Article

Lifetime Prevalence of Investigating Child Maltreatment Among US Children

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Abstract

Objectives: To estimate the lifetime prevalence of official investigations for child maltreatment among children in the United States. Methods: We used the National Child Abuse and Neglect Data System Child Files (2003-2014) and Census data to develop synthetic cohort life tables to estimate the cumulative prevalence of reported childhood maltreatment. We extend previous work, which explored only confirmed rates of maltreatment, and we add new estimations of maltreatment by subtype, age, and ethnicity. Results: We estimate that 37.4% of all children experience a child protective services investigation by age 18 years. Consistent with previous literature, we found a higher rate for African American children (53.0%) and the lowest rate for Asians/Pacific Islanders (10.2%). Conclusions: Child maltreatment investigations are more common than is generally recognized when viewed across the lifespan. Building on other recent work, our data suggest a critical need for increased preventative and treatment resources in the area of child maltreatment. (Am J Public Health. Published online ahead of print December 20, 2016: e1-e7. doi:10.2105/AJPH.2016.303545).

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... Importantly, the authors also noted that these studies tended to identify larger groups of individuals who experienced multiple CAN types. Additionally, the findings of studies focused on younger samples may differ from those focused on older samples, as the overall prevalence of lifetime CAN, as well as the prevalence of certain types of CAN (e.g., sexual abuse) increases with age (Kim et al., 2017). ...
... For example, Shenk et al. (2015) demonstrated that the strength of associations between CAN, based on CPS records, and physical and mental health outcomes increased after removing "contaminated" cases (i.e., those that retrospectively reported CAN) from the non-maltreated comparison group. CPS records are known to underrepresent CAN experiences as they only include CAN that is detected by CPS agencies (Kim et al., 2017). Importantly, Baldwin et al. (2019) reported poor agreement between prospective and retrospective CAN data regardless of the source (i.e., CPS records vs. youth or caregiver report) of prospective CAN data. ...
... Given the limitations of each source of CAN data, we integrated all available indicators of each CAN type, including whenever possible, CPS records, caregiver reports, and youth reports. Second, data were collected prospectively as well as retrospectively to ensure that our lifetime estimates of CAN include as many cases as possible (Baldwin et al., 2019;Kim et al., 2017). Third, our sample was drawn from a cohort that was characterized as being at-risk for CAN during early childhood and followed prospectively through age 18 in a multi-site, longitudinal study. ...
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Background Knowledge about the impacts of child abuse and neglect (CAN) experiences on late adolescent psychopathology has been limited by a failure to consider the frequent co-occurrence of CAN types and potential unique impacts of specific combinations. Objective Using person-centered analyses, we aimed to identify unobserved groups of youth with similar patterns of lifetime CAN experiences before age 16 and differences in psychopathology symptom counts between groups two years later. Participants and setting Participants were 919 adolescent-caregiver dyads (56% female; 56% Black, 7% Latina/o, 13% mixed/other). Methods Prospective, multi-informant data, including child protective services records and caregiver and youth reports were collected, and youth completed a diagnostic interview at age 18. Results Latent Class Analyses classified adolescents into four distinct groups based on patterns of physical neglect, supervisory neglect, and physical, sexual, and psychological abuse: “Low-Risk” (37%), “Neglect” (19%), “Abuse” (11%), and “Multi-type CAN” (33%). The Multi-type CAN class had significantly more major depressive, generalized anxiety, and nicotine use symptoms than the Low-Risk class, and more post-traumatic stress, antisocial personality, and illicit substance use symptoms, than Low-Risk and Neglect classes. The Abuse class had significantly more generalized anxiety and attention deficit/hyperactivity symptoms than the Low-Risk class, and more major depressive, antisocial personality, and illicit substance use symptoms, than Low-Risk and Neglect classes. The Neglect class did not have elevated psychopathology symptoms. Conclusion Findings highlight important differences in the associations between lifetime CAN experience patterns and psychopathology. Researchers should explore mechanisms underlying psychopathology that are impacted by different CAN experience patterns.
... Their findings are generated from state records of maltreatment submitted to the National Child Abuse and Neglect Data System (NCANDS) and foster care records submitted to the federal Adoption and Foster Care Analysis and Reporting System (AFCARS) (2,3). Documenting lifetime CPS involvement is an incredibly important contribution to the literature (4)(5)(6)(7)(8). Cumulative estimates, however, are vulnerable to significant misestimation if first events are not accurately identified (9). ...
... Cumulative estimates, however, are vulnerable to significant misestimation if first events are not accurately identified (9). And documenting a child's first investigation, even within a state, poses unique challenges in national CPS data sources (4). ...
... That said, the number of children with missing race/ethnicity was too low to explain the differences that emerged. We have included children with missing race/ethnicity in our overall "All Groups" estimates, consistent with the prior publication of investigations (4). AI/AN, American Indian/Alaska Native; PI, Pacific Islander. ...
... National data from the United States indicate that roughly 1 in 3 children will ever have a CPS investigation (1), 1 in 8 will ever experience confirmed maltreatment (2, 3), 1 in 17 will ever be placed in foster care (2,4), and 1 in 100 will ever have parental rights terminated (5). These outcomes are especially elevated for Black children and, in the case of foster care placement and TPR, Native American children (1)(2)(3)(4)(5). Although it is unclear whether CPS contact causes poor outcomes or is merely associated with them, research nonetheless shows that children who have come into contact with CPS fare poorly on a range of outcomes (6,7). ...
... The data suggest that having a CPS investigation is ubiquitous for US children (1) and that risks of later-stage CPS contact are also common for children from historically and/or economically marginalized populations (2)(3)(4)(5). This article considered both between-and within-county variation across all four of these stages. ...
... We use synthetic cohort life tables to estimate the cumulative prevalence of exposure to CPS by age 18 y. As with previous research using these methods (1)(2)(3)(4)(5), it is essential to differentiate first CPS contacts from higher-order contacts. Unique identification numbers in both datasets guarantee we are at no more than minimal risk for incorrectly considering children as experiencing their first CPS contact. ...
Article
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This article provides county-level estimates of the cumulative prevalence of four levels of Child Protective Services (CPS) contact using administrative data from the 20 most populous counties in the United States. Rates of CPS investigation are extremely high in almost every county. Racial and ethnic inequality in case outcomes is large in some counties. The total median investigation rate was 41.3%; the risk for Black, Hispanic, and White children exceeded 20% in all counties. Risks of having a CPS investigation were highest for Black children (43.2 to 72.0%). Black children also experienced high rates of later-stage CPS contact, with rates often above 20% for confirmed maltreatment, 10% for foster care placement, and 2% for termination of parental rights (TPR). The only other children who experienced such extreme rates of later-stage CPS interventions were American Indian/Alaska Native children in Middlesex, MA; Hispanic children in Bexar, TX; and all children except Asian/Pacific Islander children in Maricopa, AZ. The latter has uniquely high rates of late-stage CPS interventions. In some jurisdictions, such as New York, NY, (0.2%) and Cook, IL (0.2%), very few children experienced TPR. These results show that early CPS interventions are ubiquitous in large counties but with marked variation in how CPS systems respond to these investigations.
... Child victims of maltreatment experience poorer outcomes, including depression, inadequate physical health, suicidal ideation [4][5][6][7], lifelong health effects and early death [8]. In the United States, approximately 1 in 3 children will have a maltreatment investigation before the age of 18, with 1 in 8 children experiencing abuse or neglect during childhood [9,10]. In addition to consequences for children, child maltreatment is a pervasive public health problem on the rise. ...
... First, it is difficult to summarize findings from available trend studies given differences in measures and types of maltreatment hospitalizations assessed, and time periods and samples (Farst [14] [ages 0-3; NIS sample]; Rebbe [16] [ages 0-3; Washington State]; Zins [15] [ages 0-10; Emergency room and NIS sample]). Second, whereas national trends in maltreatment investigations include children of all ages (0-18), trends in maltreatment hospitalizations apply to young children (0-10), which does not account for the experiences of older children who have increased cumulative risk for experiencing more and varying types of child maltreatment [9]. ...
Article
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We conducted a secondary analysis of the National Inpatient Sample (NIS) to examine child abuse and neglect hospitalization from 1998–2016. The NIS is the largest all-payer, inpatient care database in the United States and is maintained by the Health Care Utilization Project. Participants were youth 18 years and younger with discharged diagnoses of child abuse and neglect from hospitals. The rate of child abuse or neglect hospitalizations did not vary significantly over the study period (1998–2016), which on average was 6.9 per 100,000 children annually. Males (53.0%), infants (age < 1; 47.3%), and young children (age 1–3; 24.2%) comprised most of the child maltreatment cases. Physical abuse was the most frequent type of maltreatment leading to hospitalization. Government insurance was the most common payer source, accounting for 77.3% of all child maltreatment hospitalizations and costing 1.4 billion dollars from 2001–2016. Hospitalizations due to child abuse and neglect remain steady and are costly, averaging over $116 million per year. The burden on government sources suggests a high potential for return on investment in effective child abuse prevention strategies.
... Bullying victimization among Black girls may be more strongly associated with the embedded context in which it occurs (e.g., school environments, neighborhoods, cultural norms) than race alone (Gage et al., 2021;Goldweber et al., 2013;Vervoort et al., 2010). For example, Black girls' experiences of victimization may be shaped by social-ecological contexts at the individual (e.g., childhood abuse), community (e.g., higher levels of poverty and exposure to community-level violence -gang violence, gun crime), relationship (i.e., higher exposure to family/domestic violence in the home), and societal-levels (e.g., race, class, and gender oppression) (Finkelhor et al., 2009b;Kim et al., 2017;Mohammad et al., 2015;Thomas & Fry, 2020). Additionally, in relation to gendered processes of repetitive bullying victimization, Black girls are often socialized from a young age to meet normalized/socialized gendered behavioral standards of the "strong Black girl/woman" stereotype/identity, and maintain strength and resilience despite struggle and distress (e.g., bullying, physical abuse, witnessing family violence, sibling aggression, etc.) (Adams, 2010), which may increase their likelihood of experiencing repetitive victimization. ...
... Scholars have argued that Black youths' experiences of bullying victimization are more conclusively understood through contextual analyses (Gage et al., 2021;Patton et al., 2013). Contextual characteristics such as physical abuse, sibling aggression, and peer delinquency are prominent risk factors for the development of emotional and behavioral problems among Black girls (e.g., Kim et al., 2017;Mohammad et al., 2015;Thomas & Fry, 2020), and may exacerbate their vulnerability to initial and recurring victimization. The current study uniquely explores the gendered and racialized contexts through which bullying victimization occurs across time. ...
Article
This study examines the relationship between prior varying forms of victimization (physical abuse) and subsequent bullying victimization (i.e., state dependence) among 574 adolescent girls, and tests how risky lifestyles (family violence, sibling aggression, peer delinquency, self-report delinquency) (i.e., population heterogeneity) mediate this relationship. A diverse, majority African American sample of adolescent girls in grades 5-7 in the Midwest were followed into middle school. The current study uniquely explores the gendered and racial contexts through which bullying victimization is experienced and occurs. Latent class growth analysis revealed four distinct bullying trajectory subgroups: early onset-stable, early onset declining, low-late peak, and normative. Prior victimizations and risky lifestyles had a significant positive effect for all three groups when compared to the normative group. Risky lifestyles partially mediated the relationship between prior physical abuse victimizations and class membership for all groups when compared to the normative group.
... Bootstrapping with 95% bias-corrected confidence intervals (CI) was used for testing the significance of the indirect effects. Based on Kenny's (2020) recommendations, goodness of fit was assessed using several indices. A nonsignificant Chi-Square Test of Model Fit, a Root Mean Square Error of Approximation (RMSEA) of .08 or less, a Comparative Fit Index (CFI) greater than 0.90, and a Standardized Root Mean Square Residual (SRMR) smaller than .08 were considered good fit. ...
... However, these studies did not include neglect as a CM type, which is an unfortunate oversight. Even though it is the most frequent type of CM reported to child protection services (Kim et al., 2017), neglect is highly understudied (McLaughlin et al., 2017) and very few studies have documented the link between neglect and emotion regulation in adulthood. In our multivariate analysis, which included all five types of CM, a maternal history of physical neglect was the only maltreatment type that was significantly related to emotional dysregulation and attachment in the complete model, while physical abuse also predicted emotional dysregulation, but only in the deprived group. ...
Article
Objective: Child maltreatment is a prevalent problem, and a lot remains unknown regarding the prevalence and mechanisms involved in its intergenerational continuity. The present study examines the sequential role of maternal emotional dysregulation and mother-to-child attachment in the intergenerational continuity of specific maltreatment types (Objective 1) as well as cumulative child maltreatment (Objective 2) among mother–young adult dyads. Method: A sample of 186 mothers and their young adult children (18–25 years old) completed an online survey measuring child maltreatment, attachment, maternal emotional dysregulation, and sociodemographic characteristics. The Canadian Survey of Economic Well-Being—Index of Material Deprivation was used to document mothers’ material deprivation. Results: Path analyses revealed that physical neglect was the maltreatment type in the mothers’ childhood that was the most consistently associated with their emotional dysregulation, attachment, and maltreatment in the next generation. Direct trajectories elucidating the homotypic and heterotypic continuity of child maltreatment were identified. A multigroup analysis revealed significant differences between the nondeprived and deprived groups for Objective 1. Regarding Objective 2, indirect paths indicated that an increase in the number of child maltreatment types that were experienced by mothers was associated with increased emotional dysregulation, which was negatively associated with attachment. In turn, attachment was negatively associated with cumulative child maltreatment in young adults. Conclusions: The present study highlights the importance of including neglect in studies of intergenerational continuity and of exploring the role of material deprivation in depth. The damage caused by cumulative child maltreatment is supported by our findings. Screening for past maltreatment experiences and their impacts on maternal functioning may be warranted when working with distressed families. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
... Statistics reveal 4-16% of children are maltreated by parents every year and, one in ten is neglected or psychologically mistreated [18]. 13% is the reported prevalence of parent-to-child maltreatment in developing countries [19,20]. According to a previous study, 43% of children in Pakistan self-reported parentto-child maltreatment and, amongst these 57% were neglected, 49% were physically maltreated, and 50% suffered from emotional maltreatment [21]. ...
Article
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Background Parent-to-child maltreatment is considered one of the risk factors for Generalized Anxiety Disorder (GAD) symptoms, but this hypothesis has not been adequately tested in Pakistani settings. Aim This study aimed to examine the association between parent-to-child maltreatment and the risk of developing GAD symptoms among adolescents. Methods The association of none to rare, occasionally, and frequently parent-to-child maltreatment with the incidence of GAD symptoms was investigated in a sample of 800 adolescents aged 11–17 years who were followed for two years. Parent-to-child maltreatment was assessed using ICAST-C (International child abuse screening tool). GAD Symptoms were determined by SCARED (Screen for children anxiety-related disorders). Cox Proportional Algorithm was used to estimate risk ratios. Results Among children with both uneducated parents, frequently maltreatment was associated with 7.31 (2.20–24.04) times the risk of GAD symptoms compared to none to rare maltreatment. In contrast, the risk of GAD symptoms in frequently maltreated children was 5.58 times (1.40–21.97) than negligibly maltreated children with either educated parent. Conclusion The frequency of parent-to-child maltreatment is significantly associated with an increased risk of developing GAD symptoms in which parental education plays a crucial role. Parents should be imparted with the awareness of the consequences of child maltreatment. In Pakistani settings the need to have this awareness is even more necessary due to the culturally acceptable disciplinary measures used by parents.
... A life course perspective suggests that adverse experiences during childhood can affect health later in life as a result of stress proliferation and accumulating disadvantage over time and/or by early biological embedding that increases physiological and psychological reactivity to stress (Elder et al., 2003;Shonkoff et al., 2009;Umberson et al., 2014). In the current study, we focus on the role of two types of childhood maltreatment, namely childhood physical abuse (e.g., striking a child with such force that bruises develop, or striking a child so hard that medical attention is needed; Bernstein & Fink, 1998) and childhood physical neglect (e.g., child not having enough to eat, not having clean clothes to wear, or not having a protecting caregiver; Bernstein & Fink, 1998). 1 Some studies have suggested an increased likelihood of African Americans experiencing reported childhood maltreatment (Dakil et al., 2011;Kim et al., 2017). Acceptability of corporal punishment-"the use of physical force with the intention of causing a child to experience pain but not injury for the purposes of correction or control of the child's behavior" (Straus, 1994, p. 4)-among African Americans may result in elevated exposure to abusive parenting (McLoyd et al., 2000). ...
Article
Despite considerable literature documenting associations between relationship functioning and depressive symptoms, there has been relatively little direct examination of this association among African American couples. Likewise, little research has investigated factors that may exacerbate this association. The current study addressed this gap by investigating longitudinal associations between relationship functioning and depressive symptoms among 344 rural African American couples and by examining whether experiences of childhood maltreatment (i.e., childhood physical neglect and childhood physical abuse) amplify this association. Results indicated relationship functioning and depressive symptoms were negatively associated, initially and over time, for both men and women. Additionally, childhood maltreatment moderated several of these associations, such that associations between relationship functioning and depressive symptoms were generally strongest for those reporting greater levels of childhood maltreatment. This pattern of results suggests that experiences of childhood maltreatment may amplify negative associations between adult relationship functioning and depressive symptoms among African American couples, providing further evidence that adverse family-of-origin experiences can contribute to negative consequences later in the life course.
... Similarly, it is important to acknowledge complexity in the assessment of family environment for African American youth. Although some studies have suggested an increased likelihood of African Americans experiencing reported childhood maltreatment (48,49). Acceptability of corporal punishment among African Americans may result in greater reports of "harsh parenting" that reflect some mixture of no nonsense parenting as well as exposure to abusive parenting (50). ...
Article
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Objective: We examined the association of prospectively assessed harsh parenting during adolescence with body mass index (BMI) in young adulthood among African American youth. We also assessed the role of methylation of obesity-related genes and gene expression markers of obesity as mediators of this association, providing a pathway for the biological embedding of early harsh parenting and its long-term impact on young adult health. Methods: Hypotheses were tested with a sample of 362 African American youth for whom harsh parenting was assessed at ages 10–15, BMI was assessed at age 10 and 29, and both DNA methylation (DNAm) and gene expression of obesity genes were assessed at age 29. Mediational analyses were conducted using bootstrap methods to generate confidence intervals. Results: Controlling for genetic risk for obesity and health-related covariates, harsh parenting across childhood and adolescence was associated with change in BMI (1 BMI) from ages 10–29. In addition, we found that the indirect effect of harsh parenting on 1 BMI was mediated through obesity-related DNAm and accounted for 45.3% of the total effect. Further, obesity-related DNAm mediated the effect of harsh parenting on gene expression of obesity-related genes (GEOG), and GEOG, in turn, mediated the impact of obesity-related DNAm on 1BMI. This pathway accounted for 3.4% of the total effect. There were no gender differences in the magnitude of this indirect effect. Conclusions: The results suggest that alterations in methylation and gene expression mediate the impact of harsh parenting on change in obesity from childhood to young adulthood, illustrating plausible biological pathways from harsh parenting to obesity and bolstering the hypothesis that harsh parenting in childhood and adolescence can become biologically embedded and contribute to obesity.
... Physical neglect was the most prevalent trauma, followed by emotional neglect, sexual abuse, physical abuse, and emotional abuse. Similar to the current findings, a study conducted in the USA showed neglect to be the most prevalent form of child maltreatment (42). In general, we found that childhood trauma was a risk factor for depressive symptoms in young adults. ...
Article
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Background: Studies have shown that low childhood socioeconomic status (SES) is associated with a high prevalence of depressive symptoms. Childhood trauma, as a potential consequence of low SES, may play an important part, but the mediation effect of childhood trauma remains to be elucidated. Methods: A cross-sectional survey was conducted among 1,807 university students. The MacArthur Scale of Subjective Social Economic Status—Youth Version, Childhood Trauma Questionnaire, and Beck Depression Inventory were used to measure childhood SES, childhood trauma, and current depressive symptoms, respectively. A structural equation model (SEM) was employed to demonstrate the mediating role of childhood trauma on the association between childhood SES and depressive symptoms. Results: The SEM demonstrated that childhood SES had significant indirect effects upon depressive symptoms via childhood trauma. Childhood trauma accounted for 89.3% of the total effect, indicating a profound mediation effect. Conclusions: The effect of childhood SES on the depressive symptoms of young adults was mediated by childhood trauma, which emphasizes the importance of early prevention and intervention of child neglect/abuse.
... Due to a number of factors, most prominently the high rates of family poverty and income inequality in the U.S. and the few universal family support services available, child welfare systems touch the lives of many American families. Fully one-third of U.S. children, and one-half of Black children will be investigated for maltreatment at some point during childhood (Kim, Wildeman, Jonson-Reid, & Drake, 2017), one in ten Black children will be separated from their families and experience foster care (Wildeman & Emanuel, 2014). The quality of services children and families receive is highly variable. ...
Article
An intense appetite for reforming and transforming child welfare services in the United States is yielding many new initiatives. Vulnerable children and families who become involved with child welfare clearly deserve higher quality and more effective services. New policies, programs, and practices should be built on sound evidence. Reforms based on misunderstandings about what the current data show may ultimately harm families. This review highlights 10 commonly held misconceptions which we assert are inconsistent with the best available contemporary evidence. Implications for better alignment of evidence and reform are discussed.
... Childhood maltreatment is a substantial public health problem in the United States (Elmquist et al., 2015;Mills et al., 2012;Negriff et al., 2017;Thornberry & Henry, 2013), with approximately one in three children experiencing some form of maltreatment before the age of 18, including physical, sexual, and emotional abuse or neglect (Kim et al., 2017). 1 Experiencing maltreatment is associated with numerous negative consequences that can impact healthy development in children; including emotion regulation, self-control, and healthy attachment formation to caregivers (Johnsona et al., 2002;Maguire-Jack et al., 2018;Mills et al., 2012;Thornberry & Henry, 2013). Early identification of maltreatment is undoubtedly necessary, as young children experience a faster rate of the development of behavioral and emotional symptomology compared to other developmental stages (Lauterbach & Armour, 2016). ...
Article
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Background When caregivers experience childhood maltreatment, their children may bear increased risk for maltreatment as well. Teachers have frequent opportunities to observe child behavior in the classroom and are likely to notice symptoms of maltreatment and have opportunities to intervene. Thus, teacher identification of PTSD may serve an important preventive purpose and may mitigate risk for children who experience any form of maltreatment early in life. Objective The present study utilized secondary data from the LONGSCAN consortium to examine caregiver history of childhood maltreatment as a moderator of the association among teacher identification of student PTSD symptomology and child-reported PTSD symptomology for children at risk for maltreatment (n = 872). Method Children and adolescents completed the Trauma Symptom Checklist for Children to assess the severity of PTSD. The Caregiver’s History of Loss and Victimization measure identified retrospective reports of caregiver history of childhood maltreatment. The Teacher Report Form was used to assess teachers’ observations of children’s behaviors in the classroom. Results Caregiver history of childhood maltreatment moderated the association between teacher identification of child internalizing behaviors and PTSD symptomology severity at age 12. Simple slope analyses indicated that the association among teacher and child report of symptomology was stronger if the child’s caregiver experienced childhood maltreatment than if caregivers were not maltreated as children. Conclusions Results illustrate the importance of teacher training in basic mental health symptomology identification in the classroom, as well as mental health services for caregivers with a history of maltreatment, to break the cycle of childhood maltreatment.
... The most recent wave of three National Surveys of Children's Exposure to Violence revealed 38.1% of children have experienced some form of maltreatment in their 17 years of life with 18.1% reporting physical abuse, 23.9% reporting emotional abuse, and 18.4% reporting neglect (Finkelhor et al., 2015). Additionally, using the National Child Abuse and Neglect Data System Child files (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014) and Census data, it is estimated that 37.4% of all children experience a child protective services investigation by 18 years (Kim et al., 2017). The impacts of child maltreatment are varied and long-lasting and include increased risk for future injury, violence victimization and/or perpetration, substance abuse, risky sexual behaviors, lower educational attainment, and limited economic opportunities (Vanderminden et al., 2019). ...
... A recent analysis estimated that over one-third of American children will be involved in a child protection investigation by age 18 (Kim et al., 2017). We need to have professionals educated about child abuse and neglect to recognize its signs, report child maltreatment when they suspect it, and respond effectively and humanely to children who have been victimized. ...
Article
A qualitative analysis of a statewide Child Advocacy Studies Training (CAST) curriculum
... [1][2][3][4][5][6][7] Rates of child sexual abuse have declined, 8 but it remains common with a lifetime prevalence of 4% for Child Protective Services (CPS)-investigated child sexual abuse in the United States. 9 Child sexual abuse is associated with a range of physical and mental health problems including post-traumatic stress, mood, anxiety, and substance use disorders 10,11 ; sexual risk behaviors, obesity and pain; and gastrointestinal, gynecologic and cardio-pulmonary symptoms. [1][2][3][4][5][6]12 Child sexual abuse is additionally associated with subsequent risks for violence perpetration and victimization. ...
Article
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Child sexual abuse recurrence can have a detrimental and devastating effect on victims. Less is known, however, about the risk and protective factors associated with child sexual abuse recurrence. In order to better understand these risk and protective factors, a narrative review was conducted of the current literature. Academic databases, cited references, and reference lists were searched for peer-reviewed research that focused on sexual abuse recurrence prior to age 18 years. The risk and protective factors identified in the literature were organized into four a priori categories based on an ecological systems framework: child, characteristics of the maltreatment, family, and community/social systems. Examples of risk factors at each level were child mental health concerns (child), the perpetrator being the mother's significant other (characteristics of the maltreatment), parental history of sexual abuse (family), and active or prior child welfare involvement (community/social systems). Only two protective factors were identified, both regarding the family: family social support and a parent believing the child's report of the initial victimization. There were mixed or inconclusive findings for several factors. Overall, the review indicates that tertiary prevention, including child-, caregiver-, and perpetrator-focused strategies, should be employed to mitigate the risk factors and enhance the protective factors for child sexual abuse recurrence. Further research is needed to address protective factors and community/social systems factors and could, building on this narrative review, involve a systematic review of the child sexual abuse recurrence literature.
... CM is understood as a chronic and severe form of interpersonal trauma (e.g., De Bellis, 2005) and collectively refers to experiences of physical, sexual, and emotional abuse and physical and emotional neglect during development (e.g., Leeb et al., 2008). CM is a fairly common experience, with an estimated one-third of all children in the United States experiencing maltreatment before the age of 18 (Kim et al., 2017). This prevalence rate is especially concerning given that CM accounts for an estimated 67% of population risk for suicide (Dube et al., 2003). ...
Article
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Suicide in youth exacts significant personal and community costs. Thus, it is important to understand predisposing risk factors. Experiencing adverse childhood experiences (ACEs), such as child maltreatment (CM-ACE), and the presence of post-traumatic stress disorder has been identified as a risk factor of suicidal behaviors among adults. Theoretical models of suicide suggest that the presence of painful experiences such as CM-ACEs increase the risk of suicidal behaviors. The relation between child maltreatment, post-traumatic stress symptom clusters (PTSS) and suicidal behaviors has not been explicitly examined among youth. The present study examined the relations between CM-ACEs, PTSS clusters, and suicidal behaviors in a clinical population of children. Children, male, ages 6 to 14, enrolled in a residential treatment program completed self-report measures to evaluate variables of interest. Path analyses revealed statistically significant direct effects of CM-ACEs and PTSS clusters on suicidal behaviors. Significant total indirect effects and marginally significant individual indirect effects of intrusion and avoidance symptoms were observed for the relation between CM-ACEs and suicidal behavior. Findings suggest that symptoms associated with specific PTSS clusters might help explain the relation between CM-ACEs and suicidal behavior, and therefore, present important implications for clinical practice and future research.
... According to the National Survey of Children's Exposure to Violence, more than a third (38%) of adolescents in the United States have experienced child maltreatment in their lifetime [1]. Similarly, a synthetic cohort lifetable analysis estimated that 37% of youths are reported to child protective services (CPS) for child maltreatment by 18 years of age [2]. The estimated lifetime economic burden of investigated child maltreatment during 2015 in the United States was USD 2 trillion [3]. ...
Article
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This study addresses gaps in knowledge of protective factors that support adaptive functioning among maltreated adolescents. The sample included 1003 high-risk youths participating in the Longitudinal Studies of Child Abuse and Neglect (53% female, 56% Black, and 82% living in poverty). Adolescent neglect (Exposure to Risky Situations, Lack of Monitoring, Inattention to Basic Needs, Permitting Misbehavior, Lack of Support) and physical, sexual, and emotional abuse were self-reported at age 16. Age 18 adaptive functioning measures included healthcare receipt (medical, dental, and mental health), self-rated global health, high school graduation or enrollment, prosocial activities, peer relationships (Companionship, Conflict, Satisfaction, and Intimacy), and independent living skills. Previous childhood maltreatment, demographics, and earlier prosocial activities and peer relationships were controls. Structural equation modeling showed that adolescent neglect and abuse were associated with lower adaptive functioning. Multigroup models showed protective effects for food security on the relationships between sexual abuse and self-rated health and between Inadequate Monitoring and Companionship. Housing stability buffered relationships between Inadequate Support and high school graduation or enrollment and between Permitting Misbehavior and independent living skills. Findings imply the need for adolescent-focused prevention, including the promotion of food security and housing stability to support adaptive functioning in maltreated adolescents. However, notable mixed findings show the need for additional research.
... Most participants in our sample were from racial and ethnic groups that are historically marginalized in the United States. Further, our sample was recruited from the child welfare system, a system that is imbedded with structural racism and in which Black children are overrepresented (Kim et al., 2017), and most families resided in low-income neighborhoods. Consequently, the children and families in our sample experienced heightened oppression that likely contributed to various adverse psychopathology outcomes. ...
Article
Childhood maltreatment is a toxic stressor that occurs in the family context and is related to adverse outcomes including elevations in internalizing symptomology and externalizing symptomology. In the present study, we tested the role of threat and deprivation dimensions of child maltreatment in the etiology of comorbid psychopathology in emerging adulthood. Additionally, we investigated emotion regulation and emotion lability/negativity as mechanisms underlying the relationship between child maltreatment dimensions and emerging adult psychopathology. To address these aims, we used a longitudinal sample of emerging adults (N = 413, Mage = 19.67, 78.0% Black, 51.1% female) who had previously participated in research assessments at age 10-12. Using a person-centered approach with latent profile analysis, we identified three classes of emerging adulthood psychopathology characterized by different levels of symptom severity and comorbidity between internalizing and externalizing symptoms. Emerging adults who experienced deprivation only, compared to those who were not maltreated, were more likely to belong to a comorbid and severe psychopathology class versus the other identified psychopathology classes. There was also a significant indirect pathway from experiences of both threat and deprivation to a high externalizing class via emotion lability/negativity. Our results contribute to current models of childhood adversity and psychopathology and have implications for interventions to prevent psychopathology among emerging adults exposed to child maltreatment.
... One of these psychosocial factors is psychological trauma, which has been linked to increased risk for CVD after controlling for traditional CVD risk factors. 2 Interpersonal and sexual violence, including assault, sexual abuse, and intimate partner violence (IPV), are traumatic experiences particularly prevalent among women. Estimates indicate that ≈25% of women have experienced childhood maltreatment, 3,4 44% have experienced sexual assault, 5 and a quarter of women have experienced IPV in their lifetime. 6 These traumatic experiences are well established as leading risk factors for adverse mental health outcomes. ...
Article
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Background Traumatic experiences have been linked to risk for cardiovascular disease (CVD). Interpersonal violence is a trauma that is prevalent in women. Among midlife women followed up for 2 decades, we examined whether interpersonal violence (childhood abuse, adulthood abuse, or intimate partner violence [IPV]) was related to increased risk of subsequent clinical CVD events. Methods and Results A total of 2201 women, aged 42 to 52 years at baseline, underwent up to 16 in‐person visits over 22 years. Measures included questionnaires (including of childhood physical/sexual abuse, adult physical/sexual abuse, and IPV), physical measures, phlebotomy, and reported CVD events (myocardial infarction, stroke, heart failure, and revascularization). Death certificates were collected. Relationships between childhood abuse, adult abuse, and IPV with incident fatal/nonfatal CVD were tested in Cox proportional hazards models. Women with a childhood abuse history had increased risk for incident CVD (versus no abuse; hazard ratio [HR] [95% CI], 1.65 [1.12–2.44]; P =0.01; adjusted for demographics and CVD risk factors); associations were strongest for childhood sexual abuse. Adult abuse was not significantly associated with CVD. Women with IPV had a doubling of risk for incident CVD in demographic‐adjusted models (versus no IPV; IPV: HR [95% CI], 2.06 [1.01–4.23]; P =0.04; no partner: HR [95% CI], 1.79 [0.91–3.53]; P =0.09); systolic blood pressure partially mediated relationships between IPV and CVD. Conclusions Childhood abuse, particularly sexual abuse, was associated with increased risk of CVD in women. IPV was associated with risk for CVD, with the higher systolic blood pressure among IPV‐exposed women important in these associations. Interpersonal violence prevention may contribute to CVD risk reduction in women.
... Studies have shown that stress is a risk factor in child maltreatment potential. [84] Nearly 40% of children experienced maltreatment by adulthood, [85] correlating with lower education attainment, lower income, and social problems, such as an increased likelihood to commit crime and attempt suicide in prison. [86,87] Therefore, it is integral that stress is reduced and cases of maltreatment are brought up by children to trusted adults, such as teachers and psychology workers in schools. ...
Article
Background: The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread wildly across the world. In March of 2020, almost all kindergarten through 12th grade (K-12) schools were closed in the United States in an urgent attempt to curb the pandemic in the absence of effective therapeutics or vaccination. Thirteen months since then, schools remain partially closed. Accumulated evidence suggests that children and adolescents are not the primary facilitators of transmission, limiting the restrictive effects of school closures on disease transmission. The negative effects of school closures on K-12 students need to be systematically reviewed. Methods: Following the guideline of Preferred Reporting Items for Systematic Reviews and Meta-analyzes, a comprehensive literature search from PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science regarding school closures and its impact on K-12 students was conducted. The primary outcomes included the impact of school closures on the mitigation of the pandemic and the resulting public health concerns of K-12 students. Results: Prolonged school closures possessed negative effects on K-12 students' physical, mental, and social well-being and reduced the number of health and social workers, hindering the reopening of the country. Conclusions: School closures were over-weighted against the mitigation of coronavirus disease 2019 (COVID-19) transmission. A safe reopening of all K-12 schools in the United States should be of top priority.
... Although the rate of child abuse in China decreased from 70.1% (12) in 2010 to 42.3-62.7% in 2019 (13), it is still much higher than that in Western developed countries (23.5-37.4%) (14,15). Child abuse will not only lead to physical injury but also cause serious psychological trauma and even affect the mental health in adulthood (13,16). ...
Article
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Background Abuse experiences in adolescents are associated with the risk of depression and suicide. Thus, there is an urgent need to develop prevention and intervention measures for clinicians, policymakers, and researchers. Methods Network analysis method was used to analyze the cross-sectional data of Chinese adolescents in this study. The Patient Health Questionnaire for Adolescents (PHQ-A) was used for assessing depression, in which item 9 of the PHQ-A was used to assess suicide ideation, and International Society for the Prevention of Child Abuse and Neglect (ISPCAN) Child Abuse Screening Tool-Children’s Home Version (ICAST-CH) was used for assessing abuse. Results The prevalence of suicidal ideation among Chinese adolescents was 21.46% (95% CI, 20.79–22.16%). The prevalence of moderate or severe depression was 16.76%, and the prevalence of violence exposure, psychological victimization, neglect, and physical victimization was 33.5%, 59.5%, 28.37%, and 31.51% in the past years, respectively. Network analysis results showed that the most central nodes in the network of abuse and depression were “unimportant,” “not cared,” and “pushed.” The bridge nodes were “suicidal ideation” and “unimportant.” The nodes “sadness,” “failure,” and “unimportant” explained the largest proportion of the variance of suicidal ideation in our network. Differences were found in the structure of both abuse and depression networks between adolescents with or without suicidal ideation. Limitations The self-reporting–based cross-sectional surveys and community sample groups limit the inference of causality and the generalization of the results. Conclusion This study shows that “unimportant” is the central and bridge nodes in the abuse and depression networks and also explains a part of variance of suicidal ideation. The effect of “unimportant” should be considered in the prevention and intervention of depression and suicide in adolescents with abuse experience. Future study is needed to confirm its role in clinical intervention.
... Child welfare families experience a clear economic disadvantage. African Americans are investigated by Child Protection Services almost twice as much as whites (Kim et al., 2017), and is correlated with their economically disadvantaged status (Drake et al., 2011). Additionally, parents in the child welfare system experience multiple risk factors, (i.e. ...
Article
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Parenting is a critical component of child welfare’s intervention efforts; however, child welfare interventions attempt to correct dysfunctional parenting practices rather than address their shared underlying causes, such as parental stress and trauma. Ongoing stress can overload a parents’ ability to access logical decision-making capabilities. Parents can utilize integrative body, mind, and spirit interventions to remain calm when they experience chronic stress. These interventions can offer stressed out parents techniques that focus on emotional regulation, and subsequently reduce the risk of child maltreatment. This article offers a comprehensive review of the literature identifying parental stress as a critical component of child welfare as well as the usefulness of including integrative mind, body, and spirit interventions with parents in the child welfare system.
... We then compare this policy to the current standard decision-making process, where workers make decisions with the assistance of AFST. Since child welfare workers themselves are known to make racially disparate decisions [24,25,27,40,54], it is unclear whether adding them back "in the loop" will do any good in this regard. The central question of this paper is thus: when people work with algorithms in a child welfare context that is known to have racial disparities, will they serve to mitigate or exacerbate disparities? ...
Conference Paper
Machine learning tools have been deployed in various contexts to support human decision-making, in the hope that human-algorithm collaboration can improve decision quality. However, the question of whether such collaborations reduce or exacerbate biases in decision-making remains underexplored. In this work, we conducted a mixed-methods study, analyzing child welfare call screen workers’ decision-making over a span of four years, and interviewing them on how they incorporate algorithmic predictions into their decision-making process. Our data analysis shows that, compared to the algorithm alone, workers reduced the disparity in screen-in rate between Black and white children from 20% to 9%. Our qualitative data show that workers achieved this by making holistic risk assessments and adjusting for the algorithm’s limitations. Our analyses also show more nuanced results about how human-algorithm collaboration affects prediction accuracy, and how to measure these effects. These results shed light on potential mechanisms for improving human-algorithm collaboration in high-risk decision-making contexts.
... For an extensive list of algorithms used in the U.S. child welfare system, see [110] or [113]. PRMs have been deployed in response to racial biases and disparities [38,70], inaccurate and inconsistent decisions, child fatalities [73], etc. Proponents of PRMs argue they make more accurate decisions than both workers and diagnostic checklists; and that they make more consistent, objective, and equitable decisions [28,34,58,88,121]. Some critics disagree with these points, arguing that PRMs are still discriminatory and still too inaccurate [29,45,83]. ...
Preprint
Child welfare agencies across the United States are turning to data-driven predictive technologies (commonly called predictive analytics) which use government administrative data to assist workers' decision-making. While some prior work has explored impacted stakeholders' concerns with current uses of data-driven predictive risk models (PRMs), less work has asked stakeholders whether such tools ought to be used in the first place. In this work, we conducted a set of seven design workshops with 35 stakeholders who have been impacted by the child welfare system or who work in it to understand their beliefs and concerns around PRMs, and to engage them in imagining new uses of data and technologies in the child welfare system. We found that participants worried current PRMs perpetuate or exacerbate existing problems in child welfare. Participants suggested new ways to use data and data-driven tools to better support impacted communities and suggested paths to mitigate possible harms of these tools. Participants also suggested low-tech or no-tech alternatives to PRMs to address problems in child welfare. Our study sheds light on how researchers and designers can work in solidarity with impacted communities, possibly to circumvent or oppose child welfare agencies.
... Evidence from a series of meta-analyses indicates that the pooled global prevalence rates of physical abuse, psychological abuse, sexual abuse, and neglect are 17.7%, 26.7%, 11.8%, and 16.3%, respectively [2][3][4][5]. In the United States, more than one third of children (37.4%) have experienced maltreatment at least once by age 18 years [6]. In China, the estimated prevalence is 26.6% for physical abuse, 19.6% for emotional abuse, 8.7% for sexual abuse, and 26.0% for neglect [7]. ...
Article
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There has been a lack of high-quality evidence concerning the association between childhood maltreatment and psychiatric diagnoses particularly for Axis II disorders. This study aimed to examine the association between childhood maltreatment exposure and Axis I and Axis II psychiatry disorders using electronic health records. In this study, the exposed group (n = 7473) comprised patients aged 0 to 19 years with a first-time record of maltreatment episode between January 1, 2001 and December 31, 2010, whereas the unexposed group (n = 26,834) comprised individuals of the same gender and age who were admitted into the same hospital in the same calendar year and month but had no records of maltreatment in the Hong Kong Clinical Data Analysis and Reporting System (CDARS). Data on their psychiatric diagnoses recorded from the date of admission to January 31, 2019 were extracted. A Cox proportional hazard regression model was fitted to estimate the hazard ratio (HR, plus 95% CIs) between childhood maltreatment exposure and psychiatric diagnoses, adjusting for age at index visit, sex, and government welfare recipient status. Results showed that childhood maltreatment exposure was significantly associated with subsequent diagnosis of conduct disorder/ oppositional defiant disorder (adjusted HR, 10.99 [95% CI 6.36, 19.01]), attention deficit hyperactivity disorder (ADHD) (7.28 [5.49, 9.65]), and personality disorders (5.36 [3.78, 7.59]). The risk of psychiatric disorders following childhood maltreatment did not vary by history of childhood sexual abuse, age at maltreatment exposure, and gender. Individuals with a history of childhood maltreatment are vulnerable to psychiatric disorders. Findings support the provision of integrated care within the primary health care setting to address the long-term medical and psychosocial needs of individuals with a history of childhood maltreatment.
... Department of Health & Human Services [DHHS], 2020). At some point in their childhoods, 37% of all children are the subject of a Child Protective Service (CPS) investigation (Kim et al., 2017). Neglect, which is characterized by inadequate supervision and failure to provide a child with basic necessities, including safety, is the most common form of child maltreatment. ...
Article
The early months of the COVID-19 pandemic led to extreme social isolation, precarious employment and job loss, working from home while tending to children, and limited access to public services. The confluence of these factors likely affects child health and well-being. We combine early release child maltreatment reports in Indiana with unique and newly available mobile phone movement data to better understand the relationship between staying at home intensively during the COVID-19 pandemic and child maltreatment. Our findings indicate that the prolonged stays at home promoted by the early public health response to COVID-19 resulted in reductions in child maltreatment reports overall and in substantiated reports of maltreatment. However, relative to areas that stayed home less, children in areas that stayed home more were more likely to be both reported for and a confirmed victim of maltreatment, particularly neglect. These areas have historically been socioeconomically advantaged and experienced lower rates of maltreatment. We only observe increases in confirmed child maltreatment in metropolitan counties, suggesting that the effects of staying home on child maltreatment may reflect both the differential risk of leaving home and access to services in metropolitan–rather than non-metropolitan–counties. Staying at home has been challenging for many families. Families likely need assistance as the pandemic persists, evolves, and when it ends.
Article
Background: Child maltreatment in immigrant families is understudied, although research suggests that they are at higher risk of child abuse and neglect. While the limited studies on the etiology of child maltreatment among immigrant families have mainly focused on children and their caregivers, this study breaks new ground by examining the neighborhood as an environmental context for child maltreatment among immigrant families. Methods: Following social disorganization theory, this study explores the mechanisms by which neighborhood structural characteristics and social processes affect the maltreatment of children in immigrant families, using the Fragile Families and Child Wellbeing Study (N = 372). Results: Structural equation modeling revealed that negative neighborhood structural characteristics were positively associated with higher physical assault (β = 0.42, p < .001), higher psychological aggression (β = 0.29, p < .001), and higher neglect (β = 0.19, p < .001) among immigrant families. Conversely, positive neighborhood social processes were associated with lower physical assault (β = -0.37, p < .001) and lower psychological aggression (β = -0.31, p < .001) among immigrant families. In addition, neighborhood social processes mediated the relationship between neighborhood structural characteristics and child physical assault (β = -0.09, p < .001) among immigrant families. Conclusions: The findings of this study highlighted the positive role of neighborhood social processes in reducing child physical assault among immigrant families, even in neighborhoods with negative structural characteristics.
Article
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Children in low socioeconomic status (SES) families are five times more likely to experience child maltreatment relative to children in high SES families. To determine whether increasing the wages of working poor families can prevent maltreatment, we examine whether changes in the local minimum wage (MW) affect child well-being and parenting behaviors. Using data from a representative, longitudinal survey, we use a lagged dependent variable model to compare parenting behaviors in localities where the MW changed to localities where the MW did not change relative to before the MW change took place. We also explore heterogeneity by child’s age and a variety of potential mechanisms. We find that increasing the minimum wage reduces spanking by both mothers and fathers, as well as physical and psychological aggression by mothers. These results appear to be driven by changes in maternal employment; whereby mothers reduce their employment and change their weekend shifts. We find no significant effects for positive parenting behaviors, household income, or maternal mental health. Finally, older children exhibit fewer externalizing behaviors as a result of increases in the minimum wage. The results of this study help inform the conversation about income supports and employment policies with regard to their effects and pathways to child well-being.
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Objectives: To examine whether postneonatal infants reported for maltreatment face a heightened risk of deaths attributable to medical causes. Methods: Birth and death records for all children born in California between 2010 and 2016 (N = 3455985) were linked to administrative child protection system records. Infants were prospectively followed from birth through death or age 1 year. Reports of maltreatment and foster care placement episodes were modeled as time-varying covariates; sociodemographic characteristics at birth were modeled as baseline covariates. Stratified, multivariable competing risk models were used to estimate the adjusted relative hazard of postneonatal infant death attributed to a medical cause (n = 1051). Results: After adjusting for baseline risk factors, and compared with infants never reported for maltreatment, the medical-related mortality risk was almost twice as great among infants reported once for maltreatment (hazard ratio: 1.77; 95% confidence interval: 1.36-2.30) and 3 times greater if there was >1 maltreatment report (hazard ratio: 3.27; 95% confidence interval: 2.48, 4.30). Among infants reported for maltreatment, periods of foster care placement reduced the risk of death by roughly half. Conclusion: Infants reported for alleged maltreatment had a higher risk of death from medical causes, with foster care emerging as protective. Targeted support services for parents and improved communication between the child protection system and the pediatric health care community is needed, especially when infants who may be medically fragile and remain at home after an allegation of abuse or neglect.
Article
Background There exists a presumption that school closures lead to a diminished capacity to detect child maltreatment, but empiric evidence is lacking. Objective To determine if child maltreatment reporting and substantiation differ between periods when schools are routinely closed compared to in session. Participants and setting Child maltreatment reporting and substantiation among all U.S. States and the District of Columbia from January 1, 2010 through December 31, 2017. Methods Two-week intervals during periods of routine school closure (early January, June through mid-August, late November, and late December) were compared to all other 2-week intervals. Negative binomial generalized estimating equations compared rates of reporting and substantiation, resulting in incidence rate ratios (IRR) with 95% confidence intervals (CI). Results Compared to when school was in session, reporting was 16.0% (IRR 0.84 [95% CI: 0.83, 0.85]) lower during school closures and substantiations were 12.3% (IRR 0.88 [95% CI: 0.86, 0.89]) lower. The largest reductions in reporting were observed among education personnel (−42.1%; IRR 0.58 [95% CI: 0.54, 0.62]), children aged 5–17 years (−18.6%; IRR 0.81 [95% CI: 0.80, 0.83), and for physical abuse (−19.6%; IRR 0.80 [95% CI: 0.79, 0.82]). Reductions during closure periods were not matched by increases during two-week intervals immediately following closure periods. Conclusions Results suggest that the detection of child maltreatment may be diminished during periods of routine school closure. Findings may inform prevention planning and risk-benefit analyses for future school closures. Further study should disentangle the issue of decreased detection versus decreased prevalence of maltreatment during school closures.
Article
An estimated one third of children in the United States will suffer from maltreatment. The use of spatial predictive analytics offers an opportunity to delineate places at elevated risk of child abuse. Risk terrain modeling is a spatial analytic framework for predicting instances of varied types of crime. This article compares a random forest negative binomial model in a risk terrain modeling framework to the question of predicting counts of substantiated child abuse in Portland, Oregon. The final model specification includes domestic incident data from the Portland Police Bureau, built environment data from the City of Portland, OpenStreetMap data, and a neighborhood deprivation index derived from American Community Survey data predicting counts of substantiated child maltreatment from the Oregon Department of Human Services administrative data. The random forest outperforms the negative binomial model, showing its superiority in a risk terrain modeling framework, though the relative lack of predictive importance of the built environment variables compared to the domestic incident neighborhood deprivation variables should encourage researchers to further investigate the role of the built environment in the problem of predicting child abuse and maltreatment.
Article
This study examined relationships between adolescent neglect and abuse and later health risk in a sample of 1050 youth (53% female, 56% Black, and 24% White) from the Longitudinal Studies of Child Abuse and Neglect. At age 16, the youth reported any adolescent exposure to neglect and physical, sexual, and emotional abuse. At age 18, they reported risk behaviors (delinquency, substance use, and sexual behavior) and emotional and behavioral problems (externalizing and internalizing problems, suicidality). Control variables were childhood maltreatment (self-reports and early childhood child protective services reports), risk behaviors and emotional and behavioral problems at age 16, and demographics. Analysis confirmed a 5-factor model of adolescent neglect (Exposure to Risk, Inadequate Monitoring, Inattention to Basic Needs, Permitting Misbehavior, and Inadequate Support). Inadequate Support and Exposure to Risk were associated with more substances used; Exposure to Risk was also associated with delinquency and suicidality. Adolescent emotional abuse was associated with not using a condom use and internalizing and externalizing problems. Findings underscore the importance of preventing or addressing neglect during adolescence.
Article
In the mid-2000s, the Wisconsin Child Abuse and Neglect Prevention Board developed an intervention called the Community Response Program (CRP), intended to fill an important gap in the continuum of services to address child maltreatment. Specifically, families reported to child protective services (CPS) for alleged child maltreatment, but diverted (i.e., their cases were screened out at the hotline call stage or closed following an investigation), were offered voluntary case management services tailored to each family’s unique circumstances and self-determined needs. The goal of CRP was to significantly reduce future contacts with the child welfare system within this population. Beginning in late 2016, seven CRP sites representing 16 Wisconsin counties participated in a randomized control trial to determine the effectiveness of the intervention for reducing CPS involvement. The sample involved families (N=12,373) diverted from CPS across the program sites. Findings include that CRP staff were able to contact 38% of families in the treatment group, and 12% of families (32% of those contacted) enrolled in the program. CRP participants identified a range of service needs, but over half identified one or more economic needs as service priorities. Just over one-third identified needs related to parenting, and about one quarter identified mental and behavioral health needs. Among participants, over half attained at least one self-determined service goal, and approximately one-quarter attained all of their service goals. To address selection into treatment, we used propensity score matching techniques to conduct treatment-on-the-treated analyses. Results showed that in some program sites, modest to large declines in child welfare system involvement were observed for the treatment versus the control group, and these declines were much more pronounced and consistent in the subgroup that had a screened-out index report compared to those with an investigated index report. However, in some sites, increases in child welfare system involvement occurred in the treatment group relative to the control group, suggesting that the CRP intervention may not be equally helpful to all families, or requires modifications to enhance success in some sites. The implications of these findings for child maltreatment prevention are discussed.
Article
The Scottish government plans a more preventive and partnership‐oriented approach to child protection. However, it has not recently published statistics on the number of child protection investigations. This paper analyses data from a request for information from government. It shows a rate of 153 investigations per 10 000 children aged 0–17 in 2017/18. There were wide variations in rates of investigations across Scottish local authorities. Almost three‐quarters of investigations in 2017/18 did not lead to the child being placed on the child protection register. A small association between investigation rates and local authority deprivation suggests that factors other than deprivation at the local authority level are at play in decisions to investigate child protection. There has been an increase of investigations by one‐third in the last two years with no change in the numbers starting a child protection plan. These trends raise the possibility that concerns about the preventive approach net‐widening and leading to more rather than less children drawn into the formal child protection system may have some basis. The limited nature of published statistical data in Scotland means that policies and activities, which are carried out with large amounts of public funding, receive limited public scrutiny. One investigation was conducted for every 65 children in Scotland in 2017/18. One child in 23 was investigated before the age of four. Rates of investigation vary widely between local authorities. One in four investigations are likely to lead to a child protection registration. There was a 33 per cent increase in investigations in the most recent two years with no change in child protection registrations. Investigations harm families and lessen the chances of engaging them with support. ‘The limited nature of published statistical data in Scotland means that policies and activities, which are carried out with large amounts of public funding, receive limited public scrutiny’
Article
The purpose of this study was to determine whether statutory wording of child maltreatment mandated reporting legislation was associated with reporting patterns and substantiation of abuse across U.S. states and territories. Annual state averages for total referrals, referrals screened-out, referrals screened-in, referrals substantiated, and child population (all children in the U.S.; annual average = 74,457,928) were obtained from the 2010-2017 Child Maltreatment Reports. Odds ratios were calculated for: (1) two major statutory language frameworks ( suspicion versus belief), (2) seven sub-categories (e.g., suspect, reasonably believe, etc.), and (3) universal mandated reporting (yes versus no). Use of suspicion (versus belief) was associated with higher rates of referrals made (OR = 1.13) and screened-in (OR = 1.13), but lower substantiation rates (OR = .92). States using universal mandated reporting (versus those who did not) had slightly lower rates of referrals (OR = .99), but higher rates of referrals screened-in (OR = 1.16) and substantiated (OR = 1.06). Differences in statutory wording are associated with variability in reports, suggesting the possibility that statutory wording is one factor involved with these differences. However, future research is needed to explore alternative contributing factors and/or explanations.
Article
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Family-based interventions delivered via telehealth are a promising mode for overcoming barriers to behavioral health treatment among youth in foster care and their families. There is a dearth of research, however, regarding effectiveness of these interventions for youth in foster care, who commonly exhibit complex behavioral health treatment needs. Clinical research in this area directly relates to equity in service access and quality for these youth and families, with numerous barriers and enabling factors to consider in order to improve engagement in clinical trials and bolster the evidence base. We present a framework to better understand the multi-systemic factors impacting youth and family engagement in clinical research on family-based telehealth interventions, drawing on relevant theory, including the bioecological model and ecodevelopmental theory. We also draw on our experiences conducting technology-based clinical research through the Family Telehealth Project, an evaluation of a brief family-based affect management intervention designed specifically for youth in foster care and their families, as a case example. Recommendations for promoting engagement in clinical research on family-based telehealth interventions with diverse youth in foster care and their families are provided.
Article
This paper unpacks the legacy of racism and white supremacy in American child psychiatry, connecting them to current racist inequities, to reimagine an antiracist future for the profession, and to serve all children's mental health body and soul. History reveals how child psychiatry has neglected and even perpetuated the intergenerational trauma suffered by minoritized children and families. By refusing to confront racial injustice, it has centered on white children's protection and deleted their role in white supremacist violence. An antiracist future for the profession demands a profound historical reckoning and comprehensive reimagining, a process that this paper begins to unfold.
Article
Current literature suggests that food insecurity increases child maltreatment risk. Yet, existing evidence is limited to individual-level associations among low-income, high-risk populations based on local, mostly urban data. This study aims to generalize prior findings to community-level associations in general populations, using national data including all urban-rural areas. We examined, for the first time, if food insecurity rates increase child maltreatment report (CMR) rates at the county level after controlling for potential confounders. We examined both within-community longitudinal changes (i.e., within-effects) and inter-community differences (i.e., between-effects) of food insecurity rates and their associations with CMR rates. We also examined differences by age, sex, race/ethnicity, maltreatment type, and urbanicity. We constructed longitudinal county-level data by linking multiple national databases, including all substantiated and unsubstantiated CMR records, the Map the Meal Gap's community food insecurity estimates, and Census data. The data covered over 96% of U.S. counties from 2009 to 2018. For analysis, we used within-between random effects models. Regarding between-effects, we found that in inter-community comparisons, higher food insecurity rates were significantly associated with increased CMR rates. This association was consistent by age, sex, maltreatment type, and urbanicity. For within-effects, we found that the association between longitudinal changes of food insecurity rates and CMR rates significantly differed by urbanicity. Specifically, longitudinal increases of food insecurity rates significantly increased CMR rates among large urban counties, but not among small urban and rural counties. Study findings highlight the importance of conducting further research to better understand the mechanisms through which food insecurity impact child maltreatment at both individual and community levels. Our community-level findings from general populations especially have significant implications for community-based programs and large-scale policies to achieve population-level impact on child well-being.
Article
Background Children are reported for maltreatment during infancy at elevated rates; research has established persistent racial/ethnic differences in the likelihood of reporting to the child protection system (CPS). Objective To model the influence of race/ethnicity and community disadvantage in CPS reporting during infancy. Participants/setting A population-based dataset consisting of more than 1.2 million children born in California between 2012 and 2014. Vital birth records were probabilistically linked to administrative CPS records. American Community Survey data were used to measure community disadvantage. Methods For each child, we coded sociodemographic information from the birth record, assigned the child to a community using their residential address at birth, and captured maltreatment reports from child protection records. We employed a modified Poisson regression model to examine an infant's likelihood of being reported to CPS by race/ethnicity across levels of community disadvantage and after adjusting for individual-level covariates. Results Infants born in neighborhoods with the most concentrated disadvantage were reported to CPS at 7 times the rate of children born in the most advantaged neighborhoods (12.3% vs. 1.8%). After adjusting for individual-level covariates, we found that both Black and Hispanic infants born on public insurance were significantly less likely than White infants to be reported for maltreatment overall — and Black and Hispanic infants had a statistically equivalent or lower likelihood of reporting at the two extremes of neighborhood disadvantage. Among privately insured families, Hispanic infants continued to have a lower likelihood of reporting, but Black infants were reported at higher rates than White infants. This Black-White difference persisted in the most advantaged neighborhoods, but disappeared in the most disadvantaged neighborhoods. Conclusions Capturing individual-level differences in socioeconomic status and associated risk factors is critical to understanding sources of racial/ethnic differences in CPS reporting, including when there is unwarranted variation or disparate treatment. Our findings suggest an elevated likelihood of maltreatment reporting among privately insured Black infants not explained by differences in observed risk or neighborhood, but no such differences were documented for Black or Hispanic infants on public insurance.
Article
Background Limited prior research has examined the rates or predictors of re-perpetration of child maltreatment. Yet, perpetrators may have multiple victims, and perpetrators, rather than their victims, are often the primary focus of child welfare services. Objective We examine rates of child maltreatment re-perpetration of repeat and new victims, and test perpetrator demographics and maltreatment index incident case characteristics as predictors of re-perpetration. Participants and setting We use a sample of 285,245 first-time perpetrators of a substantiated maltreatment incident in 2010 from the National Child Abuse and Neglect Data System. Methods We use linear probability models with full information maximum likelihood to test new victim and same victim perpetration by the end of FY 2018. Results Fifteen percent of perpetrators re-maltreated one or more of their original victims (“same victim re-perpetration”); 12% maltreated a new victim. Overall, re-perpetration was more common among younger, female, and White perpetrators. Perpetrators who were the biological or adoptive parent of their initial victim(s) had higher rates of same victim re-perpetration; new victim re-perpetration was more common among perpetrators who initially victimized an adoptive or stepchild. Same victim re-perpetration was less common among perpetrators of physical abuse than other types of maltreatment, and new victim re-perpetration was more common among perpetrators of sexual abuse and neglect than physical abuse. Conclusions Child welfare agencies should track re-perpetration in addition to revictimization as part of agency evaluations and risk assessments.
Article
Background and Purpose Child protective service (CPS) contact is consistently linked with poverty in the US, and empirical evidence is mounting to indicate that disparate exposure to income poverty explains a substantial portion of racial inequities in CPS involvement. Evidence about the different distributions of income poverty and material hardship also suggests that income poverty may not sufficiently capture economic wellbeing among families. This paper assessed whether differences in exposure to income poverty and/or material hardship explain racial inequities in CPS contact and further examined whether income poverty and material hardship predict CPS contact differently within racialized groups. Methods We used data from the Fragile Families and Child Wellbeing Study (FFCWS), an urban cohort representative of births in large US cities in 1998-2000. The FFCWS data are ideal for this study in capturing each of the key constructs: racialized group membership, income, material hardship, and CPS contact. We measured income poverty and material hardship when children were age 1 and measured any CPS contact by age five. Our final sample included 3,517 families, including 1,848 Black, 614 white, and 1,055 Latinx families. We employed logistic regression to assess the associations between income poverty and material hardship, independently and jointly, and CPS contact. We conducted analyses in our full analytic sample and among subsamples of the Black, white, and Latinx families. Results We found that that differences in income-to-poverty ratio account for differences in CPS contact between Black and white families. Differences in CPS contact between Black and Latinx families are not explained by economic wellbeing measures alone but are ameliorated when differences in income poverty, material hardship, and a full set of family characteristics are considered. Additionally, we found that material hardship was a consistent predictor of CPS contact in the full sample and within each of the Black, white, and Latinx subsamples, even accounting for differences in income and other family characteristics. Conclusions The clear role of income poverty in explaining inequities in CPS contact between Black and white families and the consistent importance of material hardship in predicting CPS contact across all families underscore the critical importance of reducing income poverty and hardship and of distinguishing material need from maltreatment in the context of CPS. Our findings offer clear implications for policy intervention to reduce income poverty and material hardship. Such interventions might include extending the currently temporarily expanded Child Tax Credit and expanded food and housing assistance benefits, toward the end of supporting child and family wellbeing and reducing economic and racial inequities in CPS contact.
Article
Child protective service (CPS) contact occurs at substantially higher rates among Black than White families. The present study considers systemic racism as a central driver of this disparity and emphasizes racialized poverty as a possible mechanism. We used data from the Fragile Families and Child Wellbeing Study and logistic regression analyses to assess the associations between income poverty, a racialized experience, and CPS contact, separately among Black and White families. Results indicated that income poverty was a significant predictor of CPS contact among White families, who were protected by higher income. In contrast, income per se was not a significant predictor of CPS contact among Black families, who were instead impacted by racialized family regulation and consequences of poverty, such as poor health and depression. Refundable state Earned Income Tax Credit (EITC) policies were protective for Black families, and more expansive Temporary Assistance for Needy Families (TANF) programs decreased CPS contact for Black and White families. Implications include centering systemic racism and specifically racialized poverty as causes of racial inequities in CPS contact and rethinking the role of CPS in protecting children.
Article
Introduction: This study examines the relationships among recent adverse childhood experiences (ACEs), somatic symptoms, and anxiety/depression symptoms during adolescence and whether anxiety/depression symptoms mediate the relationship between ACEs and somatic symptoms. Methods: Longitudinal prospective data from the Longitudinal Studies of Child Abuse and Neglect study of 1354 children and their primary caregivers in the United States was used in this study. A longitudinal cross-lagged path analysis among recent ACEs, anxiety/depression symptoms, and somatic symptoms at three points during adolescence (ages 12, 14, and 16 years) was conducted. Results: The sample was 51% female and 53% African American. The results indicated significant concurrent associations between recent ACEs and increased anxiety/depression symptoms at ages 12, 14, and 16 (β = .27, p < .001; β = .15, p < .001; β = .07, p < .05) and between anxiety/depression symptoms and increased somatic symptoms at ages 12, 14, and 16 years (β = .44, p < .001; β = .39, p < .001; β = .49, p < .001). Moreover, anxiety/depression symptoms significantly mediated the relationship between recent ACEs and concurrent somatic symptoms at ages 12, 14, and 16 years (β = .12, p < .001; β = .06, p < .001; β = .04, p < .05). However, there was no significant relationship between recent ACEs and somatic symptoms. Conclusion: The findings suggest that anxiety/depression symptoms mediate the concurrent relationships between recent ACEs and somatic symptoms at ages 12, 14, and 16. Clinicians should consider assessing anxiety/depression symptoms and possible concurrent exposure to ACEs when caring for adolescents who present with somatic symptoms.
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Parents face various stressors in their daily lives, and their child discipline practices are likely to be affected by the stressors. Existing research suggests that parental stress is a significant contributor to child maltreatment, but more research is needed, particularly among Asian American and Pacific Islander (AAPI) families. This study examined the relationship between economic hardship and aggravation in parenting and three types of child maltreatment (i.e., psychological aggression, physical assault, and neglect) in AAPI families through secondary data analysis of a longitudinal de-identified data set. This study analyzed a sample size of 146 AAPI children, with mothers as the primary caregiver. Economic hardship was positively associated with psychological aggression (β = 3.104, p < .01) and physical assault (β = 1.803, p < .05). Aggravation in parenting was positively associated with neglect (β = 0.884, p < .05). The findings suggest that AAPI parents are more likely to use certain child maltreatment methods when they experience specific stressors. Researchers and practitioners should consider the various stressors that AAPI families face and how other social or economic challenges can compound these stressors.
Article
This observational ecological study examined county-level associations between evidence-based home visiting (EHV) provisions and child maltreatment report (CMR) rates, using national county-level data from 2016–2018. We found that longitudinal changes of EHV provisions were significantly negatively associated with county CMR rates while controlling for potential confounders. Our model estimated that after EHV provisions were launched in counties, their CMR rates decreased (or after they were ceased, rates increased) by 2.21 per 1000 children overall, 2.88 per 1000 children aged 0–5, 2.59 per 1000 children aged 6–11, 2.13 per 1000 male children, and 2.24 per 1000 female children. When limiting attention to EHV provisions funded by the Maternal, Infant and Early Childhood Home Visiting (MIECHV) program, we found no significant association perhaps because MIECHV-funded EHV provisions were a small subset of all EHV provisions. These findings propose potential protective impacts of county EHV provisions on overall county CMR rates. Yet, the small effect sizes suggest that EHV provisions should be considered as a part of a complete response to child maltreatment rather than in isolation. Given that EHV is provided to a very small part of the population, nevertheless, our findings suggest that expanding coverage would increase effect sizes.
Article
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.
Article
In this study, we adopt the human capital formation framework to understand the association of the various risk and protective factors in the family settings of rural children with their cognitive performance as measured by vocabulary and math test scores. We examine the role of caregiver reading or storytelling to children at younger age and the deprivation of parental care due to labor migration at different stages of childhood on child performance in vocabulary and math tests when they are over 10 years old. Our findings confirm the crucial role of parental presence in child's cognitive development both during early childhood and later ages. Extended periods of parental absence during early and later years of childhood are most pernicious for child cognitive performance. Our analysis also reveals significantly positive effect of caregiver reading and storytelling on children's vocabulary test performance. This study provides strong evidence for the benefits of programs that promote good parenting practice and caregiver involvement in child cognitive development.
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The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology . Anda R.F., Felitti V.J., Bremner J.D., Walker J.D., Whitfield C., Perry B.D., Dube S.R. & Giles W.H. ( 2005 ) European Archives of Psychiatry and Clinical Neuroscience , ePub, posted online 29 November 2005 . Background Childhood maltreatment has been linked to a variety of changes in brain structure and function and stress–responsive neurobiological systems. Epidemiological studies have documented the impact of childhood maltreatment on health and emotional well-being. Methods After a brief review of the neurobiology of childhood trauma, we use the Adverse Childhood Experiences (ACE) Study as an epidemiological ‘case example’ of the convergence between epidemiological and neurobiological evidence of the effects of childhood trauma. The ACE Study included 17 337 adult HMO (Health Maintenance Organization) members and assessed eight adverse childhood experiences (ACEs) including abuse, witnessing domestic violence, and serious household dysfunction. We used the number of ACEs (ACE score) as a measure of cumulative childhood stress and hypothesized a ‘dose–response’ relationship of the ACE score to 18 selected outcomes and to the total number of these outcomes (comorbidity). Results Based upon logistic regression analysis, the risk of every outcome in the affective, somatic, substance abuse, memory, sexual, and aggression-related domains increased in a graded fashion as the ACE score increased (P < 0.001). The mean number of comorbid outcomes tripled across the range of the ACE score. Conclusions The graded relationship of the ACE score to 18 different outcomes in multiple domains theoretically parallels the cumulative exposure of the developing brain to the stress response with resulting impairment in multiple brain structures and functions.
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Importance Child maltreatment is a risk factor for poor health throughout the life course. Existing estimates of the proportion of the US population maltreated during childhood are based on retrospective self-reports. Records of officially confirmed maltreatment have been used to produce annual rather than cumulative counts of maltreated individuals.Objective To estimate the proportion of US children with a report of maltreatment (abuse or neglect) that was indicated or substantiated by Child Protective Services (referred to as confirmed maltreatment) by 18 years of age.Design, Setting, and Participants The National Child Abuse and Neglect Data System (NCANDS) Child File includes information on all US children with a confirmed report of maltreatment, totaling 5 689 900 children (2004-2011). We developed synthetic cohort life tables to estimate the cumulative prevalence of confirmed childhood maltreatment by 18 years of age.Main Outcomes and Measures The cumulative prevalence of confirmed child maltreatment by race/ethnicity, sex, and year.Results At 2011 rates, 12.5% (95% CI, 12.5%-12.6%) of US children will experience a confirmed case of maltreatment by 18 years of age. Girls have a higher cumulative prevalence (13.0% [95% CI, 12.9%-13.0%]) than boys (12.0% [12.0%-12.1%]). Black (20.9% [95% CI, 20.8%-21.1%]), Native American (14.5% [14.2%-14.9%]), and Hispanic (13.0% [12.9%-13.1%]) children have higher prevalences than white (10.7% [10.6%-10.8%]) or Asian/Pacific Islander (3.8% [3.7%-3.8%]) children. The risk for maltreatment is highest in the first few years of life; 2.1% (95% CI, 2.1%-2.1%) of children have confirmed maltreatment by 1 year of age, and 5.8% (5.8%-5.9%), by 5 years of age. Estimates from 2011 were consistent with those from 2004 through 2010.Conclusions and Relevance Annual rates of confirmed child maltreatment dramatically understate the cumulative number of children confirmed to be maltreated during childhood. Our findings indicate that maltreatment will be confirmed for 1 in 8 US children by 18 years of age, far greater than the 1 in 100 children whose maltreatment is confirmed annually. For black children, the cumulative prevalence is 1 in 5; for Native American children, 1 in 7.
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Background The effectiveness of paraprofessional home-visitations on improving the circumstances of disadvantaged families is unclear. The purpose of this paper is to systematically review the effectiveness of paraprofessional home-visiting programs on developmental and health outcomes of young children from disadvantaged families. Methods A comprehensive search of electronic databases (e.g., CINAHL PLUS, Cochrane, EMBASE, MEDLINE) from 1990 through May 2012 was supplemented by reference lists to search for relevant studies. Through the use of reliable tools, studies were assessed in duplicate. English language studies of paraprofessional home-visiting programs assessing specific outcomes for children (0-6 years) from disadvantaged families were eligible for inclusion in the review. Data extraction included the characteristics of the participants, intervention, outcomes and quality of the studies. Results Studies that scored 13 or greater out of a total of 15 on the validity tool (n = 21) are the focus of this review. All studies are randomized controlled trials and most were conducted in the United States. Significant improvements to the development and health of young children as a result of a home-visiting program are noted for particular groups. These include: (a) prevention of child abuse in some cases, particularly when the intervention is initiated prenatally; (b) developmental benefits in relation to cognition and problem behaviours, and less consistently with language skills; and (c) reduced incidence of low birth weights and health problems in older children, and increased incidence of appropriate weight gain in early childhood. However, overall home-visiting programs are limited in improving the lives of socially high-risk children who live in disadvantaged families. Conclusions Home visitation by paraprofessionals is an intervention that holds promise for socially high-risk families with young children. Initiating the intervention prenatally and increasing the number of visits improves development and health outcomes for particular groups of children. Future studies should consider what dose of the intervention is most beneficial and address retention issues.
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To present new estimates of the average lifetime costs per child maltreatment victim and aggregate lifetime costs for all new child maltreatment cases incurred in 2008 using an incidence-based approach. This study used the best available secondary data to develop cost per case estimates. For each cost category, the paper used attributable costs whenever possible. For those categories that attributable cost data were not available, costs were estimated as the product of incremental effect of child maltreatment on a specific outcome multiplied by the estimated cost associated with that outcome. The estimate of the aggregate lifetime cost of child maltreatment in 2008 was obtained by multiplying per-victim lifetime cost estimates by the estimated cases of new child maltreatment in 2008. The estimated average lifetime cost per victim of nonfatal child maltreatment is $210,012 in 2010 dollars, including $32,648 in childhood health care costs; $10,530 in adult medical costs; $144,360 in productivity losses; $7,728 in child welfare costs; $6,747 in criminal justice costs; and $7,999 in special education costs. The estimated average lifetime cost per death is $1,272,900, including $14,100 in medical costs and $1,258,800 in productivity losses. The total lifetime economic burden resulting from new cases of fatal and nonfatal child maltreatment in the United States in 2008 is approximately $124 billion. In sensitivity analysis, the total burden is estimated to be as large as $585 billion. Compared with other health problems, the burden of child maltreatment is substantial, indicating the importance of prevention efforts to address the high prevalence of child maltreatment.
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Childhood maltreatment represents a significant risk factor for psychopathology. Recent research has begun to examine both the functional and structural neurobiological correlates of adverse care-giving experiences, including maltreatment, and how these might impact on a child's psychological and emotional development. The relationship between such experiences and risk for psychopathology has been shown to vary as a function of genetic factors. In this review we begin by providing a brief overview of neuroendocrine findings, which indicate an association between maltreatment and atypical development of the hypothalamic-pituitary-adrenal axis stress response, which may predispose to psychiatric vulnerability in adulthood. We then selectively review the magnetic resonance imaging (MRI) studies that have investigated possible structural and functional brain differences in children and adults who have experienced childhood maltreatment. Differences in the corpus callosum identified by structural MRI have now been reliably reported in children who have experienced abuse, while differences in the hippocampus have been reported in adults with childhood histories of maltreatment. In addition, there is preliminary evidence from functional MRI studies of adults who have experienced childhood maltreatment of amygdala hyperactivity and atypical activation of frontal regions. These functional differences can be partly understood in the context of the information biases observed in event-related potential and behavioral studies of physically abused children. Finally we consider research that has indicated that the effect of environmental adversity may be moderated by genotype, reviewing pertinent studies pointing to gene by environment interactions. We conclude by exploring the extent to which the growing evidence base in relation to neurobiological and genetic research may be relevant to clinical practice and intervention.
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This article presents a population-based study of early childhood injury mortality following a nonfatal allegation of maltreatment. Findings are based on a unique data set constructed by establishing child-level linkages between vital birth records, administrative child protective services records, and vital death records. These linked data reflect over 4.3 million children born in California between 1999 and 2006 and provide a longitudinal record of maltreatment allegations and death. Of interest was whether children reported for nonfatal maltreatment subsequently faced a heightened risk of unintentional and intentional injury mortality during the first 5 years of life. Findings indicate that after adjusting for risk factors at birth, children with a prior allegation of maltreatment died from intentional injuries at a rate that was 5.9 times greater than unreported children (95% CI [4.39, 7.81]) and died from unintentional injuries at twice the rate of unreported children (95% CI [1.71, 2.36]). A prior allegation to CPS proved to be the strongest independent risk factor for injury mortality before the age of five.
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Cases of child abuse and neglect that involve black children are reported to and substantiated by public child welfare agencies at a rate approximately twice that of cases that involve white children. A range of studies have been performed to assess the degree to which this racial disproportionality is attributable to racial bias in physicians, nurses, and other professionals mandated to report suspected child victimization. The prevailing current explanation posits that the presence of bias among reporters and within the child welfare system has led to the current large overrepresentation of black children. A competing explanation is that overrepresentation of black children is mainly the consequence of increased exposure to risk factors such as poverty. We tested the competing models by using data drawn from national child welfare and public health sources. We compared racial disproportionality ratios on rates of victimization from official child welfare organizations to rates of key public health outcomes not subject to the same potential biases (eg, general infant mortality). We found that racial differences in victimization rate data from the official child welfare system are consistent with known differences for other child outcomes. We also found evidence supporting the presence of cultural protective factors for Hispanic children, termed the "Hispanic paradox." Although our findings do not preclude the possibility of racial bias, these findings suggest that racial bias in reporting and in the child welfare system are not large-scale drivers of racial disproportionality. Our data suggest that reduction of black/white racial disproportionality in the child welfare system can best be achieved by a public health approach to reducing underlying risk factors that affect black families.
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Using the National Longitudinal Study of Adolescent Health (Add Health), we estimate the determinants and direction of change in individual racial identification among multiracial and monoracial adolescents as they transition to young adulthood. We find that while many multiracials subsequently identify as monoracials, sizable numbers of monoracials also subsequently become multiracials. Native American-whites appear to have the least stable identification. We find strong support that socioeconomic status, gender, and physical appearance shape the direction of change for multiracials, and that black biracials are especially compelled to identify as monoracial blacks.
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The prevention of child maltreatment necessitates a public health approach. In the U.S. Triple P System Population Trial, 18 counties were randomly assigned to either dissemination of the Triple P-Positive Parenting Program system or to the services-as-usual control condition. Dissemination involved Triple P professional training for the existing workforce (over 600 service providers), as well as universal media and communication strategies. Large effect sizes were found for three independently derived population indicators: substantiated child maltreatment, child out-of-home placements, and child maltreatment injuries. This study is the first to randomize geographical areas and show preventive impact on child maltreatment at a population level using evidence-based parenting interventions.
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Data from the National Survey of Child and Adolescent Well-being, a national probability study of children and families investigated for child maltreatment, were analyzed to answer the question: Do substantiated and unsubstantiated cases differ in rates of recidivism over 36 months? Recidivism was classified as (a) any re-reports, (b) substantiated re-reports and (c) subsequent foster care placements. Bivariate (survivor functions estimated by the Kaplan-Meier method) and multivariate (Cox regression modeling) analyses were conducted. The results revealed that risk of recidivism was similar regardless of substantiation status of the index investigation. We suggest that the substantiation label be removed from field use. Instead, we suggest that agencies record service needs in the families they serve, and also record whether or not the family meets criteria for referral to the family court. These would be far more practical and meaningful ways to measure child welfare services.
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To determine whether child physical maltreatment early in life has long-term effects on psychological, behavioral, and academic problems independent of other characteristics associated with maltreatment. Prospective longitudinal study with data collected annually from 1987 through 1999. Randomly selected, community-based samples of 585 children from the ongoing Child Development Project were recruited the summer before children entered kindergarten in 3 geographic sites. Seventy-nine percent continued to participate in grade 11. The initial in-home interviews revealed that 69 children (11.8%) had experienced physical maltreatment prior to kindergarten matriculation. Adolescent assessment of school grades, standardized test scores, absences, suspensions, aggression, anxiety/depression, other psychological problems, drug use, trouble with police, pregnancy, running away, gang membership, and educational aspirations. Adolescents maltreated early in life were absent from school more than 1.5 as many days, were less likely to anticipate attending college compared with nonmaltreated adolescents, and had levels of aggression, anxiety/depression, dissociation, posttraumatic stress disorder symptoms, social problems, thought problems, and social withdrawal that were on average more than three quarters of an SD higher than those of their nonmaltreated counterparts. The findings held after controlling for family and child characteristics correlated with maltreatment. Early physical maltreatment predicts adolescent psychological and behavioral problems, beyond the effects of other factors associated with maltreatment. Undetected early physical maltreatment in community populations represents a major problem worthy of prevention.
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Childhood maltreatment has been linked to a variety of changes in brain structure and function and stress-responsive neurobiological systems. Epidemiological studies have documented the impact of childhood maltreatment on health and emotional well-being. After a brief review of the neurobiology of childhood trauma, we use the Adverse Childhood Experiences (ACE) Study as an epidemiological "case example" of the convergence between epidemiologic and neurobiological evidence of the effects of childhood trauma. The ACE Study included 17,337 adult HMO members and assessed 8 adverse childhood experiences (ACEs) including abuse, witnessing domestic violence, and serious household dysfunction. We used the number of ACEs (ACE score) as a measure of cumulative childhood stress and hypothesized a "dose-response" relationship of the ACE score to 18 selected outcomes and to the total number of these outcomes (comorbidity). Based upon logistic regression analysis, the risk of every outcome in the affective, somatic, substance abuse, memory, sexual,and aggression-related domains increased in a graded fashion as the ACE score increased (P <0.001). The mean number of comorbid outcomes tripled across the range of the ACE score. The graded relationship of the ACE score to 18 different outcomes in multiple domains theoretically parallels the cumulative exposure of the developing brain to the stress response with resulting impairment in multiple brain structures and functions.
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The purpose of this study was to estimate the prevalence of child maltreatment in the United States and examine its relationship to sociodemographic factors and major adolescent health risks. The National Longitudinal Study of Adolescent Health is a prospective cohort study following a national sample of adolescents into adulthood. The wave III interview, completed by 15 197 young adults in 2001-2002 (77.4% response rate), included retrospective measures of child maltreatment. We used these measures to estimate the prevalence of self-reported supervision neglect, physical neglect, physical assault, and contact sexual abuse during childhood. Next, we investigated the relationship between sociodemographic characteristics and maltreatment. Finally, we examined the association between child maltreatment and adolescent self-rated health; overweight status; depression; cigarette, alcohol, marijuana, and inhalant use; and violent behavior. Having been left home alone as a child, indicating possible supervision neglect, was most prevalent (reported by 41.5% of respondents), followed by physical assault (28.4%), physical neglect (11.8%), and contact sexual abuse (4.5%). Each sociodemographic characteristic was associated with > or = 1 type of maltreatment, and race/ethnicity was associated with all 4. Each type of maltreatment was associated with no fewer than 8 of the 10 adolescent health risks examined. Self-reported childhood maltreatment was common. The likelihood of maltreatment varied across many sociodemographic characteristics. Each type of maltreatment was associated with multiple adolescent health risks.
Article
A previous article published several years ago (Prinz et al. Prevention Science, 10, 1–12, 2009) described the main results of a place-randomized-design study focused on the prevention of child-maltreatment-related outcomes at a population level through the implementation of a multilevel system of parenting and family support (the Triple P—Positive Parenting Program). The current report, prepared at the encouragement of the journal, provides additional details about procedures, measures, and design-related decisions, presents an additional analysis of the main outcome variables, and poses questions about the study and its implications. We also offer guidance about how the field can move forward to build on this line of research. From the outset, the three designated primary child maltreatment outcomes were county-wide rates for substantiated child maltreatment cases, out-of-home placements, and hospital-treated child maltreatment injuries, derived from independent data sources available through administrative archival records. Baseline equivalence between the two intervention conditions was reaffirmed. The additional analysis, which made use of a 5-year baseline (replacing a 1-year baseline) and ANCOVA, yielded large effect sizes for all three outcomes that converged with those from the original analyses. Overall, the study underscored the potential for community-wide parenting and family support to produce population-level preventive impact on child maltreatment. Issues addressed included (1) the need for replication of population-oriented maltreatment prevention strategies like the one tested in this randomized experiment, (2) the need to demonstrate that a parenting-based population approach to maltreatment prevention can also impact children’s adjustment apart from child abuse, and (3) the role of implementation science for achieving greater population reach and maintenance over time.
Article
This article constitutes a 20-year update to a previous publication (Pelton, 1994), which showed that there is overwhelming evidence that poverty and low income are strongly related to child abuse and neglect. Subsequent evidence shows that the relationship continues to be strong. In addition, there is further evidence since the 1994 publication that this relation is not substantially due to class bias. Yet it is suggested that class bias does exist within the system. There is also further evidence that decreases in child maltreatment follow increases in material supports, and that job loss bears a complex relationship to child maltreatment. Findings pertaining to racial bias within the child welfare system continue to be mixed, but leave no doubt that racial disproportionalities within the system are overwhelmingly related to racial disproportionalities in the poverty population. There is continuing evidence that children placed in foster care are predominantly from impoverished families, and that changes in the level of material supports are related to risk of placement. It is suggested that the fact that there are nearly one million children in out-of-home placement (foster care and child-welfare involved adoption, combined) is indicative of the continuing dysfunction of the child welfare system, and that the differential response paradigm has not altered this dysfunction. A proposal for a fundamental restructuring of the child welfare system is recommended and restated here. Prospects for such change are briefly discussed. Also, to reduce poverty, a previously proposed universal social dividend and taxation system is briefly discussed and recommended.
Article
Residential mobility is a process that changes lives and neighborhoods. Efforts to build strong communities are unavoidably caught up with this dynamic but have insufficient understanding of its complexities. To shed light on the underlying forces of residential mobility, this study uses a unique panel survey from the Casey Foundations Making Connections initiative targeting poor neighborhoods in 10 cities. The study classified households in the 10 cities as movers, newcomers, or stayers, and it evaluated the push and pull factors related to their mobility decisions. Cluster analysis revealed discernible types based on life cycle, household economic factors, and neighborhood attachment. The study also investigated the effect of residential mobility on neighborhood composition, finding that neighborhood change was pnmanly due to differences between movers and newcomers rather than changes for stayers. Combining information on the mix of household types with the components of neighborhood change, the study suggests these neighborhoods functioned in quite different ways that are relevant to family well-being and community development.
Article
Child maltreatment is a major social problem. This paper focuses on measuring the relationship between child maltreatment and crime using data from the National Longitudinal Study of Adolescent Health (Add Health). We focus on crime because it is one of the most costly potential outcomes of maltreatment. Our work addresses two main limitations of the existing literature on child maltreatment. First, we use a large national sample, and investigate different types of maltreatment in a unified framework. Second, we pay careful attention to controlling for possible confounders using a variety of statistical methods that make differing assumptions. The results suggest that maltreatment greatly increases the probability of engaging in crime and that the probability increases with the experience of multiple forms of maltreatment.
Article
Substantiation rates have long been the primary variable associated with research into child protective services (CPS) early intervention. Rates of substantiation have been used to criticize the efficiency of CPS screening procedures, to suggest that mandated reporting laws are cumbersome and require revision, and to posit that large numbers of CPS assessments result in high levels of unintended negative consequences for reported families. Substantiation is commonly used in empirical research as a proxy for the appropriateness of CPS referrals. These practices are problematic for several reasons. This article argues that many or most unsubstantiated reports involve either some form of maltreatment or preventive service needs appropriate to CPS intervention, and that using substantiation as a means of gauging the validity of a CPS referral is therefore intrinsically fallacious. A harm/evidence model is presented as an aid to conceptualizing the heterogeneity of unsubstantiated reports. The validity of the model is explored through a review of relevant empirical work. The article concludes with a series of suggestions for future research.
Article
To examine the effectiveness of the Safe Environment for Every Kid (SEEK) model of enhanced pediatric primary care to help reduce child maltreatment in a relatively low-risk population. A total of 18 pediatric practices were assigned to intervention or control groups, and 1119 mothers of children ages 0 to 5 years were recruited to help evaluate SEEK by completing assessments initially and after 6 and 12 months. Children's medical records and Child Protective Services data were reviewed. The SEEK model included training health professionals to address targeted risk factors (eg, maternal depression), the Parent Screening Questionnaire, parent handouts, and a social worker. Maltreatment was assessed 3 ways: 1) maternal self-report, 2) children's medical records, and 3) Child Protective Services reports. In the initial and 12-month assessments, SEEK mothers reported less Psychological Aggression than controls (initial effect size = -0.16, 95% confidence interval [95% CI] -0.27, -0.05, P = .006; 12-month effect size = -0.12, 95% CI -0.24, -0.002, P = .047). Similarly, SEEK mothers reported fewer Minor Physical Assaults than controls (initial effect size = -0.16, 95% CI -0.29, -0.03, P = .019; 12-month effect size = -0.14, 95% CI -0.28, -0.005, P = .043). There were trends in the same positive direction at 6 months, albeit not statistically significant. There were few instances of maltreatment documented in the medical records and few Child Protective Services reports. The SEEK model was associated with reduced maternal Psychological Aggression and Minor Physical Assaults. Although such experiences may not be reported to protective services, ample evidence indicates their potential harm. SEEK offers a promising and practical enhancement of pediatric primary care.
Article
This study presents data from the first large-scale longitudinal study to track the involvement of children reported for maltreatment in both the special education and child welfare systems. A range of state and local administrative databases were combined and cross-sector service histories were established for 7,940 children who had received Aid to Families With Dependent Children between 1993 and 1994. The authors address the following questions: (a) Is maltreatment associated with entry into special education after controlling for other factors? (b) among maltreated children, does maltreatment type or child welfare service use predict special education eligibility? and (c) what is the relationship between maltreatment type and type of educational disability? Results indicate that child maltreatment system involvement generally predates special education entry and is predictive of entry even after controlling for other factors. A range of other associations between factors such as child and maternal characteristics, services received, maltreatment type, and special education classification are detailed.
Article
Chronic maltreatment has been associated with the poorest developmental outcomes, but its effects may depend on the age when the maltreatment began, or be confounded by co-occurring psychosocial risk factors. We used data from the National Survey of Child and Adolescent Well-Being (NSCAW) to identify four groups of children who varied in the timing, extent, and continuity of their maltreatment from birth to 9 years. Internalizing and externalizing problems, prosocial behavior, and IQ were assessed 21 months, on average, following the most recent maltreatment report. Children maltreated in multiple developmental periods had more externalizing and internalizing problems and lower IQ scores than children maltreated in only one developmental period. Chronically maltreated children had significantly more family risk factors than children maltreated in one developmental period and these accounted for maltreatment chronicity effects on externalizing and internalizing problems, but not IQ. The timing of maltreatment did not have a unique effect on cognitive or behavioral outcomes, although it did moderate the effect of maltreatment chronicity on prosocial behavior. There is a need for early intervention to prevent maltreatment from emerging and to provide more mental health and substance use services to caregivers involved with child welfare services.
Article
We assessed the self-reported experience, comfort and competence of primary care pediatricians in evaluating and managing child maltreatment (CM), in rendering opinions regarding the likelihood of CM, and in providing court testimony. We examined pediatricians' need for expert consultation when evaluating possible maltreatment. A questionnaire was mailed to 520 randomly selected AAP members. Pediatricians were asked how frequently they evaluated and reported children for suspected maltreatment, and whether child abuse pediatricians were available to and used by them. Pediatricians were asked to rate their knowledge, comfort and competence in the management of CM. Demographic information was also gathered. Pediatricians' experience with CM, their comfort, self-reported competence, and need for expert assistance is described. Logistic regression was used to assess factors that predicted pediatricians' sense of competence while controlling for covariates found to be significant in bivariate analyses. One hundred forty-seven questionnaires were eligible for analysis. The majority of respondents had little experience evaluating and reporting suspected CM, and was interested in having expert consultation. While pediatricians often felt competent in conducting medical exams for suspected maltreatment, they felt less competent in rendering a definitive opinion, and did not generally feel competent to testify in court. Sense of competence was particularly low for sexual abuse. Increased practice experience and more courses in CM led to increased sense of competence in some areas. Pediatricians acknowledged many limitations to providing care to maltreated children, and expressed interest in subspecialist input. These findings add additional support to the American Board of Pediatrics' decision to create a Child Abuse Pediatrics subspecialty. The findings also indicate a need to ensure funding for fellowship training programs in this field.
Article
A survey of 10% of federally recognized American Indian tribes and the states in which they are located indicates national data systems receive reports of approximately 61% of data on the abuse or neglect of American Indian children, 42% by states and 19% by counties. The author recommends that American Indians develop culturally sound definitions of abuse and neglect and that the government provide the resources and assistance necessary to develop data tracking and reporting systems on the abuse and neglect of American Indian children.
Article
The purpose of this article is to: (1) illustrate the application of life table methodology to child abuse and neglect report data and (2) demonstrate the use of indicators derived from the life tables for monitoring the risk of child maltreatment within a community. Computerized records of child maltreatment reports from a large, urban county in Ohio are cumulated for 11 years and linked for each child. Life table methods are used to estimate the probability that children from birth to age 10 will be reported victims of maltreatment by age, race, and urban or suburban residence. Using life tables, the estimates in the county of this study are that 33.4% of African American children and 11.8% of White children will appear in substantiated or indicated child abuse or neglect report(s) by their 10th birthday. The age-specific probability of a maltreatment report is highest in the first year of life for both groups. The probability of a child being reported for a substantiated or indicated incident of maltreatment before his or her 10th birthday is more than three times higher for city dwellers than for suburbanites in the urban county studied here. Life table methodology is useful for creating child well-being indicators for communities. Such indicators reveal that a larger portion of the child population is affected by maltreatment reports than would be concluded from examining cross-sectional rates and can be used to identify racial or geographic disparities.
Article
To examine whether children with substantiated maltreatment reports between 4 and 8 years of age differ from children with unsubstantiated reports on any of 10 behavioral and developmental outcomes. Longitudinal data from 806 children and their adult caregivers collected in four US study sites were pooled and analyzed using Analysis of Variance (ANOVA) and multivariate linear regression. There were no significant differences between the mean scores of children with unsubstantiated and substantiated maltreatment reports filed between 4 and 8 years of age for any of the 10 behavioral and developmental outcomes. In the multivariate analysis, substantiation status was not significantly associated with any of the 10 outcomes after adjusting for prior functioning, prior maltreatment status, and sociodemographic characteristics. Findings from within-site analyses were generally consistent with the pooled analyses in finding no association between substantiation status and the outcomes examined. In this high-risk sample, the behavioral and developmental outcomes of 8-year-old children with unsubstantiated and substantiated maltreatment reports filed between ages 4 and 8 were indistinguishable. Future research should attempt to replicate these findings on probability samples that represent the full range of childhood maltreatment risk and with models that control for the impact of social services.
Article
This article presents analyses of longitudinal data to explore whether low-income children who survived a first incident of reported maltreatment were at higher risk of later childhood death compared to a matched comparison group of low-income children without reports of maltreatment (n = 7,433). Compared to the comparison group, children in the maltreatment group had about twice the risk of death before age 18 (0.51% vs. 0.27%). Among children with mal-treatment reports, median time from the first report to subsequent death was 9 months. The majority of deaths among children who were reported for maltreatment could be categorized as preventable (accidents or recurrent maltreatment) as compared to resulting from severe health conditions.
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Accessed February 1, 2016. 20. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. CDC WONDER online databse. Bridged-race population estimates 1990-2014 request. Available at: http://wonder.cdc.gov/bridgedrace-v2014.html. Accessed February 3, 2016.
Her Majesty's Stationery Office
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CDC WONDER online databse. Bridged-race population estimates 1990-2014 request
US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. CDC WONDER online databse. Bridged-race population estimates 1990-2014 request. Available at: http://wonder.cdc.gov/bridgedrace-v2014.html. Accessed February 3, 2016.