Child and family needs profiles among cases substantiated by child protection services

Differential individual and family needs are explored in a sample of children (n = 1455) whose case has been substantiated by Child Protection Services. Using data from Quebec’s 2014 cycle of Incidence Study, latent class analyses led to the identification of 5 profiles, each displaying a specific range of individual and family needs. Profile characteristics were explored in order to obtain a deeper understanding of their specific needs, beyond the initial referral motive. Further, referred services were explored in order to verify their adequacy regarding the identified needs. Together, the obtained results support the relevance of a more in-depth needs assessment when child protection services are solicited, and the necessity to better match the referred services to these needs.     

Factors associated with mental health services referrals for children investigated by child welfare

Although child welfare caseworkers are responsible for facilitating mental health services access for maltreated children, little is known about caseworkers’ decisions to refer children to services. We aimed to identify factors associated with caseworker referral of children to mental health services after a maltreatment investigation. We analyzed data from 1956 children 2–17 years old from the Second National Survey of Child and Adolescent Well-being. We examined associations of children’s predisposing, enabling, and need-related factors and caseworkers’ work environment characteristics with referral to mental health services. Caseworkers referred 21.0% of children to mental health services. In multivariable analyses controlling for potential covariates, factors associated with increased odds of caseworker referral included: older child age; child sexual abuse (versus neglect); child out-of-home placement; caregiver mental health problems; prior maltreatment reports; clinically significant child behavioral problems; and child welfare agency collaborative ties with mental health providers (all p < .05). Factors associated with decreased odds of caseworker referral included child Black race (versus White race) and lack of insurance (versus Private insurance) (all p < .05). In summary, children’s need for mental health services was positively associated with caseworker referral to services but certain predisposing and enabling factors and caseworker work environment characteristics also correlated with services referral. Interventions to reduce disparities in services referral by race and insurance type are critically needed. These may include child welfare agency implementation of policies for mental health screening, assessment, and services referral based on clinical need and establishment of child welfare-mental health agency collaborative ties.     

Neighborhood inequality in the prevalence of reported and substantiated child maltreatment

BackgroundPrior research documents spatial concentration in the incidence of child maltreatment reported to and confirmed by Child Protective Services (CPS), but without estimates of the prevalence of such reports, the extent of CPS contact in different communities is unknown.ObjectiveTo estimate the prevalence of CPS reports during early childhood and substantiated investigations during childhood for children living in different types of neighborhoods.Participants and settingChildren who experienced CPS reports and substantiated investigations in Connecticut.MethodsThis study uses synthetic cohort life tables to estimate the cumulative risk of CPS reports before age five and substantiated CPS investigations before age 18, by neighborhood poverty rate and neighborhood racial composition.ResultsThe analysis reveals substantial stratification in the prevalence of CPS contact by the demographic characteristics of children’s residential neighborhoods. For example, while 7% of children in low-poverty neighborhoods (under 10% poor) experience a substantiated CPS investigation at some point during childhood at 2014 and 2015 rates, this risk more than doubles to 17% for their peers in moderate-poverty neighborhoods (10–20% poor) and more than triples to 26% for their peers in high-poverty neighborhoods (over 20% poor). Similar trends emerge when examining CPS reports in early childhood as well as when comparing neighborhoods with different proportions of White residents.ConclusionsCPS reports and substantiated investigations are a widespread and disproportionately experienced life event for children in poor neighborhoods and children in non-White neighborhoods.     

Identifying effective interventions for promoting parent engagement and family reunification for children in out-of-home care: A series of meta-analyses

BackgroundAn important obstacle for family reunification following child placement in residential care and other temporary out-of-home care services is the lack of engagement among parents.ObjectiveThe aim of this meta-analysis is to identify the most effective interventions to promote parental engagement and family reunification.Method and participantsEight studies, for a total of 2996 families, were used to conduct two series of meta-analyses. Each study examined the effectiveness of a goal-oriented parental engagement intervention, relative to a control group made up of parents who received standard services. Six moderators were analyzed: type of clinical modality, number of clinical strategies, sources of motivation for intervention, focus on the child care staff-parent relationship, child care staff training, and strategies to promote access to intervention.ResultsResults indicate that parents exposed to goal-oriented engagement interventions showed greater engagement (effect size d = 0.71, CI: 0.35–1.07, p < 0.001) and likelihood of reunification (effect size OR = 2.49, CI: 1.22–5.10, p < 0.05) than parents who received standard services. In particular, moderator analysis showed that parents who specifically participated in a family-focused intervention showed the highest engagement in comparison to parents involved in other types of interventions or who received standard services (effect size d = 1.08, CI: 0.58–1.59, p < 0.001). No moderators significantly explained heterogeneity of studies on family reunification.ConclusionOverall, the results underline the effectiveness of family-focused interventions to promote parental engagement. Nevertheless, greater knowledge on the mechanisms by which interventions can increase parents’ engagement and family reunification is still needed.     

Family abduction in a national sample of US children

This study examined the prevalence and characteristics of family abduction episodes occurring in a nationally representative sample of US children ages 0–17. It drew on the experiences of 13,052 children and youth from the aggregation of three cross-sectional waves (2008, 2011, and 2014) of the National Surveys of Children Exposed to Violence. The overall prevalence rate was 4.1% for a lifetime and 1.2% for a past year episode. Rates were higher for younger than older children. Parents constituted 90% of the abductors with females outnumbering males 60% to 40%, although men outnumbered women as perpetrators for certain types of abductions. A bit less than half of the episodes (43%) were reported to police. The experience of a lifetime family abduction had an independent association with traumatic stress symptoms independent of exposure to other kinds of victimization including child maltreatment and witnessing family violence.     

Child protection reports and removals of infants diagnosed with prenatal substance exposure

BackgroundA frequent response for prenatal substance exposure (PSE) is intervention by child protective services (CPS). Previous research has examined differences in reports to CPS regarding PSE by substance exposure and by maternal race. However, little is known regarding the frequency of immediate removals by CPS relating to PSE and maternal race.MethodsWe investigated hospital reports to CPS and CPS removals of PSE infants by using linked birth, hospital discharge, and CPS records for all children born in Washington State between 2006 and 2013 (N = 760,863). We identified PSE using diagnostic codes, calculated prevalence by substance type and maternal race, and tested for differences by interactions of race and substance using multinomial logistic regression.ResultsPrevalence of PSE births varied by race with 8.1% of Native American, 2.8% of black, 1.9% of white, and 0.8% of Hispanic births diagnosed with PSE. Opioids was the most common type of PSE diagnosis at 48.2%. The majority of PSE infants (86.7%) were not removed by CPS but variations by substance type were observed. Of the interactions in the multinomial logistic regression model, only black infants exposed to alcohol were more likely to result in reports to CPS without removal than the referent group of white infants exposed to opioids.ConclusionsFindings indicate that most infants diagnosed with PSE were not removed by CPS and minority PSE infants were not reported to CPS or removed by CPS more than white infants. Racial differences identified in the prevalence of PSE present opportunities for targeted prevention efforts.     

Predictors of placement for children who initially remained in their homes after an investigation for abuse or neglect

Objective

To examine the frequency and predictors of out-of-home placement in a 30-month follow-up for a nationally representative sample of children investigated for a report of maltreatment who remained in their homes following the index child welfare report.

Methods

Data came from the National Survey of Child and Adolescent Well-being (NSCAW), a 3-year longitudinal study of 5,501 youth 0-14 years old referred to child welfare agencies for potential maltreatment between 10/1999 and 12/2000. These analyses focused on the children who had not been placed out-of-home at the baseline interview and examined child, family and case characteristics as predictors of subsequent out-of-home placement. Weighted logistic regression models were used to determine which baseline characteristics were related to out-of-home placement in the follow-up.

Results

For the total study sample, predictors of placement in the 30-month follow-up period included elevated Conflict Tactics Scale scores, prior history of child welfare involvement, high family risk scores and caseworkers’ assessment of likelihood of re-report without receipt of services. Higher family income was protective. For children without any prior child welfare history (incident cases), younger children, low family income and a high family risk score were strongly related to subsequent placement but receipt of services and case workers’ assessments were not.

Conclusions/practice implications

Family risk variables are strongly related to out-of-home placement in a 30-month follow-up, but receipt of child welfare services is not related to further placements. Considering family risk factors and income, 25% of the children who lived in poor families, with high family risk scores, were subsequently placed out-of-home, even among children in families who received child welfare services. Given that relevant evidence-based interventions are available for these families, more widespread tests of their use should be explored to understand whether their use could make a substantial difference in the lives of vulnerable children.     

Suggestibility in neglected children: The influence of intelligence,language, and social skills

We administered the GSS-2, a standardised measure of suggestibility, to 5- to 12-year-old children to ascertain whether neglected children’s responses to leading questions distinguish them from those of their non-neglected counterparts. Neglected children (n = 75) were more likely than an age-matched sample of non-neglected children (n = 75) to yield to leading questions, despite no difference in their ability to recall the test stimuli. Subsequent collection of individual difference data from the neglected sample revealed that this effect could not be attributed to intelligence, language ability, problem behaviours, age at onset of neglect, or time spent in out-of-home care. With respect to social skill, however, suggestibility was positively correlated with communicative skill, and marginally positively correlated with assertion and engagement. While on the surface our social skills findings seem counter-intuitive, it is possible that maltreated children with relative strengths in these areas have learned to comply with adults in their environment as a way to protect themselves or even foster belonging. Our data, while preliminary, raise interesting questions about whether targeted interventions could help these children to more actively participate in decisions about their lives.     

A developmental approach to the risk of a first recurrence in child protective services

The objective of this study is to estimate the risk of a first recurrence over a five-year period following initial child protective services (CPS) intervention and identify the characteristics associated with the risk of recurrence for three different age groups. Recurrence is defined as the first substantiated report within the observation period after initial services have ended. The study involved a cohort of 25,897 Quebec children who received postinvestigation services for the first time and whose cases were closed between 2005 and 2009. Survival analysis was used to estimate the five-year risk of recurrence and Cox regression to model the risk of recurrence for three age groups. The covariates introduced into the regression analyses were characteristics of the child and initial services. The risk of recurrence in the five years following termination of initial CPS services was 36% for the entire cohort and varied depending on the child's age at the time of case closure. Children aged 6–11 when their cases were closed had the highest risk of recurrence. Although Aboriginal descent and prior CPS investigations have a consistent effect on the risk of recurrence in all three age groups, the effects of other covariates, such as out-of-home placement and court involvement, vary or are even reversed, depending on the child's age. These findings highlight the need to adopt a differential approach that takes into account the child's age, both in the provision of protective services and in research involving the population receiving such services.     

Training maltreating parents in elaborative and emotion-rich reminiscing with their preschool-aged children

Objective

In the current study, the effects of training maltreating parents and their preschool-aged children in elaborative and emotion-rich reminiscing were examined.

Method

44 Parent-child dyads were randomly assigned to a training (reminiscing) or wait-list (control) condition. All participating parents had substantiated maltreatment and were involved with the Department of Child Services at the time of enrollment. Children were 3–6 years old (M = 4.88, SD = .99) and living in the custody of the participating parent. Dyads in the reminiscing condition received four, weekly, in-home sessions in elaborative and emotion rich reminiscing.

Results

At a follow-up assessment, maltreating parents in the reminiscing condition provided more high-elaborative utterances, references to children's negative emotions, and explanations of children's emotion during reminiscing than did parents in the control condition. Children in the reminiscing condition had richer memory recall and made more emotion references than did children in the control condition during reminiscing with their mothers, but not with an experimenter.

Conclusion

The findings suggest that maltreating parents can be taught elaborative and emotion-rich reminiscing skills, with benefits for child cognitive and emotional development. The potential clinical utility of a reminiscing-based training for maltreating families with young children is discussed.     

Development of a prediction model for child maltreatment recurrence in Japan: A historical cohort study using data from a Child Guidance Center

To develop a prediction model for the first recurrence of child maltreatment within the first year after the initial report, we carried out a historical cohort study using administrative data from 716 incident cases of child maltreatment (physical abuse, psychological abuse, or neglect) not receiving support services, reported between April 1, 1996 through March 31, 2011 to Shiga Central Child Guidance Center, Japan. In total, 23 items related to characteristics of the child, the maltreatment, the offender, household, and other related factors were selected as predictive variables and analyzed by multivariate logistic regression model for association with first recurrence of maltreatment. According to the stepwise selection procedure six factors were identified that include 9–13 year age of child (AOR = 3.43/95%CI = 1.52−7.72), <40 year age of the offender (AOR = 1.65/95%CI = 1.09−2.51), offender’s history of maltreatment during childhood (AOR = 2.56/95%CI = 1.31−4.99), household financial instability or poverty (AOR = 1.64/95%CI = 1.10−2.45), absence of someone in the community who could watch over the child (AOR = 1.68/95%CI = 1.16−2.44), and the organization as the referral source (AOR = 2.21/95%CI = 1.24−3.93). Using these six predictors, we generated a linear prediction model with a sensitivity and specificity of 45.2% and 82.4%, respectively. The model may be useful to assess the risk of further maltreatment and help the child and family welfare administrations to develop preventive strategies for recurrence.     

Predicting re-involvement for children adopted out of a public child welfare system

Some of the approximately 400,000 children currently placed out-of-home in a public child welfare system will not reunify with their family of origin. They may instead be adopted into a new family. Adoption placements can be characterized by poor adjustment for children; some such placements even result in disruption or dissolution. We conducted a stratified Cox regression of 4,016 children from the Colorado public child welfare system. All of the children had a finalized adoption during the years 2002 through 2006. The two outcomes analyzed were new child protection and youth-in-conflict referrals and assessments for these previously adopted children. New child welfare referrals and assessments may be early indicators of poor adjustment for adopted children within the adoptive family. Study results indicate that older children and Hispanic children had higher rates of referral and assessment. Children with a pre-adoption history including longer time out-of-home or a larger number of out-of-home placements also experienced higher referral and assessment rates. Additional factors which predicted subsequent system re-involvement included presence of paid adoption assistance, adoption by a non-relative foster parent and younger adoptive parent age. Several study results were moderated by the presence or absence of an ethnic match between the child and the adoptive parents. We provide an overview of the statistical model used for analysis and we discuss implications of the study results for child welfare practice.     

Predictors of psychological recommendations in child protection evaluation

Child protection matters from an important social and legal challenge, in which psychologists may be called upon to address a series of questions relevant for judicial decision-making. In an explorative manner, the current study investigates variables that influence psychological evaluators’ recommendations in child protection cases. The data is based on a quantitative content review of 103 psychological evaluation reports, conducted at an institute of forensic psychology in Germany. Using bivariate and logistic regression analyses, the following predictors were analyzed in this study: Child-related factors, familial risk factors, and general custody criteria. The outcome measure was the evaluator’s recommendation regarding long-term placement of the child and long-term custody arrangements. Evaluators were more likely to recommend permanent foster placement if the child showed insecure or disorganized attachment patterns, especially when combined with developmental delays, or if the child was temporarily in institutional or foster placement at the time of evaluation. The results support the conclusion that the most important factors for psychological expert recommendations refer to the “harm of the child” criterion in terms of developmental and psychological maladaptation.     

Victimization and adversity among children experiencing war-related parental absence or deployment in a nationally representative US sample

This study compares children and youth who have experienced lifetime war-related parental absence or deployment with those having no such history on a variety of victimization types, non-victimization adversity, trauma symptoms, and delinquency; and assesses whether cumulative adversity and victimization help to explain elevated emotional and behavioral problems among children of parents who have experienced war-related absence or deployment. The National Surveys of Children’s Exposure to Violence (NatSCEV) are comprised of three cross-sectional telephone surveys conducted in 2008, 2011, and 2014. Data were collected on the experiences of children aged one month to seventeen years. In each survey, interviews were conducted with youth 10–17 years old and with caregivers of children 0–9 years old. The analyses use pooled data from all three U.S. nationally-representative samples (total sample size of 13,052). Lifetime parental war-related absence or deployment was a marker for elevated childhood exposure to a wide array of victimization and adversity types. Cumulative past year exposure to multiple forms of victimization and adversity fully explained elevated trauma symptoms and delinquency in this population of children. Given the breadth of victimization and adversity risk, children with histories of parental war-related absence or deployment, as well as their families, represent important target groups for broad-based prevention and interventions to reduce exposure and ameliorate consequences when it does occur.     

Self-reported adverse childhood experiences and quality of life among children in the two last grades of Dutch elementary education

BackgroundAdverse Childhood Experiences (ACEs) may have a life-long impact on mental health and are related to physical disease, such as diabetes and cardiovascular diseases in adulthood. Research on ACEs suffers from recall bias when performed with adults.ObjectiveTo estimate the prevalence of ACEs and the interrelationships between ACEs as reported by children, and to determine the impact on their self-reported quality of life (QoL). Children’s opinions on the ACE-Questionnaire were also obtained.MethodA cross-sectional study was conducted with a child version of the ACE-Questionnaire. This questionnaire assesses parental separation or divorce, physical and emotional child abuse and neglect, sexual violence, domestic violence, household substance abuse, psychological issues or suicide, and incarceration of a household member. QoL was measured with the Kidscreen-10.Participants and settingThe questionnaire was completed by 644 children at a mean age of 11 years (range 9–13 years), in the two last grades of regular elementary schools, recruited throughout the Netherlands.ResultsData were weighted by ethnicity to obtain a representative sample of children in Dutch elementary education. Of all children, 45.3% had one or more out of ten ACEs. Child maltreatment was experienced by 26.4%. ACEs often co-occurred. A higher number of ACEs correlated with a lower mean level of QoL (p < 0.001). Mean QoL was 8.5 points lower (Cohen’s d = 0.8) in children who experienced child maltreatment. Children’s opinions on the questionnaire were positive in 82.4%.ConclusionPrevention of ACEs, professional training and trauma-focus in schools are urgently needed.     

Responding to information about children in adversity: Ten years of a differential response model in Western Australia

This article uses a comprehensive database about children in adversity collected over the 16-year period from 1990 to 2005 in the state of Western Australia. The focus of this interrogation is the effect of major changes in responses to information about children brought to the attention of the Western Australian statutory authority in a 10-year period during this 16 years. The initiative for these changes was termed New Directions, and its associated policy and practice changes were aimed at differentiating information expressing concerns about children and families from allegations of child maltreatment. They emphasized the provision of supportive and empowering services to families experiencing difficulties – a form of differential response to children in adversity. The article covers the period leading up to the policy and practice change and the 10 years during which these changes were implemented. It examines some effects of the new policy and comments on whether the changes resulted in missed opportunities to protect children from harm, which in turn, might have led to higher rates of re-reporting. The authors present an overall picture of the nature of the information accepted by the statutory authority and how the interpretation of that information might have affected subsequent outcomes for children. In doing so, it shows that the policy and consequential practice changes associated with a differential response mechanism had long lasting positive effects that, despite dire warnings, did not compromise the protection of the small group of children identified as requiring protective interventions.     

Family risk as a predictor of initial engagement and follow-through in a universal nurse home visiting program to prevent child maltreatment

Objective

As nurse home visiting to prevent child maltreatment grows in popularity with both program administrators and legislators, it is important to understand engagement in such programs in order to improve their community-wide effects. This report examines family demographic and infant health risk factors that predict engagement and follow-through in a universal home-based maltreatment prevention program for new mothers in Durham County, North Carolina.

Methods

Trained staff members attempted to schedule home visits for all new mothers during the birthing hospital stay, and then nurses completed scheduled visits three to five weeks later. Medical record data was used to identify family demographic and infant health risk factors for maltreatment. These variables were used to predict program engagement (scheduling a visit) and follow-through (completing a scheduled visit).

Results

Program staff members were successful in scheduling 78% of eligible families for a visit and completing 85% of scheduled visits. Overall, 66% of eligible families completed at least one visit. Structural equation modeling (SEM) analyses indicated that high demographic risk and low infant health risk were predictive of scheduling a visit. Both low demographic and infant health risk were predictive of visit completion.

Conclusions

Findings suggest that while higher demographic risk increases families’ initial engagement, it might also inhibit their follow-through. Additionally, parents of medically at-risk infants may be particularly difficult to engage in universal home visiting interventions. Implications for recruitment strategies of home visiting programs are discussed.     

The efficacy of family reunification practices: reentry rates and correlates of reentry for abused and neglected children reunited with their families

OBJECTIVE: Since the 1980s Child Protective Services has increasingly relied on family reunification for abused/neglected children rather than long term foster care or adoption. While family reunification practices are controversial, little research is available to inform the debate. This research explores the efficacy of these practices. METHODS: This study utilizes two CPS data sources and both quantitative and qualitative methodologies to identify reentry rates and correlates of reentry for abused and neglected children returned to their families by CPS. RESULTS: System reentry due to additional maltreatment is considerable. Thirty-seven percent of the children reunited with their families reenter the system within 3 1/2 years. Correlates of reentry are identified as; abuse type, CPS history, parental competency, race, criminal history, substance abuse, and social support. Notably, assessments of risk made by caseworkers are found to be unrelated to reentry. CONCLUSIONS: The high reentry rate and the limitations of current risk assessment procedures suggest that CPS family reunification practices have not been entirely successful. The identification of specific risks of reentry, such as those revealed in this study, will be helpful in assessing risk on cases. In addition, future studies should explore the systemic deficiencies that contribute to the additional maltreatment that occurs for a sizable proportion of the children served by the system.