, limited research has directly contrasted the role of maternal versus paternal criminal offending or mental health problems in contributing to earlier contact with the child protection system. In this study we examined the relative contributions of these risk factors in relation to the time to the offspring's first report to child protection services, or first placement in out of home care (OOHC), using administrative records for a population sample of 71,661 children. Prior paternal offending had a greater independent effect on time to the offspring's first contact with child protection services (HR = 2.27 [95% CI = 2.14-2.40]) than maternal offending (HR = 1.75 [95% CI = 1.63 -1.87]) or maternal mental disorder diagnosis (HR = 1.66 [95% CI = 1.57 -1.77]). By contrast, prior maternal offending (HR = 2.58 [95% CI = 2.26-2.95]) and mental disorder diagnosis (HR = 2.33 [95% CI = 2.05-2.63]) had a greater effect on earlier placement in OOHC, relative to prior paternal offending (HR = 1.59 [95% CI = 1.35 -1.88]) and mental disorder diagnosis (HR = 1.06 [95% CI = 0.94 -1.19]). These findings demonstrate the potential benefits of coordinated government responses across multiple agencies to identify vulnerable children and families who might benefit from early interventions or support services.

The Government's Involvement in Prenatal Drug Testing May Be Toxic

In 25 U.S. states, healthcare professionals are mandated to report pregnant people for substance use to child protection service (CPS) agencies. This practice is not evidence-based, and we believe it harms the patient-provider relationship, opposes reproductive autonomy, and contributes to racial disparities in CPS referrals and their outcomes. Black patients are more often screened and reported than white patients for prenatal substance use; besides the impact on their obstetric care, this may be a barrier to seeking treatment for substance use disorders. Furthermore, strict, punitive state-level policies are associated with greater odds of neonatal abstinence syndrome. The treatment of substance use disorders in pregnancy under the Child Abuse Prevention and Treatment Act opposes robust evidence understanding substance use disorders as chronic illnesses. Among non-pregnant people seeking healthcare, substance use is not a "reportable offense." This double marginalization of pregnant patients limits their autonomy and unduly exposes them to the criminal-legal system. Given disparities in prenatal drug screening, Black pregnant patients are at greater risk of such double-jeopardy. Public health and medical organizations have released policy statements against states' punitive laws, but little has changed. Healthcare providers and institutions should prioritize evidence-based care to benefit the health and wellbeing of birthing person and their infant and combat "legal" interference at the clinic and public-health scale.

Effect of home environment on academic achievement in child protective service-involved children: Results from the second national survey of child and adolescent well-being study

BACKGROUND

Children involved with Child Protective Services (CPS) have been shown to have lower academic achievement. It is unclear whether certain qualities of the home environment can optimize academic achievement in this vulnerable population.

OBJECTIVE

This study sought to determine whether home environments with higher levels of emotional support and cognitive stimulation predict later academic achievement and whether this relationship is moderated by placement type (i.e. biological/adoptive parent care, kinship care, or non-kinship foster care).

PARTICIPANTS AND SETTING

This study included 1,206 children from the second National Survey of Child and Adolescent Well-Being (NSCAW-II) who were involved with CPS between 2-7 years of age.

METHODS

Multivariate analyses were completed to examine the effect of the Home Observation for Measurement of the Environment (HOME) score on later Woodcock-Johnson III Tests of Achievement (WJ-ACH) scores. Moderation analyses were conducted to determine the effect of placement type on this relationship.

RESULTS

Although these relationships between HOME scores and WJ-ACH scores were significant in bivariate analyses, they were not statistically significant in multivariate analyses, primarily due to the variable of household income. Although children placed primarily in non-kinship foster care demonstrated higher WJ-ACH scores for Passage Comprehension and Letter-Word Identification subscales, placement type did not appear to moderate the relationship between HOME scores and academic achievement.

CONCLUSION

Child- and caregiver-level factors, as well as financial resources available in the environment, may account for the relationship between home environment and academic achievement.

Prevalence and context of firearms-related problems in child protective service investigations

BACKGROUND

Despite the significance of firearm safety, we need additional data to understand the prevalence and context surrounding firearm-related problems within the child welfare system.

OBJECTIVE

Estimate proportion of cases reporting a firearm-related problem during case initiation and the contexts in which these problems exist.

SAMPLE AND SETTING

75,809 caseworker-written investigation summaries that represented all substantiated referrals of maltreatment in Michigan from 2015 to 2017.

METHODS

We developed an expert dictionary of firearm-related terms to search investigation summaries. We retrieved summaries that contained any of the terms to confirm whether a firearm was present (construct accurate) and whether it posed a threat to the child. Finally, we coded summaries that contained firearm-related problems to identify contexts in which problems exist.

RESULTS

Of the 75,809 substantiated cases, the dictionary flagged 2397 cases that used a firearm term (3.2 %), with a construct accuracy rate of 96 %. Among construct accurate cases, 79 % contained a firearm-related problem. The most common intent for a firearm-related problem was violence against a person (45 %). The co-occurrence of domestic violence and/or substance use with a firearm-related problem was high (41 % and 48 %, respectively). 49 % of summaries that contained a firearm-related problem did not provide information regarding storage.

CONCLUSION

When caseworkers document a firearm within investigative summaries, a firearm-related risk to the child likely exists. Improved documentation of firearms and storage practices among investigated families may better identify families needing firearm-related services.

Dental Neglect

Dental neglect can be an indicator of general child neglect. Inadequately treated dental disease may have significant long-term impacts on the physical and psychological well-being of children. Primary care providers play a critical role in the prevention of dental neglect, and should be aware of the manifestations of dental caries and dental trauma. When diagnosing dental neglect, health professionals should ensure the child's caregivers have demonstrated an understanding of the condition, its consequences, and the recommended treatment and then failed to comply with the treatment. Attempts should be made to eliminate any barriers preventing caretakers from complying with professional advice. Dental neglect is a form of child maltreatment and, if suspected, should be reported to the appropriate child protective agencies.

Family homelessness, subsequent CWS involvement, and implications for targeting housing interventions to CWS-involved families

BACKGROUND

Homelessness is a risk factor for family involvement with child welfare services (CWS). Housing interventions are promising-but reasons for this are not well understood, and housing resources could be better targeted to families at risk of increased CWS involvement.

OBJECTIVE

We sought to better understand the relationship between homelessness and CWS involvement and examine whether homeless shelter data could combine with CWS data to enhance intervention targeting.

PARTICIPANTS AND SETTING

For 4 years, we followed 2063 families investigated by the San Francisco Human Services Agency in 2011.

METHODS

Matching CWS data to homeless shelter data, we fit Cox models to examine the relationship between shelter use and subsequent CWS outcomes and produced ROC curves to judge model accuracy with and without shelter information.

RESULTS

Absent CWS covariates (family demographics, CWS history, and family safety and risk), past shelter entry predicted repeat maltreatment referral (HR = 1.92, p < .001), in-home case opening (HR = 1.51, p < .05), and child removal (HR = 1.95, p < .01), but not child reunification. With CWS covariates, past shelter use no longer predicted case opening and child removal, but still predicted referral (HR = 1.58, p < .01). Shelter data did not contribute to models' predictive accuracy.

CONCLUSIONS

We find mixed evidence that shelter use independently leads to CWS involvement. Housing interventions might help by addressing present housing problems and family experiences correlated with past shelter use. However, we find no evidence that data matches with shelter systems could enhance targeting.

Longitudinal Understanding of Child Maltreatment Report Risks

BACKGROUND

Child maltreatment reports (CMR) are both common and strongly associated with various negative outcomes.

OBJECTIVE

To examine CMR risks by child age, early childhood context, current/cumulative economic status (welfare receipt), race, and other risk factors with a longitudinal dataset.

PARTICIPANTS AND SETTING

The CAN sample included 2,111 children having a CMR ≤ age 3, suggestive of a harmful early childhood context. The AFDC sample included 1,923 children having AFDC but no CMR ≤ age 3, suggestive of early childhood protective factors despite poverty.

METHODS

We estimated the CMR likelihood at each age from 1-17 years based on various risk factors while following up children from 1995-2009.

RESULTS

During follow-up, CMR likelihoods were substantially higher for the CAN sample than for the AFDC sample. The age-CMR relationship was strongly negative for the CAN sample (OR = 0.87, 95% CI = 0.86-0.88). This relationship was weaker for the AFDC sample (OR = 0.92, 0.89-0.95) and became non-significant for children who exited welfare. Current welfare receipt remained a strong predictor of CMR likelihoods for both CAN (OR = 2.32, 1.98-2.71) and AFDC (OR = 2.08, 1.61-2.68) samples. Prior welfare receipt moderately increased CMR likelihoods among those not currently on welfare. Controlling for other risk factors, White children had the highest likelihood of CMR. Other child and parent level vulnerabilities also increased CMR risk over time.

CONCLUSIONS

This study highlights the importance of longitudinal analytic approaches and the utility of cross-sector administrative data in improving our ability to understand and predict CMRs over time.

It's not "Just poverty": Educational, social, and economic functioning among young adults exposed to childhood neglect, abuse, and poverty

BACKGROUND

Neglect is the most common allegation in Child Protective Services (CPS) investigations. Researchers and media have questioned whether and how CPS-investigated neglect differs from poverty. Prior studies are limited by self-reported or cross-sectional measures, small samples, and short observation periods.

OBJECTIVE

(1) To estimate the "added harm" of CPS-investigated neglect, net of poverty exposure (depth and duration), on high school completion, employment and earnings, incarceration, and teen parenthood; (2) To assess whether abuse is a stronger risk factor for adverse outcomes than neglect.

PARTICIPANTS AND SETTING

29,154 individuals born in 1993-1996 from Milwaukee County, WI, who either received food assistance or were reported to CPS before age 16.

METHOD

Using logistic regression with a rich set of social and demographic controls, we compared individuals with CPS-investigated neglect, abuse, or both abuse and neglect in early childhood or adolescence to those who experienced poverty but not CPS involvement. We calculated cumulative measures of poverty duration and poverty depth between ages 0 and 16 for the full sample using public benefit records.

RESULTS

Outcomes among children with alleged or confirmed neglect were statistically significantly worse in all domains than impoverished children without maltreatment allegations, and similar to children with alleged or confirmed abuse. Effect sizes varied by outcome.

CONCLUSIONS

Overall, this study suggests that CPS allegations of neglect are distinct from poverty and an important risk factor for adverse outcomes in adulthood.

Patterns of intergenerational child protective services involvement

BACKGROUND

Prior research on Child Protective Services (CPS) involvement among at-risk youth focuses on their roles as parents perpetrating maltreatment against biological offspring. Given family complexity and assortative partnering, measuring all CPS involvement - as perpetrators and non-offending parents of victims - provides new insight into intergenerational maltreatment patterns.

OBJECTIVES

Our objective was to investigate the risk of multiple forms of parent or perpetrator CPS involvement (PP-CPS) by age 25, among those exposed to three forms of adversity in their late teens (at ages 14-17): alleged victim on a CPS investigation, out-of-home care (OHC), and poverty.

PARTICIPANTS AND SETTING

We used a sample of 36,475 individuals born in 1990-1991 from the Wisconsin Data Core longitudinal administrative database, and tracked their involvement in CPS, OHC, and the food assistance program (SNAP) over time. Our sample consisted of individuals who, at ages 14-17, met one of the following criteria: were in OHC; had CPS involvement as a victim but no OHC (CPSV group), or received food assistance without CPSV or OHC (SNAP group).

METHODS

Using logistic regression, we modeled four forms of PP-CPS involvement: parent-perpetrator, resident parent non-perpetrator, nonresident parent non-perpetrator, and non-biological parent-perpetrator.

RESULTS

Predicted risks of any PP-CPS involvement by age 25 were 10 % (SNAP group), 17-22 % (CPSV group), and 26-33 % (OHC group); among OHC youth known to have a biological child, rates exceeded 40 %. The proportion of CPS involvement that involved parent-perpetration varied substantially by sex and adversity type.

CONCLUSIONS

Focusing only on intergenerational maltreatment in which the parents are the perpetrators may substantially understate the risk of maltreatment recurring across generations.

Risk factors that predict longitudinal patterns of substantiated and unsubstantiated maltreatment reports

BACKGROUND

Substantiated and unsubstantiated reports of maltreatment are associated with similar risk of emotional and behavioral problems. However, substantiation status often determines service provision.

OBJECTIVE

We examined substantiated and unsubstantiated reports to identify patterns of recurrence over a five-year period and identified family risk factors that predicted recurrence patterns.

PARTICIPANTS AND SETTING

We studied a subsample (N = 246,021) of the National Child Abuse and Neglect Data System from 2011-2015.

METHODS

Measures included child, caregiver, and child protective services case characteristics obtained in 2011. We used latent class analysis to identify heterogeneous classes, then entered class membership as the outcome variable in a multinomial logistic regression to identify risk factors.

RESULTS

Four latent classes emerged: (1) initial unsubstantiation and moderate recurrence, (2) initial unsubstantiation and low recurrence, (3) initial substantiation and moderate recurrence, and (4) initial substantiation and low recurrence. Domestic violence (relative risk ratio (RRR) = 2.56, β = 0.94, SE = .02, p < .001), caregiver substance abuse (RRR=2.23, β=0.80, SE=.02, p < .001), and Native Hawaiian/Pacific Islander race (RRR=1.67, β=0.52, SE=.11, p < .001), predicted initial substantiation status but were not meaningful predictors of long-term recurrence. Prior substantiated report and poverty predicted initial substantiation status (report RRR=1.50, β=0.41, SE=.02, p < .001; poverty RRR=1.50, β=0.41, SE=.02, p < .001) and long-term recurrence (report RRR=2.60, β=0.96, SE=.02, p < .001; poverty RRR = 1.35, β=0.30, SE=.02, p < .001). Asian American race predicted low recurrence rates (RRR=2.09, β=0.74, SE=.12, p < .001).

CONCLUSIONS

Similar recurrence patterns between substantiated and unsubstantiated reports emphasize the importance of providing services regardless of substantiation status. Integrating administrative databases may reveal more variables that predict long-term recurrence.

Childhood adversities and prior involvement with child protective services

Objectives

We aimed to determine the relation between childhood adversities and prior involvement with Child Protective Services (CPS) history among children presenting for evaluation at a Child Advocacy Center.

Study design

The study evaluated children presenting to a Child Advocacy Center (CAC) from 2009 to 2014. A five-item child adversity measure, based on mother's report, was characterized into a scale of none, one, or two or more adversities. Caseworkers at the CAC assessed whether families had a prior history of involvement with CPS.

Results

Among the 727 children included in the analyses, 43% had a prior history of involvement with CPS. Twenty-six percent of the children experienced one childhood adversity while 29% experienced two or more. In regression analyses adjusting for socio-demographics, experiencing one (Prevalence Ratio (PR) 1.25 95%CI 1.0-1.5) or two or more adversities (PR1.67 95%CI 1.4, 2.0) was associated with higher prevalence of CPS history compared to those who reported none.

Conclusions

Childhood adversities are associated with prior contact with CPS, suggesting there are missed opportunities to provide services to high-risk families. CACs may be in a unique position to advocate for families and prevent further victimization of children.

Trajectories of child protective services contact among Alaska Native/American Indian and non-Native children

BACKGROUND

Contact with child protective services (CPS) functions as an independent marker of child vulnerability. Alaska children are an important population for understanding patterns of CPS contact given high rates of contact overall and among specific demographic groups.

OBJECTIVE

We aimed to identify longitudinal trajectory classes of CPS contact among Alaska Native/American Indian (AN/AI) and non-Native children and examine preconception and prenatal risk factors associated with identified classes.

PARTICIPANTS AND SETTING

We used data from the Alaska Longitudinal Child Abuse and Neglect Linkage (ALCANLink) project, a linkage of 2009-2011 Alaska Pregnancy Risk Assessment Monitoring System (PRAMS) births with administrative data including CPS records.

METHODS

We conducted growth mixture modeling to identify trajectory classes of CPS contact from birth to age five years. We used Vermunt's three-step approach to examine associations with preconception and prenatal risk factors.

RESULTS

Among AN/AI children, we identified three classes: 1) no/low CPS contact (75.4%); 2) continuous CPS contact (19.6%), and 3) early, decreasing CPS contact (5.0%). Among non-Native children, we identified four classes: 1) no CPS contact (81.3%); 2) low, increasing CPS contact (9.5%); 3) early, rapid decline CPS contact (5.8%); and 4) high, decreasing CPS contact (3.3%). Maternal substance use had the largest impact on probabilities of class membership, increasing the probability of membership in classes characterized by CPS contact, among both AN/AI and non-Native children.

CONCLUSIONS

Results reveal heterogeneity in longitudinal patterns CPS contact across early childhood among Alaska children and identify maternal substance use as an important target for primary prevention.

Interventions to Reduce the Problems of Abused Children and Adolescents in Residential Facilities in South Korea: An Integrative Review

Purpose

The purpose of this study was to review the literature on intervention studies for abused children and adolescent in residential facilities in South Korea (ACARF-K). The goal was to understand the problems they experience, to evaluate the content and effectiveness of interventions applied to them, and to develop evidence-based nursing intervention programs.

Methods

We used four electronic databases to search for relevant articles. 18 studies according to Whittemore and Knafl's integrative review method to synthesize the literature.

Results

The ACARF-K experienced problems in biophysical, psychological, and sociocultural domains related to attachment impairment. Effective intervention strategies were building trust through empathy and fulfillment of needs, encouraging ACARF-K to express themselves and helping them to clarify emotions in an unthreatening environment, and improving their self-concept through activities in which they experienced achievement.

Conclusion

Interventions are needed to help restore attachment damage among ACARF-K. The interventions in this study utilized emotional, cognitive, relational, and behavioral therapeutic tools to improve their psychological and social capacities. Future intervention programs for ACARF-K should include these key elements.