The complexity of child protection recurrence: The case for a systems approach

ObjectiveResearch on child protection recurrence has found consistent child, family, and case characteristics associated with repeated involvement with the child protection system. Despite the considerable body of empirical research, knowledge about why recurrence occurs, and what can be done to reduce it, is limited.MethodThis paper reviews the empirical literature and analyses the approaches of prior recurrence research. Four related conceptual challenges are identified: (1) a tendency to conflate child protection recurrence with repeated child maltreatment; (2) uncertainty about how best to operationalize and measure child protection recurrence in research; (3) inconsistency between prevailing explanations for the most frequently observed patterns of recurrence; and (4) difficulty in developing coherent strategies to address child protection recurrence based on research.ResultsAddressing these challenges requires a greater consideration of the effects of decision-making in the child protection system on recurrence. This paper proposes a methodology based in systems theory and drawing on existing administrative data to examine the characteristics of the child protection system that may also produce recurrence.     

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.     

Factors associated with racial differences in child welfare investigative decision-making in Ontario,Canada

Despite the substantial body of literature on racial disparities in child welfare involvement in the Unites States, there is relatively little research on such differences for Canadian children and families. This study begins to address this gap by examining decision-making among workers investigating Black and White families investigated for child protection concerns in Ontario, Canada. Using provincially representative data, the study assessed whether Black children were more likely than White children to be investigated by child welfare, if there was disparate decision-making by race throughout the investigation, and how the characteristics of Black and White children contribute to the decision to transfer to ongoing services. The results indicate that Black children were more likely to be investigated than White children, but there was little evidence to suggest that workers in Ontario child welfare agencies made the decision to substantiate, transfer to ongoing services, or place the child in out-of-home care based on race alone. Black and White children differed significantly with respect to child characteristics, characteristics of the investigation, caregiver risk factors, and socioeconomic circumstances. When adjusting for these characteristics, Black families had 33% greater odds (OR = 1.33; 95% CI: 1.26, 1.40; p = <0.001) of being transferred to ongoing services compared to White families. Among Black families, the assessed quality of the parent-child relationship and severe economic hardship were the most significant and substantial contributors to the decision to provide child welfare services. Implications for practice, policy, and research are discussed.     

National survey of hospital child protection teams in Japan

This study aimed to investigate the penetration rate of child protection teams (CPTs) in medical institutions and associations between CPT functions and hospital services. We collected data in October of 2015 from 377 hospitals in Japan offering pediatric organ transplantation. The questionnaire included questions regarding the existence of a CPT, the number of child maltreatment cases discussed and reported per year, CPT functions including 21 items about staffing, manuals, meeting, prevention, education, and collaboration, and the services provided by the hospital. Of the 377 institutions, 122 (32.4%) answered the survey. There were significant associations between CPT functions and the number of pediatric beds (r = .27), number of pediatricians (r = .27), number of outpatients (r = .39), number of emergency outpatients (r = .28), and emergency medical care (p = .009). In a multiple regression analysis, CPT functions were significantly associated with the number of CPT members, pediatric outpatient numbers, and pediatric emergency outpatient numbers. Japan has no CPT guidelines that outline what CPTs should offer in terms of structure, staffing, functions, and systems. Hospitals with many pediatric and emergency outpatients are expected to play major roles in providing services such as specialty care, intensive care, and education. They are also expected to play a role in detecting and managing child maltreatment, and have, by their own initiative, improved their capacities to achieve these goals.     

Reported contact with child protection services among those reporting child physical and sexual abuse: results from a community survey

OBJECTIVE: This study uses results from a large community survey to examine the relationship between a history of child maltreatment and self-reports of contact with Child Protection Services (CPS). METHODS: The Ontario Health Supplement was a province-wide, probability-based survey of household dwellings in the province of Ontario, Canada. A random sample of residents aged 15 and older participated in the Ontario Health Supplement (N=9953). A face-to-face interview included a question about contact with Child Protection Services (CPS), and the Child Maltreatment History Self-Report, a self-administered questionnaire, was used to assess history of child physical and sexual abuse. RESULTS: Only a very small percentage of respondents with a history of child abuse reported contact with CPS; 5.1% of those with a history of physical abuse, and 8.7% of those with a history of sexual abuse. Contact with CPS was associated with younger age of respondent for both types of abuse and female gender for physical abuse. In the case of sexual abuse, younger respondents whose parental employment classification was in the lower socioeconomic group were more likely to have contact with CPS. CONCLUSIONS: Interventions that target only those who come in contact with CPS will not reach most persons exposed to child abuse.     

Hospitalisations for maternal assault are associated with increased risk of child protection involvement

BackgroundPrevious research shows a co-occurrence between children's exposure to violence and child maltreatment.ObjectiveThis study examined the risk of maltreatment allegations in children whose mothers had been hospitalised due to an assault.Participants and settingThe study used a retrospective cohort of children born in Western Australia between 1990–2009 (N = 524,534) using de-identified linked-administrative data.MethodsMultivariate Cox regression determined the adjusted and unadjusted hazard ratios for child maltreatment allegation in children with a mother hospitalised for assault. Models were adjusted for a range of sociodemographic characteristics.ResultsOne in five children had a maltreatment allegation following their mother's hospitalisation for assault. This increased to two in five children when the mother was assaulted in the prenatal period. Aboriginal children accounted for 57.6% of all allegations despite representing only 7.8% of the population.Children whose mother had a hospitalisation for assault were nine-times (HR = 9.20, 95%CI: 8.98–9.43) more likely to have a subsequent maltreatment allegation than children whose mother did not have a hospitalisation for assault. Following adjustment for confounding factors, both Aboriginal and non-Aboriginal children had an almost two-fold increased risk of maltreatment allegation (HR = 1.56, 95%CI: 1.43–1.70; HR = 1.93 95%CI:1.80–2.07).ConclusionsOur study shows that child maltreatment allegation is common in children following a maternal hospitalisation for assault. Targeted early intervention is required for families with young children, and pregnant women experiencing violence. Importantly service staff need awareness of the impact of violence on families and the appropriate services to refer families to.     

Repeat reports among cases reported for child neglect: A scoping review

BackgroundIn the United States (US), child welfare policy prioritizes prevention of future harm (e.g., repeat reports) after a report of maltreatment. The majority of reports include some form of child neglect, but no prior review of the recurrence literature has focused on neglect.ObjectiveThis review sought to help guide future research, policy and practice by summarizing recurrence findings related to child neglect with attention to the broader ecological context in which maltreatment occurs.ParticipantsThe final review included 34 US studies of maltreatment recurrence. Twenty-eight studies compared child neglect with at least one other form of maltreatment and six studies examined recurrence among neglect cases.MethodsEleven online databases were searched to locate relevant empirical studies. This review attended specifically to contextualizing findings according to other modifiable factors as well as methodological variation. A scoping review approach was used to summarize findings.ResultsOf the 28 studies comparing neglect to other types of maltreatment, 14 found increased risk for neglect, 12 found no association, and two reported a lower risk. When significant, the effect size ranged from 10% to over three times higher risk for neglect. Poverty or material need was the most commonly included control (15 studies), with two thirds finding that lower resource families had higher risk.ConclusionMethodological variability across studies confounds current ability to guide practice or policy. More research is needed that can replicate and extend findings with comparable samples and model specifications that take into account the regional and policy context.     

Borderline personality features and emotion regulation deficits are associated with child physical abuse potential

The present study extends prior research examining the association between borderline personality disorder (BPD) features and child physical abuse (CPA) risk. We hypothesized that: (1) high CPA risk parents (compared to low CPA risk parents) would more often report clinically elevated levels of BPD features; (2) high CPA risk parents with elevated BPD features would represent a particularly high-risk subgroup; and (3) the association between elevated BPD features and CPA risk would be partially explained by emotion regulation difficulties. General population parents (N = 106; 41.5% fathers) completed self-report measures of BPD features, CPA risk, and emotion regulation difficulties. Results support the prediction that BPD features are more prevalent among high (compared to low) CPA risk parents. Among the parents classified as high CPA risk (n = 45), one out of three (33.3%) had elevated BPD features. In contrast, none of the 61 low CPA risk parents reported elevated BPD symptoms. Moreover, 100% of the parents with elevated BPD features (n = 15) were classified as high-risk for CPA. As expected, high CPA risk parents with elevated BPD features (compared to high CPA risk parents with low BPD features) obtained significantly higher scores on several Child Abuse Potential Inventory scales, including the overall abuse scale (d = 1.03). As predicted, emotion regulation difficulties partially explained the association between BPD features and CPA risk. Findings from the present study suggest that a subset of high CPA risk parents in the general population possess clinically significant levels of BPD symptoms and these parents represent an especially high-risk subgroup. Interventions designed to address BPD symptoms, including emotion regulation difficulties, appear to be warranted in these cases.     

Entryway into the child protection system: The impacts of child maltreatment reporting policies and reporting system structures

This study was designed to assess the impacts of maltreatment reporting policies and reporting system structures on four aspects of entry into the child protection system (the maltreatment referral rate, the percentage of referrals screened in for investigation, the screened-in report rate and the substantiated report rate). Using secondary data from several sources, eight multiple linear regression models were created and analyzed. Results from a sample of 44 states indicated significant effects for system structure but no effects for reporting policies. Specifically, states with decentralized reporting system structures were significantly more restrictive in access than other states. These results have implications for child welfare administrators and policymakers seeking to maximize access for maltreated children and their families.     

The child protection and juvenile justice nexus in Australia: A longitudinal examination of the relationship between maltreatment and offending

There is convincing evidence that many young people who are in the justice system have had contact with child protection services and that victims of childhood maltreatment are at increased risk of subsequent youth justice involvement. In Australia, however, there have been few longitudinal studies that have examined these associations and relatively less is known in this area. This study examines the overlap between the child protection and youth justice involvement in South Australia, and determines how substantiated maltreatment and variations in these experiences (e.g., the type, timing and recurrence of maltreatment) relate to criminal convictions as a youth. The results show that although the majority of child-protection involved youth do not become convicted offenders, the odds of subsequent convictions are significantly greater both for those with notifications and substantiated maltreatment and for those who had been placed in out-of-home care. Multivariate analyses revealed that the strongest predictors for receiving a conviction among maltreated youth were: male gender, Aboriginal and Torres Strait Islander ethnicity, experiences of physical abuse and emotional abuse, a greater number of substantiations (recurrence), experiencing maltreatment that commenced in childhood and continued into adolescence, and placement in out-of-home care. The mechanisms through which maltreatment might be linked with behavior are then considered, along with directions for future research in this area.     

Resilience in young children involved with child protective services

Child maltreatment increases the risk of poor developmental outcomes. However, some children display resilience, meaning they are high-functioning despite their adverse experiences. To date, few research studies have examined protective factors among very young maltreated children. Yet, domains of resilience, and the protective factors that promote resilience among maltreated children, are likely to differ by developmental stage. Drawing on ecological systems theory and life course theory, we examined how protective factors at multiple ecological levels across early childhood were related to social and cognitive resilience among very young children involved with child protective services. The results demonstrated that the buffering effects of protective factors varied by social or cognitive resilience and the cumulative effects of protective factors were more consistently related to later resilience than protective factors at specific time points. In addition, the influence of specific protective factors on resilience slightly varied by initial in-home or out-of-home placement. These findings have important policy and research implications for promoting optimal development among children involved in child protective services.     

Risk of maltreatment for siblings: Factors associated with similar and different childhood experiences in a dyadic sample of adult siblings

Siblings share the same environment and thus potentially a substantial number of risk factors for child maltreatment. Furthermore, the number of siblings and the sibling constellation itself might pose a risk for child maltreatment. Little is known about the likelihood that more than one child in a family is maltreated and which factors increase the risk. This study sought to investigate similarities and differences in maltreatment in siblings and risk factors associated with the maltreatment of more than one child from the same family. Data on maltreatment during childhood and adolescence, family background, and sibling constellation were collected from 870 pairs of siblings. In the dyadic analyses, siblings reported similar maltreatment experiences, especially when any type of maltreatment was considered. Parents’ mental health problems were significant predictors for maltreatment of at least one sibling. Father’s mental health problems were predictive of maltreatment of both or only the younger sibling, mother’s mental health problems of both or only the older sibling. Closeness in age and same gender of siblings did not emerge as a consistent predictor. The increasing number of siblings was a risk factor for any type of maltreatment of both siblings. The results highlight the need for preventive measures for families with a large number of children and with parents with mental health problems as well as a repeated risk assessment of all siblings in a family when one sibling was maltreated.     

Environmental and individual attributes associated with child maltreatment resulting in hospitalization or death

Maltreatment continues to be a leading cause of death for young children. Researchers are beginning to uncover which neighborhood attributes may be associated with maltreatment outcomes. However, few studies have been able to explore these influences while controlling for individual family attributes, and none have been able to parse out the most severe outcomes—injuries resulting in hospitalization or death. This study utilizes a retrospective, case-control design on a dataset containing both individual and environmental level attributes of children who have been hospitalized or died due to maltreatment to explore the relative influence of attributes inside and outside the household walls. Binary conditional logistic regression was used to model the outcome as a function of the individual and environmental level predictors. Separate analyses also separated the outcome by manner of maltreatment: abuse or neglect. Finally, a sub-analysis included protective predictors representing access to supportive resources. Findings indicate that neighborhood attributes were similar for both cases and controls, except in the neglect only model, wherein impoverishment was associated with higher odds of serious maltreatment. Dense housing increased risk in all models except the neglect only model. In a sub-analysis, distance to Family Resource Centers was inversely related to serious maltreatment. In all models, variables representing more extreme intervention and/or removal of the victim and/or perpetrator from the home (foster care or criminal court involvement) were negatively associated with the risk of becoming a case. Medi-Cal insurance eligibility of a child was also negatively associated with becoming a case. Government interventions may be playing a critical role in child protection. More research is needed to ascertain how these interventions assert their influence.     

Fatal child maltreatment in England, 2005-2009

Objective

This paper presents comprehensive and up-to-date data covering 4 years of Serious Case Reviews into fatal child maltreatment in England.

Methods

Information on all notified cases of fatal maltreatment between April 2005 and March 2009 was examined to obtain case characteristics related to a systemic classification of 5 broad groups of maltreatment deaths (severe physical assaults; covert homicide/infanticide; overt homicide; extreme neglect/deprivational abuse; deaths related to but not directly caused by maltreatment).

Results

A total of 276 cases were recorded giving an incidence of 0.63 cases per 100,000 children (0-17) per year. 246 cases could be classified based on the data available. Of these the commonest specific group was those children who died as a result of severe physical assaults. Apparently deliberate overt and covert homicide was less common, while deaths as a direct consequence of neglect were rare. In contrast, some evidence of neglect was found in at least 40% of all cases, though not the direct cause of death.

Conclusions

Class characteristics differ between the different categories of death and may suggest the need for different strategies for prevention.     

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.     

Effect of worker contacts on risk of child maltreatment recurrence among CPS-involved children and families

The mission and responsibility of child protective services (CPS) is to investigate maltreatment; intervene to protect children from harm; and promote safety, permanency, and well-being (DePanfilis & Salus, 2003; Goldman, Salus, Wolcott, & Kennedy, 2003). In 2015, approximately 7.2 million children in the United States were referred to CPS agencies, and 3.4 million children had an investigation or received an alternative response (US Department of Health & Human Services, 2017). Fluke, Shusterman, Hollinshead, and Yuan (2005) found that about one third of children with an allegation of maltreatment would have at least one re-report within a five-year period. Research indicates that the rates of child maltreatment or changes in indicators of child maltreatment have remained unchanged over time (Gilbert et al., 2012). Despite policies aimed at reducing or preventing maltreatment, the development of CPS systems across the United States, and a CPS workforce, the aggregate effects of the CPS system, services, and worker efforts are not well understood.     

Less money,more problems: How changes in disposable income affect child maltreatment

A number of research studies have documented an association between child maltreatment and family income. Yet, little is known about the specific types of economic shocks that affect child maltreatment rates. The paucity of information is troubling given that more than six million children are reported for maltreatment annually in the U.S. alone. This study examines whether an exogenous shock to families’ disposable income, a change in the price of gasoline, predicts changes in child maltreatment. The findings of a fixed-effects regression show that increases in state-level gas prices are associated with increases in state-level child maltreatment referral rates, even after controlling for demographic and other economic variables. The results are robust to the manner of estimation; random-effects and mixed-effects regressions produce similar estimates. The findings suggest that fluctuations in the price of gas may have important consequences for children.     

Fatal and non-fatal child maltreatment in the US: An analysis of child,caregiver, and service utilization with the National Child Abuse and Neglect Data Set

The purpose of this study was to compare children who are fatally and non-fatally maltreated in the United States. In this first national-comparison study, we used the Child Abuse and Neglect Data Set of children and families who encounter/receive support from child welfare services. We found that children who were fatally maltreated were younger, were more likely to live with both their parents, and that their families experienced more financial and housing instability compared to non-fatally maltreated children. Overall, families in which children die use/receive fewer social services, as compared to families in which children live. We discuss the results with regard to child welfare practice and research.