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Lifetime Prevalence of Investigating Child Maltreatment Among US Children
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).
... 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. ...
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.
... 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. ...
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.
... 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]. ...
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.
... PRISMA flow diagram of the systematic review search process. Curtis, 2003;Hampton & Newberger, 1985;Jonson-Reid et al., 2013;Klein & Merritt, 2014;Lavergne et al., 2008;Skrypek, Woodmass, Rockymore, Johnson, & Wells, 2017), report investigation (Fluke et al., 2003;Jonson-Reid et al., 2013;Kim, Wildeman, Jonson-Reid, & Drake, 2017;King et al., 2017), allegation substantiation (Dettlaff et al., 2011), out-of-home placement (Bywaters et al., 2017;Carter & Myers, 2008;Foster et al., 2011;Garland et al., 1998;Huggins-Hoyt et al., 2019;Lau et al., 2003;Lu et al., 2004;Owen & Statham, 2009ab;Watt & Kim, 2019), re-entry to foster care (Courtney, 1995), lower reunification rate (Lu et al., 2004;Owen & Statham, 2009ab), exits to permanency (i.e., fewer adoptions; (Akin, 2011), and ongoing services (King et al., 2017). Moreover, cases involving Black youth considered fewer alternative response paths (McCallum & Cheng, 2016) and had a greater number of placement changes (Summersett-Ringgold, Jordan, Kisiel, Sax, & McClelland, 2018). ...
... In terms of investigations and substantiation of allegations, a study conducted in the United-States found that Black youth have higher rates of first time investigation than other racial groups (Kim et al., 2017). Additionally, a Canadian-based study found that Black youth are overall 41% more likely to be investigated than White youth (King et al., 2017). ...
The overrepresentation of Black children in child protection services has been reported continuously in western societies, but remains poorly understood. This systematic review's objective was: 1) to confirm or refute the existence of racial disparities and the overrepresentation of Black youth in child protection systems in countries where Black communities constitute a minority; 2) to analyze the risk and protective factors associated with these observations. Our study confirmed the overrepresentation of Black children and their disproportionate representation across stages of involvement with child welfare services. Two categories of factors: sociodemographic (gender, age, race and socioeconomic status) and racial discrimination (associated with referrals, investigations and caregivers), were identified as contributing to these disparities. Implications for practice and policy are discussed.
... Among Black children, an estimated close to 50% are likely to be subject to such an investigation. 1 Although rates of serious physical injury to children are on the decline, 2 the number of children reported for neglect has increased. Child maltreatment investigations have become the foremost intervention to safeguard children in the United States. ...
... Allegations of maltreatment involving Black children are more likely to be reported to 1 and substantiated by child welfare agencies than those involving white children. 4 Once investigated, Black children are more likely to be removed from their homes than white children and subsequently less likely to be reunified. ...
... (Note that we refer to features as "factors, " as this language is more familiar to our users.) Labeled elements are as follows: 1) The risk score for the case (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). 2) Categories for each factor, such as demographics (DG) or referral history. ...
... Child abuse victims can suffer physical injuries and emotional problems, and may experience trauma resulting in long-term mental health problems [1]. More than one-third of American children are investigated as potential victims of abuse or neglect by age 18 [10]. Still, in 2018, there were 1,770 reported fatalities resulting from child abuse and neglect [1]. ...
Machine learning (ML) is being applied to a diverse and ever-growing set of domains. In many cases, domain experts -- who often have no expertise in ML or data science -- are asked to use ML predictions to make high-stakes decisions. Multiple ML usability challenges can appear as result, such as lack of user trust in the model, inability to reconcile human-ML disagreement, and ethical concerns about oversimplification of complex problems to a single algorithm output. In this paper, we investigate the ML usability challenges present in the domain of child welfare screening through a series of collaborations with child welfare screeners, which included field observations, interviews, and a formal user study. Through our collaborations, we identified four key ML challenges, and honed in on one promising ML augmentation tool to address them (local factor contributions). We also composed a list of design considerations to be taken into account when developing future augmentation tools for child welfare screeners and similar domain experts.
... An estimated 37% of children in the United States are investigated for alleged maltreatment during childhood (Kim et al., 2017); roughly one in 12 will experience at least three reports of alleged maltreatment by age 12 (Kim & Drake, 2019). Studies have demonstrated notable differences between children who have been reported for maltreatment at least once and those who have never been reported (Jonson-Reid et al., 2007;Putnam-Hornstein, 2011;Putnam-Hornstein et al., 2013). ...
... As such, our examination and labeling of classifications in this analysis produced distinctive maltreatment experiences, wherein neglect appeared to be a common element in most maltreatment classes. This confirms and extends research indicating that neglect is the most common maltreatment type during childhood (Kim et al., 2017), although the conditions or experiences that are recorded as neglect remain unknown. Note. ...
Childhood maltreatment involves dynamics between the type of maltreatment experienced and the context of maltreatment. Reports of alleged maltreatment to child protective services may overlap and shift over time, complicating understanding of their independent and interacting nature, including how child protection systems respond. Latent class analysis (LCA) and latent transition analysis (LTA) were used to construct data-based models of longitudinal dynamics of alleged maltreatment throughout childhood. We sought to identify patterns leading to system decisions to substantiate allegations of maltreatment and place children in foster care. Using linked birth and child protection records, we defined a cohort of children born in California in 1999, 29.4% of whom had at least one referral for alleged maltreatment before their 18th birthday. Maltreatment and perpetrator indicators were coded, and LCA identified five alleged maltreatment classes and one class of children without referrals. LTA determined consistency of classifications and estimated transitions between classes over age periods. Children with multitype maltreatment patterns or experiences of neglect were most likely to experience future maltreatment allegations. Estimated probabilities of placement indicated children with Multitype Maltreatment allegations were more likely to experience substantiated maltreatment allegations and out-of-home placements. Findings identify a repeatable method for better understanding complex systems.
... 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. ...
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.
... Department of Health & Human Services, 2020). Research from the National Child Abuse and Neglect Data System Child Files indicates that by age 18 years approximately 1 in 3 children are referred to CPS (Kim, Wildeman, Jonson-Reid, & Drake, 2017), with 1 in 8 children found to have confirmed maltreatment (Wildeman et al., 2014). ...
Background:
Despite being well-positioned to identify maltreatment in the children that they provide care for and being legally required to report suspected child maltreatment, early childhood professionals (ECPs) make a limited proportion of reports to child protective services. It is critical to identify evidence-based interventions to improve the reporting practices of this group of mandated reporters allowing for the better protection of children from maltreatment.
Objective:
The goal of the present study was to determine if iLookOut, an online child abuse identification and reporting training for ECPs, results in differential gains in knowledge and attitudes towards child abuse and its reporting among ECPs, as compared to an online standard training.
Participants and setting:
Both interventions were completed online by participants recruited from licensed child care programs in Southern Maine from October 2017 to January 2020. Eligibility criteria included being at least 18 years of age, English-speaking, and working as paid or volunteer staff at a licensed child care program taking care of children 5 years of age or younger. Of the 1152 enrolled individuals, 1094 provided complete pre- and post-intervention data.
Methods:
A randomized controlled trial comparing iLookOut with an online standard training.
Results:
ECPs who completed iLookOut significantly outperformed those who completed Standard mandated reporter training in terms of both knowledge (d=1.09 vs. 0.67) and attitudes (d=0.67 vs. 0.54) relative to pre-test scores.
Conclusions:
iLookOut is a promising candidate for widespread use in meeting the need for evidence-based training on child abuse and its reporting.
... Upon receiving maltreatment reports, social workers visit reported families to assess children's safety, often with the assistance of structured decision-making tools (Hirschman & Bosk, 2020). Based on cumulative prevalence estimates from national administrative data, 37% of U.S. children experience an investigation by CPS at some point during their childhoods, following reports of child abuse and/or neglect (Kim, Wildeman, Jonson-Reid, & Drake, 2017). 2 The agency determines whether there is enough evidence to substantiate maltreatment allegations and whether to remove children from their homes. ...
Each year, nearly 2.5 million evictions are filed in the United States. Recent research links evictions to a host of negative outcomes, but effects on child well-being are less studied, even as evictions are disproportionately experienced by families with children. In this article, we investigate the relationship between evictions and reports of child abuse and neglect, a key indicator of child well-being. Drawing on 5 years of block-group-level administrative data in Connecticut, we find that as eviction notices increase within a neighborhood, reports of maltreatment also increase, even net of zip-code-level factors and time-invariant block group characteristics. The relationship is driven by reports of neglect and is strongest among adolescents (children ages 10–17). These results suggest that mitigating housing insecurity has the potential to reduce child abuse and neglect reports.
... Our last case considers family separation that occurs through offices of child protection. Ample evidence shows that Black children are overrepresented in the child welfare system relative to their representation in the general child population (Putnam-Hornstein et al., 2013); according to recent estimates, upward of 50% of Black children will experience a child welfare investigation before the age of 18 (compared to 28% of white children) (Kim et al., 2017). Researchers have linked the overrepresentation of Black children in child welfare to systemic racism, including what we would consider historical trauma, which has resulted in vast income and wealth inequality between Black and white families (Dettlaff et al., 2011). ...
We utilize intersectionality as the framework for analyzing and critiquing the literature on the intergenerational transmission of trauma in early childhood. In particular, we assess the extent to which the literature replicates the oppression of marginalized and minoritized children and families by deemphasizing traumas and traumatic processes that are attributable to interlocking systems of oppression. In addition, building on the emphasis on systems that is central to intersectionality, we assess the degree to which the literature engages with trauma perpetrated through formal social systems. We assert that an intersectional lens demands acknowledgement of state-perpetrated violence and that this acknowledgment is absent from the extant literature. To illustrate our argument, we present three structural analyses (“cases”) of state-perpetrated violence, leveraging life course theory and theories of historical and cultural trauma in addition to intersectionality theory to draw inferences about the intergenerational impacts of these cases. Through our analysis, we demonstrate how efforts to reduce contemporary state-perpetrated violence and repair the effects of historical state-perpetrated violence are well aligned with ongoing efforts in the public policy arena at promoting early childhood mental health and family thriving. We close with a proposed agenda for better integrating such efforts into research and policy. © 2020 The Society for the Psychological Study of Social Issues
... Traumatic childhood experiences such as histories of abuse and neglect are common in the U.S. Data from national reports indicated a lifetime prevalence rate of 37.4% for all children who had experienced a formal investigation by child protective services (Kim, Wildeman, Jonson-Reid, & Drake, 2017). The immediate and long-term consequences of histories of abuse and neglect have been well-documented and have included problems relating to mental health, affect and behavioral regulation, and impaired relationships (Gilbert et al., 2009). ...
Objective
This study tested the effectiveness of Cognitive Behavioral Intervention for Trauma in Schools (CBITS) in adolescent girls involved in the child welfare system. Three outcomes were evaluated: symptoms of posttraumatic stress disorder (PTSD), depression, and social problem-solving skills.
Method
A randomized controlled trial was utilized to compare the effects of an adapted version of CBITS with usual care (UC) services. Participants were ages 12 to 19 (N = 249), the majority of whom (69.5%) were African American. Participants’ symptoms of PTSD, depression, and social problem-solving skills were evaluated at pre, post (3 months), and follow-up (6 months) assessments. Linear mixed models were used to compare condition by time interactions using all available data. Control variables were demographics, service use, and number of types of traumas. Treatment fidelity, participant acceptability, and satisfaction with the intervention were also examined.
Results
Analyses indicated that participants in the CBITS condition showed significantly greater increases in social problem-solving than the UC condition. For both PTSD and depression symptoms, there were no significant differences between the two conditions. Both the CBITS and UC participants showed significant reductions in symptoms. Results also indicated that this intervention is an acceptable model for this population.
Conclusions
Despite the growth of trauma-focused, evidence-supported interventions for reducing PTSD and depression, knowledge of effective interventions in child welfare youth lags behind. Because CBITS is more effective than UC in increasing social problem-solving skills, this intervention may be an important treatment option for this population.
... These findings also raise new questions about the child welfare response to communities of color, especially geographic areas with majority Black populations. Black children are disproportionately represented in child maltreatment reports, and have greater exposure to child maltreatment risk factors Kim, Wildeman, Jonson-Reid, & Drake, 2017;Putnam-Hornstein et al., 2013;Wildeman, Emanuel, Leventhal, Putnam-Hornstein, Waldfogel, & Hee, 2014). Yet this study did not focus on racial disproportionality or disparities at the child or family level, or on who received child maltreatment investigations; it focused on where investigations took place. ...
Child maltreatment report rates vary widely among states and counties. A portion of the variation likely reflects varying community-level risk and protective factors, but the variation also likely reflects community characteristics unrelated to risk, raising questions of equity and justice, in addition to safety. This study builds on previous research that focused only on the U.S. South to investigate nationally how county racial/ethnic compositions, poverty rates, and rurality relate to child maltreatment report rates. Aggregated county-level data from the National Child Abuse and Neglect Data System (NCANDS) from nearly all U.S. counties (n = 2,966 in 2015) were linked to data from the U.S. census and other sources. Bivariate tests and multi-level regression models assessed county-level factors associated with the child maltreatment investigated report rate. Consistent with previous studies, despite higher child poverty rates, child maltreatment report rates were lower in rural counties with majority populations of color compared to other counties. In addition, although county-level child poverty rates were generally positively associated with child maltreatment report rates, child poverty was not positively associated with child maltreatment report rates in rural counties with majority populations of color, primarily due to low report rates in rural counties with majority Black populations. To our knowledge, this is the first national child maltreatment study to disentangle county rurality from racial/ethnic composition by specifically investigating rural counties with majority populations of color.
... Another group of studies examines other types of adverse childhood experiences that predominantly occur in disadvantaged households, such as parental incarceration (Wildeman 2009;Wildeman and Andersen 2015), foster care placements (Magruder and Shaw 2008;Fallesen, Emanuel, and Wildeman 2014;, child maltreatment (Sabol, Coulton, and Polousky 2004;Kim et al. 2017;Kim and Drake 2019), and termination of parental rights (Wildeman, Edwards, and Wakefield 2020). These studies similarly find that far more children ever experience such an event than is suggested by annual rates. ...
... Not only are these decisions difficult to make, they are made about a large number of children. By age 18, approximately one-third of all children in the USA will have been the subject of a CPS investigation (Kim et al. 2017). Among them, only a small percentage will have had the allegations confirmed (approximately one in eight) (Wildeman et. ...
The racial and ethnic disproportionality and disparity in the child protective system (CPS) has been a concern for decades. Structural factors strongly influence engagement with the child welfare system and families experiencing poverty or financial hardship are at a heightened risk. The economic factors influencing child welfare involvement are further complicated by structural racism which has resulted in a greater prevalence of poverty and financial hardship for families who are Black, Native American or Alaska Native (Indigenous), or and Latino/Hispanic (Latino) and their communities. The multiple decision points within CPS are an opportunity to reify or correct for bias in child welfare outcomes. One major effort to eliminate racial disparities and disproportionalities has been to enact standardized decision-making procedures that aim to control for implicit or explicit bias in CPS. The Structured Decision-Making Model’s (SDM) actuarial-based risk assessment (RA) is the gold-standard of these efforts. In this conceptual article, we ask (1) How are structural factors accounted for in assessment of risk within CPS? and (2) What are the consequences when structural factors are left out of risk assessments procedures? We posit that the exclusion of race, ethnicity, and economic factors from the RA has inflated the importance of variables that become proxies for these factors, resulting in inaccurate assessments of risk. The construction of this tool reflects how structural racism has been overlooked as an important cause of disproportionality in CPS, with interventions then focused on individual workers and cases, rather than the system at large. We suggest a new framework for thinking about risk, the structural risk perspective, and call for a revisioning of assessment of risk within child welfare that acknowledges the social determinants of CPS involvement.
... Also, Black children are more likely to experience official investigations for child maltreatment than White and other racial minority children (H. Kim et al., 2017;Maguire-Jack et al., 2015). However, these racial differences may change based on geographic locations: White children living in poor communities are more likely to be reported than Black children living in poor communities. ...
Neighborhoods have profound impacts on children and families. Using structural equation modeling and data from 4,898 children in the Fragile Families and Child Wellbeing Study, the current study examines the direct and indirect effects of neighborhood poverty on the likelihood of being maltreated at age 5. Two neighborhood social processes, social cohesion and informal social control, were examined as mediators. The study found that neighborhood poverty was indirectly related to physical assault and psychological aggression through its impact on social cohesion, and indirectly related to neglect through its impact on informal social control. The results highlight the need to reduce poverty across communities and increase social cohesion and social control as potential pathways for interrupting the impact of neighborhood poverty on maltreatment.
... These findings are consistent with studies which asked adoptive parents about their child's maltreatment (e.g. Neil et al., 2020) and used case file approaches (Kim, Wildeman, Jonson-Reid, & Drake, 2017). In addition to maltreatment, around a third of our sample was exposed to domestic violence and/or a parent who abused drugs. ...
Background
Children adopted from care are more likely to have experienced early adversity, but little is known about the impact of early adversity on later post-traumatic stress (PTS) symptoms.
Objective
To investigate sub-groups of adversity in a sample of adopted children and examine the association with later PTS symptoms.
Participants and setting
A study of British children adopted from care using social worker records (N = 374) and questionnaire-based longitudinal study of n = 58 children over 4-years post adoptive placement.
Methods
We used latent class analysis to identify subgroups of children based on commonalities in perinatal and postnatal adversity experienced prior to adoption and examined differences in PTS symptoms at 4-years post-placement between subgroups.
Results
Nearly one in five (19 %) children were in the clinical or borderline ranges for symptoms of PTS arousal, 14 % for PTS avoidance and 8 % for PTS intrusion. The 5-class solution fitted the data best, with one class characterized by children with a low probability of experiencing any adversity, one perinatal adversity class and three classes capturing different patterns of adversity. The multiple complex adversity class involving both perinatal and postnatal adversity had significantly higher symptoms of PTS avoidance and arousal than other sub-groups.
Conclusions
The prevalence and complexity of PTS symptoms among adoptive children highlights the need for effective interventions considering different profiles of early adversity.
... Second, it is also possible that child maltreatment incidents have indeed increased but are offset by changes in awareness and perception among nonprofessional reporters. Given the high prevalence of CPS investigations especially among lowincome families and communities (Fong, 2019a;Kim et al., 2017), widespread distrust toward CPS may exist among these families and communities (Fong, 2019b), which in turn, may discourage nonprofessionals from reporting maltreatment incidents to CPS. However, it is puzzling why the longitudinal trend of maltreatment reports is not consistent with the postrecession downturn of child poverty, which has been found to be a powerful risk factor of child maltreatment (Drake & Jonson-Reid, 2014;Kim & Drake, 2018;Pelton, 2015;Slack et al., 2017). ...
... 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]. ...
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.
... We used the accelerated longitudinal NCANDA dataset to investigate developmental trajectories linking childhood adversity, functional brain connectivity, and psychopathology in adolescence. Regarding the prevalence of adverse childhood experiences, our sample is comparable to previously reported lifetime prevalence metrics in the general population (Kim et al., 2017). The occurrence of child neglect, particularly Table 2 Significant covariances and paths of parallel process latent growth models to link sample demographics to childhood adversity, functional network connectivity and (1) externalizing and (2) Note. ...
Childhood adversity has been associated with elevated risk for psychopathology. We investigated whether development of functional brain networks important for executive function (EF) could serve as potential mediators of this association. We analyzed data of 475 adolescents, a subsample of the multisite longitudinal NCANDA (National Consortium on Alcohol and Neurodevelopment in Adolescence) cohort with completed measures of childhood trauma, resting-state functional brain connectivity data, and symptoms of internalizing and externalizing psychopathology at baseline and follow-up years 1-4. Using parallel process latent growth models, we found that childhood adversity was associated with increased risk for externalizing/internalizing behaviors. We specifically investigated whether functional connectivity of the dorsal anterior cingulate cortex (dACC) to brain regions within the cingulo-opercular (CO) network, a well-known EF network that underlies control of attention and self-regulation, mediates the association between adversity and symptoms of psychopathology. We found that childhood adversity, specifically child neglect was negatively associated with functional connectivity of the dACC within the CO network, and that this connectivity mediated the association between neglect and externalizing behaviors. Our study advances a mechanistic understanding of how childhood adversity may impact the development of psychopathology, highlighting the relevance of dACC functional networks particularly for externalizing psychopathology.
... Although the mental health, child protection and forensic criminal justice systems have grown tremendously in recent decades, the proportion of the population receiving such services continues to grow (Children's Bureau, 2018;Edwards, 2019;Olfson et al., 2019). Kim et al. (2017) estimate that 37.4% of all US children experience a child-protective services investigation by age 18 years. Moreover, staff growth continues even though crime rates are falling (Federal Bureau of Investigation, 2020); the US Bureau of Labor Statistics (2019) projects a 14% job growth in criminal justice. ...
Mental health treatment, child protection and forensic services for criminality need major reorganisation in conceptualisation and service provision. This need results from the failure of current diagnostic methods, administrative organisations and treatment approaches to reduce the prevalence of mental illness, child maltreatment or criminal behaviour. We propose that defining these problems as individual deficits and responding to them by category of harm (to self, progeny and others, respectively) stands in the way of effective prevention and treatment. We address four topics: (1) the common basis of all of these problems in unprotected and uncomforted exposure to danger, (2) the developmental process of psychological maladaptation that occurs interpersonally in endangered families, (3) the behavioural expression of psychological development as protective strategies that can be adaptive or maladaptive, depending upon the context in which they are used, and (4) proposals for systemic change that could improve prevention and treatment. These proposals include using functional formulations to guide treatment planning, single portal entry to assessment and services, integrated universal transdisciplinary training followed by specialisation for all mental health professionals, delivering customised treatment through transitional attachment relationships and consolidating disparate disciplines in ‘departments of human adaptation’.
Few conditions epitomize severe and chronic stress to a greater extent than child maltreatment, which can derail development across multiple domains of functioning and throughout the life course. Furthermore, child maltreatment tends to co-occur with other adversities, such as poverty. Many individuals grow up under the stressful conditions of these adversities and exhibit developmental competence. The current study prospectively charted the developmental progression of economically disadvantaged maltreated and nonmaltreated children from childhood to emerging adulthood, and examined patterns of competence across multiple developmental domains of functioning central to the period of emerging adulthood. The study investigated childhood precursors to these patterns of adaptation and maladaptation, as well as the physiological cost of these patterns of adaptation (i.e., C-reactive protein ; CRP). Latent class analysis revealed four distinct classes of functioning: multifaceted competence across domains ( Multifaceted Competence ); (multifaceted maladaptation across domains ( Multi-Problem ); (c) and two classes with mixed patterns of competence and maladaptation ( Externalizing Problems and Work/School Impairment ). Maltreated individuals were less likely than nonmaltreated individuals to demonstrate patterns of multifaceted competence and more likely to demonstrate aggregate maladaptation across domains. Additionally, Black men who demonstrated a pattern of multifaceted psychosocial competence also evidenced higher levels of low-grade inflammation (indexed by CRP), suggesting physiological distress was associated with adaptation in the context of stress among these individuals. Findings demonstrate the heterogenous patterns of functioning and diverse developmental outcomes that follow early adversity.
Purpose of review:
The purpose of this review was to synthesize the empirical literature regarding key risk and protective factors for child maltreatment at each level of the socioecological model and to identify directions for future research and practice.
Recent findings:
Prior research has largely focused on risk and protective factors at the individual and interpersonal levels of the socioecological model. More recently, research has begun to examine risk and protective factors at the community and societal levels, with results suggesting that programmatic and policy interventions that reduce risk and enhance protection at these levels are promising primary prevention strategies for child maltreatment.
Summary:
Future research should continue to focus on risk and protective factors at the community and societal levels with the aim of building the evidence base for population-wide prevention strategies. Such strategies have the potential to create contexts in which families and children thrive.
There is strong evidence that childhood maltreatment has significant long-term mental health consequences, and these adverse childhood experiences have resulted in a serious public health crisis. Though they are highly prevalent, these early life stress (ELS) events contribute substantially to the risk of a variety of psychiatric and medical disorders including mood disorders, substance use, anxiety, suicidality, and common medical comorbidities such as obesity, diabetes, and cardiovascular disease. The consensus of most studies show that childhood maltreatment is associated with a higher incidence, worsened course, and poorer treatment response to both psychotherapy and psychopharmacology. Multiple genetic polymorphisms interact to increase risk for these disorders, increasing the likelihood of long-term consequence when children are exposed to the stressful events. Numerous animal studies report long lasting neurobiological consequences of ELS to include alterations in endocrine regulation and neural development. Substantial research supports that childhood maltreatment leads to elevated inflammatory markers in later life, and that these elevated biomarkers contribute toward the risk of inflammatory-linked disorders including autoimmune diseases, heart disease, diabetes, cancer, GI disorders, as well as other medical conditions. Imaging studies demonstrate persistent structural brain changes after individuals suffered physical, sexual, and emotional abuse. Many studies point toward epigenetic mechanisms causing heritable changes in gene expression as a causative mechanism by which ELS may influence gene expression. Other studies document advanced cellular aging in the form of shortened telomere length as another mechanism by which psychological stress and trauma contribute to both medical and psychiatric disorders. In this review, we examine the expanding body of research on the long-term biological and clinical consequences of child maltreatment, and the need for public health efforts to work toward reducing the incidence of this abuse, and the consequent lifelong morbidity it creates.
Background
Recent research has shown that the likelihood of children experiencing intergenerational, upward income mobility depends on the community in which they are raised. Whether parents consider their children's economic chances in their parenting decisions, however, is not well understood.
Objective
To examine the relationship between county-level income mobility–distinct from income inequality and poverty–and child maltreatment.
Participants and setting
Administrative data from the National Child Abuse and Neglect Data System: Child File for 2406 counties were merged with measures of intergenerational income mobility from Chetty et al. (2014a), including the probability that a child born in the bottom quintile of the national income distribution reaches the top quintile by age thirty.
Methods
Weighted least squares analyses were used to empirically estimate the relationship between intergenerational income mobility and child maltreatment report rates. Maltreatment reports were also divided into subgroups by age and metropolitan status.
Results
Counties where children have a greater chance of moving up the income ladder have lower child maltreatment report rates, independent from income inequality and poverty rates. This relationship is consistent across all child ages (0–17). The relationship between upward income mobility and substantiated child maltreatment is also negatively correlated among non-metropolitan counties.
Conclusions
Children experience a lower risk for maltreatment if they are more likely to move up the income ladder in adulthood. Macroeconomic factors and policies that reduce income inequality and enhance economic mobility are likely to prevent child maltreatment.
Background
The Ontario Incidence Study of Reported Child Abuse and Neglect (OIS) is the only source of province-wide statistics on families investigated by child welfare.
Objective
This paper presents key findings from the 2018 cycle of the OIS (OIS-2018) and highlights select policy and practice implications of these findings.
Participants and Settings
The OIS-2018 captured information directly from investigating child protection workers about children and families who were the subject of a child protection investigation sampled for inclusion in the study.
Methods
The OIS-2018 sample was drawn in three stages: first, a representative sample of child welfare agencies in Ontario was selected, then cases were sampled over a three-month period within selected agencies, and, finally, investigations that met the study criteria were identified from the sampled cases. The data collected for the OIS-2018 were weighted in order to derive provincial, annual incidence estimates.
Results
An estimated 158,476 child maltreatment-related investigations were conducted in Ontario in 2018. In the majority of investigations, there was no documented physical or emotional harm to the child. The overall incidence of investigations remains unchanged between 2008 and 2018. The only statistically significant difference during this time period is an increase in risk investigations between 2013 and 2018.
Conclusions
Data from the OIS gives Ontario child welfare policymakers and practitioners an empirical basis for making evidence-informed decisions. Findings are compared to the United States and Australia.
Research on Latinx disproportionality and disparities tells a complex and nuanced story of risk, resilience, and differential treatment within the U.S. child welfare system. Studies suggest disproportionality and disparities in child welfare vary not only by geography among the Latinx population when compared with other major racial/ethnic groups, but also between Latinx subgroups based on factors such as birthplace, geographic location, socioeconomic position, country of origin, language, and immigration experiences, among a host of other factors. Research also reveals disparate findings with regard to patterns of disproportionality and disparities by maltreatment subtype. Knowledge of these differences, and the theories that have been advanced to explain them, is critically important for the design of strategies to address disproportionality and disparities and to prevent child maltreatment. In this chapter, we explore the history and diversity of the Latinx population in the U.S. and present available data on disparities and disproportionality in child maltreatment and child welfare system involvement. We examine the major theories that have been advanced to explain disproportionality and disparities among Latinx children, propose strategies to address observed differences, and outline directions for future research.
While staying at home is crucial for controlling the COVID-19 pandemic, there is concern that such public health measures may increase the risk for child maltreatment (CM). Using a qualitative content analysis of news coverage and a quantitative survey (N = 250) of media consumers, this study explored the framing of CM as an issue during COVID-19, as well as audience recall and perceived efficacy to prevent maltreatment. Findings from the content analysis indicate that domestic violence and CM are frequently discussed together, and that less frequent interaction with mandatory reporters during the pandemic was often cited as a problem. Survey results suggest that social media and public service announcements are more important compared to news media for increasing audience perceptions of salience and efficacy around CM during a pandemic. Implications for studying media coverage of intertwined public health issues, like a pandemic and CM, are discussed.
Background:
The estimated number of youth who come into contact with both the child welfare and juvenile justice systems, or "dual system" youth, varies widely because studies use different methodologies. Recent work using linked administrative data shows promise for identifying a stable range of dual system rates, generalizable to other jurisdictions and useful for understanding the nature and timing of system involvement.
Objective:
This study replicates the U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention (OJJDP) Dual System Youth Design Study methodology to explore dual system overlap and six distinct dual system pathways defined by the type (i.e., nonconcurrent or concurrent) and timing (i.e., first contact with child welfare or juvenile justice) of dual system contact in Los Angeles County.
Participants and setting:
Using data from the Los Angeles Probation Department, a cohort of youth born in/after 1998 with a first juvenile justice petition between 2014 and 2016 was identified (N = 6877) and matched to statewide child welfare records between 1998 and 2017.
Method:
Descriptive statistics were produced for dual system youth and pathways, and differences across groups were tested using chi-square and t-tests.
Results:
Two-thirds of youth with a first juvenile justice petition interacted with the child welfare system. The majority of dual system youth did not have contact with both systems at the same time and nearly all dual system youth were involved with the child welfare system before the juvenile justice system. Female and Black youth were more likely to be dual system youth and to have more extensive involvement with the child welfare system. Probation experiences and outcomes were associated with the nature and chronicity of child welfare involvement.
Conclusion:
Implementing a delinquency prevention continuum that starts with community-based supports and continues throughout all levels of child welfare and juvenile justice involvement is essential to disrupting dual system involvement.
While there is a growing body of research examining resilient development in adolescents with a history of maltreatment, it remains unclear whether youth resilient functioning changes over time and what factors predict such change. The current study aimed to identify the socio-ecological predictors of the change in resilient functioning over time among adolescents with a history of maltreatment. Multinomial logistic regression analyses were conducted with a sample of 771 adolescents drawn from the National Survey of Child and Adolescent Well-Being (NSCAW-II). Over 18 months, 23.2% of the adolescents remained in the less resilience group, 45.4% stayed in the greater resilience group, 17.4% moved from the greater resilience group to the less resilience group, and 14.0% moved from the less resilience group to the greater resilience group. Younger age, better parent-child relationship quality, and neighborhood safety were associated with stable and continued resilient functioning over time. Conversely, child physical abuse, affiliation with deviant peers, and receipt of behavioral services were negatively associated with continued resilience. Our findings suggest that interventions that support adolescents in building positive relationships with their parents and peers may prevent a loss of resilience over time and ensure continued resilient functioning in child welfare-involved adolescents.
Early adverse experiences are believed to have a profound effect on inhibitory control and the underlying neural regions. In the current study, behavioral and event-related potential (ERP) data were collected during a go/no-go task from adolescents who were involved with the child welfare system due to child maltreatment ( n = 129) and low-income, nonmaltreated adolescents ( n = 102). The nonmaltreated adolescents were more accurate than the maltreated adolescents on the go/no-go task, particularly on the no-go trials. Paralleling the results with typically developing populations, the nonmaltreated adolescents displayed a more pronounced amplitude of the N2 during the no-go trials than during the go trials. However, the maltreated adolescents demonstrated a more pronounced amplitude of the N2 during the go trials than during the no-go trials. Furthermore, while the groups did not differ during the go trials, the nonmaltreated adolescents displayed a more negative amplitude of the N2 than the maltreated adolescents during no-go trials. In contrast, there was not a significant group difference in amplitude of the P3. Taken together, these results provide evidence that the early adverse experiences encountered by maltreated populations impact inhibitory control and the underlying neural activity in early adolescence.
Several studies have shown that child maltreatment is associated with both positive and negative effects on the recognition of facial emotions. Research has provided little evidence of a relation between maltreatment during childhood and young adults’ ability to recognize facial displays of emotion in children, an essential skill for a sensitive parental response. In this study, we examined the consequences of different forms of maltreatment experienced in childhood on emotion recognition during parenthood. Participants included sixty-three mothers of children aged 2 to 5 years. Retrospective self-reports of childhood maltreatment were assessed using the short form of the Childhood Trauma Questionnaire (CTQ). Emotion recognition was measured using a morphed facial emotion identification task of all six basic emotions (anger, disgust, fear, happiness, sadness, and surprise). A Path Analysis via Structural Equation Model revealed that a history of physical abuse is related to a decreased ability to recognize both fear and sadness in children, whereas emotional abuse and sexual abuse are related to a decreased ability to recognize anger in children. In addition, emotional neglect is associated with an increased ability to recognize anger, whereas physical neglect is associated with less accuracy in recognizing happiness in children’s facial emotional expressions. These findings have important clinical implications and expand current understanding of the consequences of childhood maltreatment on parents’ ability to detect children’s needs.
Background
The 2016 Presidential Commission to Eliminate Child Abuse and Neglect Fatalities identified systematic review of all cases of near-fatal child maltreatment as a necessary step towards prevention of child maltreatment fatalities. A critical barrier to adoption of this recommendation is the lack of a standard definition of “near-fatality” in the context of suspected child maltreatment.
Objective
To develop a consensus definition of near-fatal child maltreatment to be used in practice, policy, and research.
Participants and Setting
A multidisciplinary expert panel of 23 individuals from across the U.S. including child abuse pediatricians, pediatric intensivists, pediatric emergency medicine physicians, child welfare administrators, child welfare researchers, and child injury/fatality researchers.
Methods
A modified Delphi process reflecting an iterative process of 3 rounds of surveys of expert opinion, statistical summary of survey response, and feedback of summary statistics. Consensus was defined as 75 % of panelists ranking an element as required (≥80 on a scale of 0–100) to meet a definition of near-fatality (75th% threshold).
Results
Experts defined near-fatal child maltreatment as life-threatening cardiopulmonary dysfunction directly attributable to suspected abuse or neglect as evidenced by (a) respiratory insufficiency/failure requiring intubation and mechanical ventilation, (b) respiratory insufficiency/failure requiring medications to reverse effects of toxic ingestion, or (c) cardiac arrhythmia with/without cardiopulmonary resuscitation (CPR).
Conclusions
A consensus definition of near-fatal child maltreatment should be introduced in child protective services processes and in child fatality/near-fatality reviews to improve our ability to identify, review, and respond to trends in near-fatal child maltreatment at local, regional, and national levels.
Background
Understanding factors that contribute to parents’ use of physical and psychological parent-child aggression (PCA) is critical in efforts to mitigate child maltreatment.
Objective
Extant research has not adequately distinguished risk factors that may differ by race.
Participants and methods
The present study investigated potential racial differences in worry, approval of PCA, justification for PCA use, negative child intent attributions, and discrimination experiences in relation to child abuse risk and physical and psychological PCA use in a sample of 292 Black (44.9 %) and White mothers.
Results
As hypothesized, compared to White mothers, Black mothers demonstrated higher child abuse risk and reported more PCA use, stronger approval for using PCA, and more justification of their PCA to teach children obedience. Although Black mothers reported more discipline-relevant worry as well as more experience of discrimination, White mothers’ lower trait worry related to their greater approval of PCA for discipline, which indirectly related to their abuse risk. Contrary to expectations, perceptions of greater discrimination were related to White mothers’ increased child abuse risk, approval of PCA, and justification for PCA because of anger and to teach obedience—findings not observed for Black mothers.
Conclusions
The current results underscore the need for additional research on the role of discrimination and the cultural context of parenting and highlight the importance of explicitly testing racial differences to develop more culturally informed abuse prevention approaches.
An increasing prevalence of early childhood adversity has reached epidemic proportions, creating a public health crisis. Rather than focusing only on adverse childhood experiences (ACEs) as the main lens for understanding early childhood experiences, detailed assessments of a child’s social ecology are required to assess “early life adversity.” These should also include the role of positive experiences, social relationships, and resilience-promoting factors. Comprehensive assessments of a child’s physical and social ecology not only require parent/caregiver surveys and clinical observations, but also include measurements of the child’s physiology using biomarkers. We identify cortisol as a stress biomarker and posit that hair cortisol concentrations represent a summative and chronological record of children’s exposure to adverse experiences and other contextual stressors. Future research should use a social–ecological approach to investigate the robust interactions among adverse conditions, protective factors, genetic and epigenetic influences, environmental exposures, and social policy, within the context of a child’s developmental stages. These contribute to their physical health, psychiatric conditions, cognitive/executive, social, and psychological functions, lifestyle choices, and socioeconomic outcomes. Such studies must inform preventive measures, therapeutic interventions, advocacy efforts, social policy changes, and public awareness campaigns to address early life adversities and their enduring effects on human potential.
Current research does not support the practice of using ACEs as the main lens for understanding early childhood experiences.
The social ecology of early childhood provides a contextual framework for evaluating the long-term health consequences of early life adversity.
Comprehensive assessments reinforced with physiological measures and/or selected biomarkers, such as hair cortisol concentrations to assess early life stress, may provide critical insights into the relationships between early adversity, stress axis regulation, and subsequent health outcomes.
Objectives. To document the cumulative childhood risk of different levels of involvement with the child protection system (CPS), including terminations of parental rights (TPRs).
Methods. We linked vital records for California’s 1999 birth cohort (n = 519 248) to CPS records from 1999 to 2017. We used sociodemographic information captured at birth to estimate differences in the cumulative percentage of children investigated, substantiated, placed in foster care, and with a TPR.
Results. Overall, 26.3% of children were investigated for maltreatment, 10.5% were substantiated, 4.3% were placed in foster care, and 1.1% experienced a TPR. Roughly 1 in 2 Black and Native American children were investigated during childhood. Children receiving public insurance experienced CPS involvement at more than twice the rate of children with private insurance.
Conclusions. Findings provide a lower-bound estimate of CPS involvement and extend previous research by documenting demographic differences, including in TPRs.
Public Health Implications. Conservatively, CPS investigates more than a quarter of children born in California for abuse or neglect. These data reinforce policy questions about the current scope and reach of our modern CPS. (Am J Public Health. Published online ahead of print April 15, 2021: e1–e7. https://doi.org/10.2105/AJPH.2021.306214 )
Poverty is an important predictor of child maltreatment. Social policies that strengthen the economic security of low-income families, such as the Earned Income Tax Credit (EITC), may reduce child maltreatment by impeding the pathways through which poverty leads to it. We used variations in the presence and generosity of supplementary EITCs offered at the state level and administrative child maltreatment data from the National Child Abuse and Neglect Data System (NCANDS) to examine the effect of EITC policies on state-level rates of child maltreatment from 2004 through 2017. Two-way fixed effects models indicated that a 10-percentage point increase in the generosity of refundable state EITC benefits was associated with 241 fewer reports of neglect per 100,000 children (95% Confidence Interval [CI] [−449, −33]). An increase in EITC generosity was associated with fewer reports of neglect both among children ages 0–5 (−324 per 100,000; 95% CI [−582, −65]) and children ages 6–17 (−201 per 100,000; 95% CI [−387, −15]). Findings also suggested associations between the EITC and reductions in other types of maltreatment (physical abuse, emotional abuse); however, those did not gain statistical significance. Economic support policies may reduce the risk of child maltreatment, especially neglect, and improve child wellbeing.
Objective: Child maltreatment is among the strongest predictors of posttraumatic stress disorder (PTSD). However, less than 40% of children who have been maltreated are ever diagnosed with PTSD, suggesting that exposure to child maltreatment alone is insufficient to explain this risk. This study examined whether epigenetic age acceleration, a stress-sensitive biomarker derived from DNA methylation, explains variation in PTSD diagnostic status subsequent to child maltreatment.
Method: Children and adolescents (N = 70; 65.7% female), 8–15 years of age (M = 12.00, SD = 2.37) and exposed to substantiated child maltreatment within the 12 months prior to study entry, were enrolled. Participants provided epithelial cheek cells via buccal swab for genotyping and quantification of epigenetic age acceleration within a case-control design. PTSD diagnostic status was determined using the Child PTSD Symptoms Scale according to the DSM-IV-TR algorithm.
Results: Epigenetic age acceleration predicted current PTSD status, revealing an effect size magnitude in the moderate range, OR = 2.35, 95% CI: 1.22– 4.51, after adjusting for sample demographics, polygenic risk for PTSD, and lifetime exposure to other childhood adversities. Supplemental analyses demonstrated that epigenetic age acceleration was related to a greater severity of PTSD arousal symptoms (r =.29, p =.015). There were no differential effects for child maltreatment subtype on epigenetic age acceleration or PTSD status.
Conclusions: The biological embedding of child maltreatment may explain variation in PTSD diagnostic status and serve as a novel approach for informing selective prevention or precision-based therapeutics for those at risk for PTSD.
The majority of alleged abuse or neglect reports to the U.S. child welfare system are either screened out prior to an investigation (i.e., at the “hotline” stage) or investigated only to be closed with no finding of immediate child safety concerns. Yet while many of these children and families are at risk of subsequent incidents of child maltreatment or child welfare system involvement, they are not systematically offered services or benefits intended to reduce this risk at the point that child protective services (CPS) ends its involvement. This article provides an overview of the “front end” of the child welfare system, commonly referred to as CPS, highlighting which families are served and which are not. We then argue for a systematic and coordinated child maltreatment prevention infrastructure that incorporates elements of “community response” programs that several U.S. states have implemented in recent years. Such programs are focused on families that have been reported to, and sometimes investigated by, CPS, but no ongoing CPS case is opened. We further argue that such programs need to pay particular attention to economic issues that these families face.
This volume of The ANNALS aims to increase awareness among scholars, policy-makers, and practitioners of the size, scope, and functions of child welfare services in the United States. We aim to promote a wider understanding of the broad impacts of child welfare policies and point to ways in which child welfare services can be better incorporated into cross-cutting social policy debates. The articles in this volume offer concrete recommendations for policies and practices that can reduce child maltreatment, and for systemic approaches—both within the purview of child welfare services and across the broader community and social policy landscape—that can better identify and respond to the needs of children and families in which maltreatment has already occurred or where there is a risk of abuse and neglect. This introduction sets a foundation for understanding the contents of the volume: we provide an overview of child welfare services in the United States and highlight current challenges that the U.S. child welfare systems face.
Childhood adversity in form of child abuse and neglect is associated with elevated risk for psychopathologies. We investigated whether development of functional brain networks important for executive function (EF) could serve as potential mediators of this association. We analyzed data of 475 adolescents, a subsample of the multisite longitudinal NCANDA (National Consortium on Alcohol and Neurodevelopment in Adolescence) cohort with completed measures of childhood trauma, resting-state functional brain connectivity data, and internalizing/externalizing psychopathological syndrome data at baseline and follow-up years 1-4. Using parallel process latent growth models, we found that childhood adversity was associated with increased risk for externalizing/internalizing behaviors. We specifically investigated whether functional connectivity of the dorsal anterior cingulate cortex (dACC) to brain regions within the cingulo-opercular (CO) network, a well-known EF network that underlies control of attention and self-regulation, mediates the association between adversity and psychopathological behaviors. We found that childhood adversity, specifically neglect was negatively associated with functional connectivity of the dACC within the CO network, and that this connectivity mediated the association between child neglect and externalizing behaviors. Our study advances a mechanistic understanding of how childhood adversity may impact the development of psychopathology, highlighting the relevance of dACC functional networks particularly for externalizing psychopathology.
Maternal imprisonment and foster care placement represent two system-enforced forms of mother-child separation. To inform policies and practices that may prevent such separations, this study examined the timing of mother’s incarceration in relation to her children’s involvement with social services, contributory factors leading to foster care placement, and foster care discharge outcomes. North Carolina administrative records from the Department of Corrections, Vital Statistics, and the Division of Social Services were used. Participants included women who entered state prison between 2006 and 2009, who had at least one child aged 0–14 years, and who had at least one child enter foster care in the 3 years before or after prison entry (N = 893 women). Outcomes were examined annually during the 3 years prior to and following maternal prison entry and included whether or not the mother had at least one child who (a) had a child protective services assessment/investigation, (b) entered foster care, (c) had parental rights terminated, and (d) exited foster care. Rates of child welfare engagement in the years prior to maternal prison entry were high, and substance-related issues were documented in over half the sample. A quarter of women had parental rights terminated, and one in six had a child adopted. This study extends prior work on the timing of maternal prison entry and her children’s social services involvement by focusing on a state prison population and investigating the contributory factors associated with foster care placement. These findings suggest opportunities that may reduce maternal-child separation by preventing future criminal justice involvement and foster care placements.
Background: Parent-to-child maltreatment is considered to be one of the risk factors for Generalized Anxiety Disorder (GAD) symtoms 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 a period of 2 years. Parent-to-child maltreatment was assessed using ICAST-C (International child abuse screening tool) whereas GAD Symptoms was determined by SCARED (Screen for children anxiety related disorders). Cox Proportional Algorithm was used to estimate risk ratios.
Results: Forty-two percent of frequently maltreated children developed GAD symptoms compared to nine percent of none to rare maltreated children. Among children with both uneducated parents, frequently maltreatment was associated with 7.31 (2.20-24.04) times the risk of GAD symptoms as compared to none to rare maltreatment.
Conclusion: The frequency of parent-to-child maltreatment is significantly associated with an increased risk of development of GAD symptoms in which parental education plays a crucial role, hence evaluation for the GAD symptoms should be a priority for adolescents with history of occasionally to frequently parent-to-child maltreatment. Parents should be imparted awaress about the ultimate consequences of child maltreatement.
Prevention of child maltreatment is a goal of home visiting (HV) for new mothers. How home visitors and their clinical supervisors manage concerns about child maltreatment may impact both the families’ and the home visitors’ engagement with the program. We sought to understand how HV personnel encounter and respond to concerns of child maltreatment and how these concerns are related to their work with families. We conducted an interpretive descriptive qualitative study of home visitors and supervisors in a statewide HV program, using the Parents as Teachers curriculum, to describe the experience of HV personnel. Two researchers conducted semi-structured interviews March 2016 to October 2017. Interviews were concurrently transcribed, coded, and analyzed, using thematic analysis. After 13 interviews with home visitors and 13 interviews with supervisors, codes and themes were saturated. We identified three themes: Decision to Call Child Protective Services (CPS), Relationships, and Collaborating with CPS. The decision to call CPS was described as difficult, and there was substantial variation in the details of this decision. The relationship between home visitor and family was consistently the most important. Variations were seen in how home visitors and supervisors collaborated with CPS, ranging from strong connections through liaisons to frustrations due to poor communication and perceived variation in how cases were handled. The decision to report a family to CPS is a challenging clinical issue; additional training and connections with CPS may improve consistency across sites for home visitors.
Purpose
The purpose of this study was to provide a population-based analysis of child protection system (CPS) involvement among children and adolescents who died by suicide.
Methods
We performed a case–control study of child and adolescent suicide and CPS involvement. Using linked birth, death, and CPS records, we longitudinally followed all children born in California in 1999 and 2000 (N = 1,052,333) in CPS and death records through 2017. Cases were defined as children who died in California and had a manner of death coded as suicide using the International Classification of Diseases, 10th revision (n = 170). Each suicide case was matched to four living controls, and children were classified based on CPS exposure: no history, reported for alleged child maltreatment, substantiated for child maltreatment, and placed in foster care. Crude suicide rates were documented, and conditional logistic regression models were used to estimate the adjusted odds of suicide.
Results
Among children and adolescents who died by suicide, 56.5% had a history of past allegations of abuse or neglect. Children with any CPS history had three times the odds of suicide compared to children with no history. No additional risk was found for children substantiated or placed in foster care compared to children with only an allegation.
Conclusions
Suicide risk is not isolated to the relatively small group of children and youth placed in foster care. Findings reinforce the importance of increased attention to the experiences of the larger universe of children who remain at home after alleged or substantiated maltreatment.
Background
Research has indicated an association between child abuse and adolescent suicide. Little population-based information exists, however, about the nature of maltreatment experiences or interactions with the child protection system (CPS).
Objective
To examine child maltreatment characteristics and system-level responses associated with risk of adolescent suicide.
Participants and setting
Linked vital death records and CPS records were used to identify the population of adolescents who died by suicide in California between 2010 and 2017 and who had a history of at least one report to CPS prior to death.
Method
A case control design was used, with cases defined as a suicide of an adolescent with a history of CPS involvement. Using CPS records, living controls were then matched to cases based on year of birth, sex, race and ethnicity, and age of first child maltreatment allegation. A conditional logistic regression model was used to estimate the adjusted odds of adolescent suicide across various CPS and maltreatment characteristics.
Results
Recent CPS involvement, allegations of physical abuse, and allegations of sexual abuse emerged as significant risk factors for death by suicide. No differences in suicide risk were observed between youth with unsubstantiated or substantiated allegations.
Conclusions
Suicide risk appears to be more closely tied to specific maltreatment experiences than to substantiation or placement into foster care. As adolescent suicide rates rise, better a understanding of risk factors among already vulnerable populations of youth is critical.
As championed by the work of Ed Zigler, investing in nurturing environments for all children is a chief tenet of primary prevention that will have far-reaching benefits to the health and welfare of all members of society. Children who endure child maltreatment (CM) are among society's most vulnerable. Prospective longitudinal research aimed at a comprehensive understanding of the mechanisms linking CM to subsequent adverse health consequences is needed to improve outcomes and to strengthen causal inference. This paper outlines the methods of the Child Health Study (CHS), a large, state-wide longitudinal cohort of recently maltreated and nonmaltreated youth aged 8–13 who will be assessed every 2 years. The CHS is designed to include in-depth assessments of multiple environmental, behavioral, neural, physiological, and molecular mechanisms through which CM may impact a broad spectrum of youth development, including behavioral and physical health outcomes. In addition to describing the conceptual framework and methods underlying the CHS, we provide information on valuable “lessons learned” in the hopes of supporting future research efforts facing similar challenges. The ultimate goal of this research is demonstrating how policies regarding CM impact the well-being, resilience and recovery of survivors and that they are worthy of large public investment.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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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