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An examination of child protective service involvement among children born to mothers in foster care
Abstract
Objective:
This study identified children born to mothers in foster care and documented Child Protective Service (CPS) involvement among children.
Methods:
Probabilistically linked birth and CPS records from California (2009-2012) were used to identify all mothers in foster care on or after conception. Children were followed prospectively using linked records to identify CPS involvement occurring during the first three years of life. Differences between reported and unreported children were examined using χ2 tests. The Latent Class Analysis (LCA) identified classes of children born to mothers in care who were at increased risk of CPS involvement. Model fit was assessed using the Bayesian Information Criterion, entropy, and likelihood ratio tests. For each of the classes, the relationship to the distal outcome (i.e., a maltreatment report by age three), was examined.
Results:
Findings indicate that 53% of children born to mothers in care were reported. The proportion of children reported to CPS for maltreatment declined over time, from 63% of children born to mothers in foster care in 2009, to 46% in 2012. The LCA documented three distinct classes of mother-child dyads with varying risk of report. More than one third of children in Class 1 and nearly 70% of children in Class 3 were reported.
Conclusions:
This study was the first to develop multi-dimensional class profiles of two-generation CPS involvement among mother-child dyads. This study documents that mothers' experiences in care and mental health conditions vary widely, underscoring the importance of providing services that fit the needs of dyads.
... Unsurprisingly, studies with children born to teenage mothers in care show overall high rates of CWS involvement (39-53 %) and child removal (11-19 %;Dworsky, 2015;Eastman & Putnam-Hornstein, 2019). Within this group, that risk is unevenly distributed and markedly increased for children of younger mothers with more placement instability, more mental health conditions, history of running away from care, and history of sexual abuse (Eastman & Putnam-Hornstein, 2019). ...
... Unsurprisingly, studies with children born to teenage mothers in care show overall high rates of CWS involvement (39-53 %) and child removal (11-19 %;Dworsky, 2015;Eastman & Putnam-Hornstein, 2019). Within this group, that risk is unevenly distributed and markedly increased for children of younger mothers with more placement instability, more mental health conditions, history of running away from care, and history of sexual abuse (Eastman & Putnam-Hornstein, 2019). However, a systematic overview of prevalence and specific protective and risk factors associated with care alumni's parenting, adjustment and child protection involvement into adulthood is still missing. ...
... Another study in the US of foster youth suggesting that extending foster care beyond the age of 18 years may be another way to reduce teenage pregnancies among this population (Dworsky, 2015). Furthermore, providing services that fit the need of mother-child dyads in foster care are important intervention targets (Eastman and Putnam-Hornstein, 2019). ...
Background:
Recent research and policy recognize care alumni (i.e., adults formerly in out-of-home care [OHC]) as a population with a high accumulation of disadvantages well into adulthood, often in combination with early parenthood compared to the general population.
Objective:
The aim of this systematic review is to provide an overview on the impact of parental OHC on outcomes for both parents (i.e. parental adjustment, parenting) and their children (i.e. prevalence rates of OHC or child welfare system (CWS) involvement, adjustment, development), as well as protective and risk factors associated with those outcomes.
Methods:
Relevant articles were searched in four electronic databases from conception to 16 February 2022 according to PRISMA guidelines for systematic reviews; supplemented with hand-searched citations from relevant references. Evidence was synthesized via a qualitative summary.
Results:
A total of 38 studies were included (19 quantitative, 14 qualitative, and 5 mixed-methods studies). Studies confirm increased rates of early parenthood among care alumni and an elevated risk of OHC among their children. However, most children remain with their care alumni parents, and some parents were met with the needed support to cope with challenging circumstances. Qualitative studies point to a great need for specialized services, including parenting programs that address past trauma and attachment issues. They also highlight potential protective factors.
Conclusions:
Findings suggest that care alumni parents experience compounding disadvantage, which may increase their children's risk of OHC. More research is needed on child adjustment, and on protective factors that can be leveraged to design effective interventions that decrease transgenerational CWS involvement.
... They found that child protection involvement with these young women's children was unevenly distributed across three groups. Young women with less stable placement histories tended to experience mental illness and had higher rates of sexual abuse histories (Eastman & Putnam-Hornstein, 2019). Sixty-eight per cent of this group were reported to child protection and 35% had children removed (Eastman & Putnam-Hornstein, 2019). ...
... Young women with less stable placement histories tended to experience mental illness and had higher rates of sexual abuse histories (Eastman & Putnam-Hornstein, 2019). Sixty-eight per cent of this group were reported to child protection and 35% had children removed (Eastman & Putnam-Hornstein, 2019). On the other hand, young mothers with more stable placement histories tended to have their children later, could call on the support of previous carers or the child's other parent, and were less likely to experience mental illness. ...
... Thirty-six per cent of this group were reported to child protection; however, only 5.8% had their children removed. Of a third group of mothers who had been in care for less than a year, 55% of these mothers were reported to child protection and 19.6% of them had children removed (Eastman & Putnam-Hornstein, 2019). For the mothers with more stable care histories, there appears to still be a high rate of reporting to child protection, but a lower rate of removal, which suggests that with support many are quite capable of looking after their children. ...
Young people transitioning from out-of-home care (termed care leavers) are known to be a relatively vulnerable group. One example is their over-representation in early pregnancy and parenting. This paper presents findings from a study of care leaver early parenting in the Australian state of Victoria. Sixteen service provider staff working with care leavers who had become young parents were asked, via focus groups and interviews, for their perspectives on the factors that influence the high prevalence of early parenting amongst care leavers, and the key support services that are available and necessary to assist both care leavers and their children. Service providers raised multiple issues common to the existing leaving care literature concerning the lack of support provided to young people being exited from state care as potentially leading to both early parenting and parenting challenges. Service providers also expressed concern about what many studies of care leaver early parenting have termed ‘surveillance bias’. There was a clear consensus that young people transitioning from care face unique challenges and social isolation due to their difficult experiences pre-care, in-care and post-care. Those experiences place them at risk of disadvantages that impede their ability to demonstrate the practical, physical and financial means to safely raise children. At the same time, they are under greater scrutiny than other parents by being known to child protection already. Service providers argued in favour of greater support for young care leaver parents to prevent their children’s engagement with child protection systems.
... ). Yet few studies have explored the outcomes of adolescent mothers with current or past foster care involvement (Eastman & Putnam-Hornstein, 2019;Eastman, Schelbe, & McCroskey, 2019;Font et al., 2018;Combs et al., 2017;Shpiegel & Cascardi, 2018;Schelbe & Geiger, 2017). The limited research on this topic has produced inconsistent findings, with some studies describing heightened challenges among young women who have given birth (e.g., Combs et al., 2017;Shpiegel & Cascardi, 2018) whereas others depicting motherhood as more nuanced, including both challenges and a renewed sense of purpose and motivation (e.g., Pryce & Samuels, 2010;Schelbe & Geiger, 2017). ...
... Several investigations applied a person-centred framework to youths involved with foster care (Courtney et al., 2012;Keller et al., 2007;Miller, Paschall, & Azar, 2017;Shpiegel & Ocasio, 2015;Yates & Grey, 2012), though only a few focused specifically on adolescent mothers (Eastman & Putnam-Hornstein, 2019;. ...
... As expected, existing studies revealed substantial variability in youths' adjustment, ranging from seemingly resilient functioning to marked impairments across multiple domains (e.g., Eastman & Putnam-Hornstein, 2019;Courtney et al., 2012;Miller et al., 2017;Yates & Grey, 2012). For instance, Courtney et al. (2012) used a latent class analysis to identify subgroups of foster youth ages 23-24, based on indicators such as education and employment, parenthood status, living arrangements, and criminal involvement. ...
Few studies have explored the outcomes of adolescent mothers leaving foster care, especially using person‐oriented methods. The current study employed a cluster analysis to identify unique patterns of functioning among adolescent mothers aged 19 (n = 777). Data from the National Youth in Transition Database and the Adoption and Foster Care Analysis and Reporting System were utilized. Findings revealed five subpopulations characterized by distinct constellations of outcomes at age 19. The largest group (43%) exhibited competent functioning across all the domains studied—its members were connected to school and/or employment and did not experience homelessness, substance abuse referrals, or incarceration during the past 2 years (i.e., “resilient”). A relatively small group (12%) exhibited challenges across all the above‐referenced domains, whereas the remaining groups presented challenges in some domains, but not in others. Follow‐up analyses revealed that adolescent mothers classified as resilient at age 19 had the lowest rates of congregate care placements and the highest rates of nonrelative foster care placements at age 17. Moreover, they had lower placement instability and higher rates of extended foster care as compared with members of the other clusters. Implications for practice, policy, and research are discussed.
... Yet, many scholars and practitioners are concerned with young mothers' ability to form healthy parent-child relationships, particularly among those in the child welfare system. This concern is supported by the high percentage of young mothers in care who are reported to child protective services (Dworsky, 2015;Eastman & Putnam-Hornstein, 2019). Identity development is a central developmental task of adolescence, and research demonstrates that young mothers are more likely to be focused on themselves and their needs, which can result in less responsiveness to the needs of their children (Borkowski et al., 2007;Coley & Chase-Lansdale, 1998;Fulton et al., 1991;Noria et al., 2007;Tamis-Lemonda et al., 2002). ...
... The existing literature on pregnant and parenting youth in foster care, to a certain extent, addresses the impact of childhood trauma on parenting. In particular, researchers highlight concerns about intergenerational maltreatment among parenting youth in foster care due to their own experiences of abuse and neglect (Eastman & Putnam-Hornstein, 2019;Geiger & Schelbe, 2014;Putnam-Hornstein & King, 2014). However, few studies on parenting youth in foster care addresses the extent to which youth experience trauma while becoming parents (Stephens & Aparicio, 2017). ...
Research on young mothers in foster care focuses on the risks associated with pregnancy and parenting among these youth, with less attention paid to the contexts in which they parent. This narrative study examines how young mothers’ identities, parenting experiences, and parenting decisions are developed in several relational contexts. The analysis explores how relationships to self, to baby, to families of origin and friends, to their baby’s father, and to the child welfare system shape the transition to motherhood for young mothers in foster care in Illinois. Findings are the result of narrative analysis of data from a total of 40 in-depth interviews with 29 young mothers (N = 29 first interviews; N = 11 s interviews). Young mothers’ interpersonal relationships and child welfare system involvement both support and constrain their thriving as new mothers. This study makes a significant contribution to the research on pregnant and parenting youth in foster care, with major implications for trauma-informed child welfare practice, identifying appropriate resources and services for these young parents and their children, supporting both parent-child relationships and co-parenting relationships, and for future directions of scholarship on this population.
... The high levels of involvement with child welfare that participants experienced in their childhood and again as parents also corroborate research documenting intergenerational involvement in the child welfare system among youth in the juvenile justice system (Putnam-Hornstein et al., 2015). Research also reveals that risk for intergenerational involvement in child welfare is nuanced, with mothers with mental health problems (Hammond et al., 2017), those (Eastman and Putnam-Hornstein, 2019) at greatest risk for intergenerational involvement in child welfare. Future research should seek to understand the protective factors that buffer risk for intergenerational involvement in child welfare, particularly in females with multiple intersecting risk factors. ...
Introduction
Females are the fastest growing justice involved population in the United States, yet there is relatively little empirical research on the collateral consequences of juvenile justice involvement specifically for females. A growing body of empirical research underscores linkages between juvenile justice involvement and negative health and psychosocial outcomes, both in the short and long term.
Method
The current study describes the long-term collateral consequences of juvenile justice involvement for females previously involved in the juvenile justice system, drawing from a longitudinal dataset of 166 women who were initially recruited in adolescence due to chronic and severe justice system involvement. Participants were 15 years-old on average at study enrollment and 35 years-old on average at the current assessment. This paper describes the adolescent and adult experiences of the sample, therefore depicting the developmental trajectories of risk and protective factors for females involved with juvenile justice.
Results
As adults, 73% of the sample experienced arrest and 36% experienced incarceration. High rates of mental and physical health problems were reported, including that 50% of the sample met diagnostic criteria for posttraumatic stress disorder. Over 400 children were born to the sample, with high rates of documented intergenerational child welfare involvement.
Discussion
Study findings are discussed in the context of best practices for supporting adolescent girls involved with the juvenile justice system.
... Colleges and universities should offer parenting classes that educate student parents in or aging out of foster care about child development and positive parent-child relationships and parent support groups that connect parents to each other and provide opportunities for parents to ask questions, share concerns and provide mutual support. Equally important, these student parents need access to contraception, given the high prevalence of rapid, repeat births among young mothers in or aging out of care (Shpiegel, Day, et al., 2021;Shpiegel, Fleming, et al., 2021), and to mental health services, given the high percentage of young mothers in foster care with a mental health diagnosis (Eastman, & Putnam-Hornstein, 2019). ...
This paper explains why more attention should be paid to promoting the postsecondary education of parents in and aging out of foster care. It reviews what is known about postsecondary educational attainment among parents in or aging out of foster care and these parents’ unique challenges to pursuing postsecondary education. The paper describes the Healthy Teen Network Young Parents Logic Model as a framework to think about the needs of parents in and aging out of foster care, including needs related to postsecondary educational attainment. The paper applies the Young Parents Logic Model and highlights strategies to increase postsecondary educational attainment among young parents in the general population and youth aging out of foster care which can also benefit young parents in foster care or aging out. Using the Young Parents Logic Model as a framework, the paper presents policy and practice recommendations to increase postsecondary educational attainment among young parents in and aging out of foster care and with directions for future research.
... One study that uses data from the Illinois Department of Children and Family Services (DCFS) finds that 39 percent of children whose parents were in care when they were born were the subject of at least one Child Protective Services (CPS) investigation, and 17 percent had at least one indicated child maltreatment report before their fifth birthday (Dworsky 2015). A more recent study that used California birth and CPS records finds that 53 percent of children born to mothers in care were reported to CPS by age 3 (Eastman and Putnam-Hornstein 2019). ...
... There is evidence that a call to a child protection hotline, regardless of the disposition, is the best predictor of a later child abuse or neglect fatality (Commission to Eliminate Child Abuse and Neglect Fatalities 2016). Further, research shows that CWS involvement as a child is related to CWS involvement when the child becomes a parent, although there is considerable variation in outcomes that requires flexibility in response (Eastman and Putnam-Hornstein 2019). Taken together, the accumulating information on the risks of subsequent child maltreatment among those who have ever been reported to CWS and ever been involved with CWS requires developing an approach with more sustained engagement and support provided to families. ...
Child maltreatment calls for a broad range of preventative policies and practices, but limited governmental funding and leadership has been devoted to the problem. Effective strategies to prevent maltreatment exist, but they have had limited uptake in the child welfare system. In this article, we trace how government responsibility for the prevention of child maltreatment became centered within the nation’s child protection response. Further, we discuss developments in prevention science, review the existing literature on the effectiveness of a range of prevention strategies, and present a public health approach to prevention. The article concludes with a set of recommendations to inform future efforts to prevent child maltreatment through approaches that seek to expand capacity for the implementation of evidence-based prevention programs, while addressing the adverse community experiences that exacerbate risk for child maltreatment.
... Children's circumstances are inextricably tied to those of their parents. Two-generation intervention strategies recognize that improving the capacity and circumstances of parents will yield benefits in this generation and the next (Chase-Lansdale et al., 2019;Eastman & Putnam-Hornstein, 2019). Health and human services agencies administer essential services to vulnerable individuals in at-risk families that aim to enhance family safety and well-being. ...
Children’s circumstances are inextricably tied to those of their parents. Two-generation intervention strategies recognize that improving the capacity and circumstances of parents will yield benefits in this generation and the next. Administrative data from health and human services agencies present a unique source of information concerning these interventions designed to buffer child and parent risk. Those records, however, often exist in silos, collected by discrete programs for administration and primarily focused on the client served. Breaking down those silos by linking parents and children, as well as other family or household members, makes it possible to effectively develop, coordinate, and evaluate two-generation intervention strategies. The objective of this review is to outline conceptual strategies for constructing household and family units with linked administrative records for research purposes. Specifically, this paper: (1) provides an understanding of how households and family units have historically been conceptualized in the United States and illustrate the limitations of this approach for studying complex families; (2) examines the limitations of this approach for studying contemporary families; and (3) explores strategies for organizing administrative data into household and family units for this purpose.
... 6,7 Importantly, the young children of parenting foster youth are themselves at high risk of child welfare involvement and placement in foster care. [7][8][9][10] Given foster youths' heightened risk for early childbirth and their potential vulnerability as young parents, understanding which youth are most likely to give birth during adolescence is crucial to targeting prevention and early intervention efforts. 2 The evidence is mixed regarding whether spending time in foster care is a causal factor for early childbirth. One seminal study found that among adolescents who had a roughly equivalent chance of being placed in foster care or remaining at home, birth rates were higher for those who went into care. ...
Context:
Research has documented elevated rates of early childbirth among adolescents who have spent time in foster care, and a better understanding is needed of the characteristics of vulnerable individuals and the circumstances of their time in care.
Methods:
California birth records for 1999-2010 were probabilistically linked to state child welfare service records spanning the same date range to identify females aged 12-19 who had spent time in foster care and had had a first birth before age 20. Latent class analysis was used to identify subgroups based on age at most recent entry into care, length of this stay and three indicators of placement instability. The probability of a first birth being related to class membership was assessed as a distal outcome, and differences across classes were assessed using chi-square tests.
Results:
Four distinct classes of foster youth were identified: Later Entry/High Instability (20% of individuals), Later Entry/Low Instability (43%), Earlier Entry/High Instability (12%) and Earlier Entry/Low Instability (25%). The probability of a first childbirth ranged from 31% (class 1) to 15% (class 4); classes 2 and 3 experienced moderate risk (23% and 24%, respectively). Two groups were further characterized by high rates of reentry into care, with 56% of class 1 and 41% of class 3 individuals experiencing more than one episode in care.
Conclusions:
Identifiable subgroups of female foster youth are at heightened risk of early childbirth and may benefit from early intervention, enhanced support and access to reliable, ongoing sexual and reproductive health care.
Literature on human trafficking suggests the vulnerability to commercial sexual exploitation of children (CSEC) and child sexual abuse (CSA) changes by the prevalence of certain risk factors (e.g., runaway), trafficker-used lures (e.g., isolation), and the environmental conditions present at the time of victimization (e.g., foster care). Often, youth in foster care are at high risk for CSEC and CSA victimization associated with runaway instances. This scoping review aims to identify prevention and intervention strategies for CSEC/CSA of youth who run away from foster care. PRISMA scoping review guidelines were followed to review the literature across two search parameters(CSEC; CSA). An electronic review was conducted between August 2022 and January 2023 across four databases: PubMed, SAGE Journals Online, ScienceDirect, and Web of Science. The CSEC and CSA search parameters comprised three domains(sexual exploitation, foster care, and runaway; sexual abuse, foster care, and runaway, respectively). Literature published between 2012 and 2022 was included regardless of the methodological approach. Literature not concerning youth who run from foster care was excluded. Database searches yielded 206publications for CSEC and 351 for CSA, reduced to 185 and 212,respectively, after removing duplicates. Seventy-one articles were identified, of which, 64 articles (28 CSEC, 36 CSA) were categorized as prevention strategies and seven (five CSEC, two CSA) as interventions. The intersection and dual victimization of CSEC and CSA of youth who run away from foster care are discussed. This paper also discusses applied behavior analysis principles for developing function-based interventions.
Purpose
This study examines the relationship between mental illness diagnoses and four intergenerational patterns of child protection services involvement: cycle breakers, cycle maintainers, cycle initiators, and a comparison group (no maltreatment). Existing research is limited and inconsistent, and rarely incorporates multiple categories of mental illness or considers variation between mental illnesses.
Methods
Data were drawn from an administrative population-based data repository in Queensland, Australia and includes 32,494 individuals identified as biological parents. Child protection data were obtained from the Department of Children, Youth Justice and Multicultural Affairs and mental illness diagnoses were obtained from Queensland Health hospital admissions. Any mental illness diagnosis, age at onset (adolescence or adulthood), and diagnosis types (common, severe, personality disorders, childhood-onset, adolescent- and adult-onset, and substance use) were examined. Multinomial and logistic regressions were conducted to investigate whether the mental illness diagnosis variables distinguished the four intergenerational patterns of child protection service involvement.
Results
Overall, 10.4% of individuals had at least one hospital admission involving a mental illness diagnosis. The prevalence of mental illness diagnoses significantly differed across the intergenerational patterns. Cycle maintainers and cycle initiators received the highest rates of diagnoses (50% and 38.8%, respectively), compared to cycle breakers (21.1%) and the comparison group (7.7%).
Conclusions
Our findings underline the need for early access to mental health supports for families involved with the child protection system, which could help prevent the cycle of maltreatment.
The Children's Data Network (CDN) is a data and research collaborative focused on the linkage and analysis of administrative records. In partnership with public agencies, philanthropic funders, affiliated researchers, and community stakeholders, we seek to generate knowledge and advance evidence-rich policies that improve the health, safety, and well-being of the children of California. Given our experience negotiating access to and working with existing administrative data (and importantly, data stewards), the CDN has demonstrated its ability to perform cost-effective and rigorous record linkage, answer time-sensitive policy- and program-related questions, and build the public sector's capacity to do the same. Owing to steadfast and generous infrastructure and project support, close collaboration with public partners, and strategic analyses and engagements, the CDN has promoted a person-level and longitudinal understanding of children and families in California and in so doing, informed policy and program development nationwide. We sincerely hope that our experience—and lessons learned—can advance and inform work in other fields and jurisdictions.
Over the past 30 years, there has been a surge of interest in understanding the experiences and outcomes of expectant and parenting foster youth. Despite the importance of understanding this unique population of foster youth, there remains a lack of research on fathers in foster care. Most studies of expectant and parenting foster youth focus on mothers in care, and studies that have examined fathers in care provide little insight compared to what we know about mothers. Furthermore, existing research on fathers in foster care is limited by underreporting, service engagement issues, lack of meaningful engagement data, and very little information on fathers’ involvement with their children. There is very little published research on the experience of fatherhood in foster care or on related outcomes for fathers in care such as residency with children, father engagement with children, coparental relationship quality, or the health and well-being of their children. While there have been over 60 studies and three reviews on expectant and parenting foster youth spanning roughly 30 years, the articles have primarily focused on empirical findings relating to mothers in foster care. Information on fathers in foster care has received little attention and is restricted to empirical studies. This scoping review aims to fill this gap by examining the available information on fathers in foster care. To this end, our scoping review explores empirical findings and knowledge from practice-, legal-, and policy-related literature related to fathers in foster care from peer-reviewed journal articles, reports, dissertations, white papers, and grey literature published between 1989 and 2021. Findings from 94 sources of evidence on expectant and parenting foster youth suggest that mothers in foster care are consistently the focus of the literature. If fathers in foster care are included in the literature, findings or guidance are often provided in the aggregate (e.g., parents in care). However, when aggregated, literature still focuses on mothers in care, or female pronouns are used to describe the larger expectant or parenting foster youth population. Many of the studies excluded fathers, and the primary exclusion rationale includes a lack of identified fathers in care, unreliable child welfare data on fathers, or high attrition of fathers in parenting services. In terms of information on fathers in foster care by the source of evidence, research papers often provided quantitative descriptions of fathers, practice papers focused on rights of fathers, legal papers centered on paternity establishment or paternal rights, and policy papers largely discussed the need for improved data tracking and interventions for fathers. More research is needed to support fathers in foster care as they transition out of care into early adulthood and young fatherhood.
The Children's Data Network (CDN) is a data and research collaborative focused on the linkage and analysis of administrative records. In partnership with public agencies, philanthropic funders, affiliated researchers, and community stakeholders, we seek to generate knowledge and advance evidence-rich policies that improve the health, safety, and well-being of the children of California. Given our experience negotiating access to and working with existing administrative data (and importantly, data stewards), the CDN has demonstrated its ability to perform cost-effective and rigorous record linkage, answer time-sensitive policy- and program-related questions, and build the public sector's capacity to do the same. Owing to steadfast and generous infrastructure and project support, close collaboration with public partners, and strategic analyses and engagements, the CDN has promoted a person-level and longitudinal understanding of children and families in California and in so doing, informed policy and program development nationwide. We sincerely hope that our experience-and lessons learned-can advance and inform work in other fields and jurisdictions.
Background
This scoping review aimed to overview studies that used administrative data linkage in the context of child maltreatment to improve our understanding of the value that data linkage may confer for policy, practice, and research.
Methods
We searched MEDLINE, Embase, PsycINFO, CINAHL, and ERIC electronic databases in June 2019 and May 2020 for studies that linked two or more datasets (at least one of which was administrative in nature) to study child maltreatment. We report findings with numerical and narrative summary.
Results
We included 121 studies, mainly from the United States or Australia and published in the past decade. Data came primarily from social services and health sectors, and linkage processes and data quality were often not described in sufficient detail to align with current reporting guidelines. Most studies were descriptive in nature and research questions addressed fell under eight themes: descriptive epidemiology, risk factors, outcomes, intergenerational transmission, predictive modelling, intervention/service evaluation, multi-sector involvement, and methodological considerations/advancements.
Conclusions
Included studies demonstrated the wide variety of ways in which data linkage can contribute to the public health response to child maltreatment. However, how research using linked data can be translated into effective service development and monitoring, or targeting of interventions, is underexplored in terms of privacy protection, ethics and governance, data quality, and evidence of effectiveness.
Despite U.S. child protective services (CPS) agencies relying on mandated reporters to refer concerns of child maltreatment to them, there is little data regarding which children mandated reporters decide to report and not to report. This study addresses this gap by utilizing a population-based linked administrative dataset to identify which children who are hospitalized for maltreatment-related reasons are reported to CPS and which are removed by CPS. The dataset was comprised of all children born in Washington State between 1999 and 2013 (N = 1,271,416), all hospitalizations for children under the age of three, and all CPS records. We identified maltreatment-related hospitalizations using standardized diagnostic codes. We examined the records for children with maltreatment-related hospitalizations to identify hospitalization-related CPS reports and if the child was removed from their parents. We tested for differences in these system responses using multinomial regression. About two-thirds of children identified as experiencing a child maltreatment-related hospitalization were not reported to CPS. We found differences in responses by maltreatment subtype and the type of diagnostic code. Children whose hospitalizations were related to abuse and associated with a specific maltreatment code had increased odds of being both reported to CPS and subsequently removed by CPS.
This paper is a narrative review examining the high prevalence of care leaver early parenting in the context of (i) key transitions from care studies taken from the last few decades, (ii) a structured review using Scopus of studies from 2015–2020 focussed specifically on young people transitioning from care and early parenting and (iii) Boss’s (2010) Ambiguous Loss theory. Young care leavers’ challenges, in general, put them at higher risk of protective interventions with their children and may contribute to the growing numbers of children being placed in increasingly over-stretched out-of-home care systems. Questions of surveillance bias for service-connected young people are examined in light of recent large-scale studies using administrative data sets. Serious oversights in responding to young people’s experiences of trauma and exploitation are identified. The relevance of sexual health programs for young people actively seeking pregnancies is discussed with emerging evidence that disengagement from schooling may have more of a role in explaining early pregnancy and parenting than previously thought. The authors test the relevance of Ambiguous Loss theory in understanding how removal from families of origin and placement experiences may affect young people and lead to ‘ wanted ’ pregnancies.
Objective
To assess the incidence of child maltreatment-related hospitalizations for children under three for the population of Washington State.
Study design
A population-based study utilizing retrospective linked administrative data for all children born in Washington State from 2000 through 2013 (N = 1,191,802). The dataset comprised of linked birth and hospitalization records for the entire state. Child maltreatment-related hospitalizations were identified using diagnostic codes, both specifically attributed to and suggestive of maltreatment. Incidence were calculated for the population, by birth year, by sex, and by maltreatment subtype.
Results
A total of 3,885 hospitalizations related to child maltreatment were identified for an incidence of 10.87 per 10,000 person-years. Hospitalizations related to child maltreatment accounted for 2.1% of all hospitalizations for children under the age of three. This percentage doubled over time reaching a high in 2012 (3.6%). More than half of all hospitalizations were related to neglect. Maltreatment-related hospitalizations occurred most frequently in the first year of life for all subtypes except for neglect, which occurred the most between one and two years. Male children had higher incidence than female children in general (11.97 vs 9.70 per 10,000 person-years) and across all subtypes.
Conclusions
Hospitalizations can be a useful source of population-based child maltreatment surveillance. The identification of neglect-related hospitalizations, likely the result of supervisory neglect, as the most common subtype is an important finding for the development of prevention programming.
Background
Multisystem youth involved in both the child welfare and juvenile justice systems report elevated rates of risky sexual behaviors, associated health problems as well as having a disproportionally higher risk for concurrent mental health disorders.
Objective
The current study aimed to provide in-depth nuanced insights about mental and reproductive needs and challenges of multisystem youth using a multi-informant approach (youth, parole/probation officers).
Participants and setting
Qualitative in-depth interviews were conducted with multisystem youth (N = 15; 14–17-years-old; 40% females) and parole/probation officers (N = 20; 35–67-years-old; 33% females) working with foster care and juvenile justice systems.
Methods
Informed by Socio-Ecological Theory, analyses were conducted using Thematic Network Analysis (TNA) and qualitative software Atlas.ti.7.
Results
Youth and parole/probation officers identified key challenges related to mental health (e.g., criminalization of behaviors, unstandardized screening procedures), reproductive health (e.g., abnormalization of sexual behaviors, lack of parenting and comprehensive reproductive services), and shared challenges across systems (e.g., lack of data sharing across systems, overuse of “crisis” procedures, lack of trauma-informed providers and services).
Conclusions
Multisystem youth have significant mental and reproductive health needs that are not adequately met mostly due to system and institutional challenges, differences in protocols, and discontinuance of services and treatment across systems among other problems. Mental and reproductive health disparities are key factors in stigmatization, criminalization and further victimization of youth across systems. Multidisciplinary and multi-sectoral partnerships are key to advance service, protocols and procedural gaps that address the mental and reproductive health needs of multisystem youth.
Children born to mothers in foster care have increased numbers of reports of alleged abuse or neglect in comparison to children born to mothers who are not in care. The present investigation leveraged unstructured, case narrative fields in child welfare records to enhance knowledge about Child Protective Services (CPS) involvement among children born to mothers in care. A content analysis was conducted to assess reasons described for CPS involvement among children who were (1) born to mothers who were in foster care on or after the estimated date of conception and (2) reported to CPS during the first 3 years of life. The present investigation builds upon a prior Latent Class Analysis that identified classes of children born to mothers in care who were at varying risk of CPS involvement. Thirteen mother-child dyads from each of the three distinct classes identified in the prior study were selected for a detailed examination of mother and child case records (N = 39). Findings show class membership varied based on the mother's earlier experiences in care and reasons for the children's maltreatment report. A lack of placement stability for the mother can have long term consequences for the mother with cascading effects for the children. Study findings illustrate the importance of linking parents to services that meet their unique needs and those of their children. Findings add depth to the understanding of factors associated with the maltreatment of children born to mothers in foster care and demonstrate the importance of two-generation strategies.
Youth “aging out” of foster care experience higher rates of adolescent parenting than their peers who have not been in care. Due to their history of maltreatment, high adolescent pregnancy rates, and poor psychosocial outcomes, youth aging out who are parents are a vulnerable at-risk group. This study examines the parenting experiences of 33 youth aging out (21 mothers and 12 fathers) using data from a larger ethnography. Field notes of observation and transcribed interviews of youth aging out who are parents were analyzed using open coding strategies. Findings show parents encountered challenges while aging out and parenting, yet they found joy in their children and strived to be good parents despite having limited parenting skills, few resources, and little support. Desiring a better life for their children and fearing their children would enter foster care, parents were motivated to improve their lives for their children. Implications are discussed.
Purpose
No research has examined childbirth from a national perspective among females emancipating from foster care. The present study fills this gap by: (1) documenting the rates of initial and repeat births among females ages 17 and 19 in a national prospective study and (2) identifying risk and protective factors at age 17 that predict childbirth between ages 17 and 19.
Methods
This study used data from the National Youth in Transition Database and Adoption and Foster Care Analysis and Reporting System to identify risk and protective factors associated with childbirth in a national sample of transition-age female youth (N = 3,474).
Results
The cumulative rate of childbirth by age 19 was 21%, with higher rates reported between ages 17 and 19 (17%; n = 602) compared with age 17 or earlier (9%; n = 313). In logistic regression analysis, black race and Hispanic ethnicity, placement with relatives, runaway status, trial home visit placement, early emancipation from foster care, and lifetime incarceration histories were associated with increased likelihood of childbirth. In contrast, school enrollment and employment skills were associated with decreased likelihood of childbirth. The multivariate odds of childbirth between ages 17 and 19 increased 10-fold if youth already had a child by age 17.
Conclusions
Sexual health and pregnancy prevention programs should specifically target youths who already have children. Increased attention should be paid to adolescents placed with biological families and those with histories of criminal involvement.
This study examined factors associated with youth remaining in extended foster care. Cohorts of youth in care in California at age 17 years were defined for the period from 2003–2012. Multivariable generalized linear models documented factors associated with remaining in care through age 19. Findings indicate that: a) the population of youth in care at age 17 has declined over time; b) youth in care at age 17 in 2012 were qualitatively different from those a decade earlier; c) a larger proportion of youth who do not exit to permanency are remaining in extended foster care; and d) although the characteristics of youth who remain in foster care as non-minor dependents continue to vary relative to those who age out, differences have diminished. Findings highlight the potential to target subgroups of youth who may benefit from the extension of care but are remaining in care at lower rates.
Purpose:
This analysis examined California county birth rate variations among girls in foster care. The objective was to generate data to assess potential intervention points tied to federal legislation extending foster care beyond age 18 years.
Methods:
Child protection records for all adolescent girls in foster care at age 17 years between 2003 and 2007 (N = 20,222) were linked to vital birth records through 2011. The cumulative percentage of girls who had given birth by age 21 years was calculated by county and race/ethnicity.
Results:
One in three (35.2%) adolescent girls in foster care had given birth at least once before age 21 years. Although significant birth rate variations emerged, even at the low end of the county range, more than one in four girls had given birth by age 21 years.
Conclusions:
Child welfare systems are now charged with coordinating transitional services for foster youth beyond age 18 years. Extended foster care provides new opportunities for pregnancy prevention work and targeted parenting support.
Adolescent parenthood occurs with relative frequency among youth in the foster care system. Few studies describe the characteristics of adolescent parents in foster care, or compare male and female parents, particularly using large, national samples. The present study used data from the National Youth in Transition Database (NYTD; N = 15,601) to document the number of foster youth who had children at age 17, the factors associated with adolescent parenthood, and the differences between male and female parents on general functioning indicators and use of Chafee services. Results revealed that 4% of males and 10% of females in the NYTD sample had children. Multivariate analyses indicated that for males and females alike, non-White race and Hispanic ethnicity were associated with increased likelihood of childbirth. Among males, the multivariate odds of being a parent increased substantially if they had a history of homelessness, substance abuse referral, or incarceration. Among females, only a history of incarceration was significantly associated with parenthood. Receiving Chafee-funded services was not related to either male or female parenthood. These findings highlight the high rates of adolescent parenthood among youth in foster care, particularly if other risk factors are also present. Practice implications and future research directions are discussed.
Teens in foster care give birth at more than twice the rate of other teens in the United States. Significant challenges exist for these most vulnerable teens and their babies. To preserve teens’ families, programs and services need to be able to improve teens’ prospects for parenting success, delay subsequent pregnancies, and reduce intergenerational placement in care. The Inwood House theory of change for pregnant and parenting teens is a roadmap for providing the range and types of services that have the potential to improve outcomes for these most vulnerable families. The theory of change builds on insights and data from a demonstration project which took place in the residential program of a New York City foster care agency, with an approach that addressed the developmental needs of adolescents and the practical needs of parenting. Inwood House’s experience provided insights into the role of a theory of change focused on the development of young people, not only their protection, to improve the health and well-being of young mothers and their babies, and reduce intergenerational placement in care. Insights and data derived from this project, which reflect the challenges of research in foster care, are discussed.
The Fostering Connections to Success and Increasing Adoptions Act of 2008 ("Fostering Connections Act") fundamentally changed the nature of federal support for young people in state care by extending entitlement funding under Title IV-E of the Social Security Act to age 21 beginning in FY2011. While the Fostering Connections Act provides states with entitlement funding and great flexibility in terms of the nature of the care being provided for young adults, it also imposes considerable responsibilities on the states, and the young people themselves, in order for states to receive reimbursement; young people who do not or cannot participate in the activities required for eligibility, and who do not meet the yet-to-be determined criteria for a "medical condition," will not be eligible to remain in care. It remains unclear how many states will take up the option made available under the Fostering Connections Act to extend foster care past 18, and, for those states who take up the option, how they will implement the provisions directed towards young adults. Information on the characteristics and needs of former foster youth making the transition to adulthood is sorely needed to assist states as they decide whether and how to implement the Fostering Connections Act older youth provisions. In this paper, the authors use information provided by young people participating in the Midwest Evaluation of the Adult Functioning of Former Foster Youth ("Midwest Study") to identify distinct subgroups of young adults making the transition to adulthood based on their experiences across several key transition domains. The characteristics of these subgroups call for a nuanced approach to policy and practice directed towards foster youth in transition. Some of the subgroups may be difficult to serve under the policy framework provided by the Fostering Connections Act
This study tested the association between mother’s early age at first birth and various life outcomes for her children in later adolescence and early adulthood. Data were analyzed from the Rochester Youth Development Study, an ongoing panel study of adolescents enrolled in seventh or eighth grade in Rochester Public Schools in 1988 (N =729). Boys born to mothers who began childbearing before age 19 had elevated risks of drug use, gang membership, unemployment, and early parenthood. Girls born to young mothers only had elevated risks of early parenthood. Of the mediators tested, low maternal education had the largest mediating effects. The findings suggest that the risks associated with being born to a young mother are substantial but perhaps disproportionately so for boys.
Mixture modeling is a widely applied data analysis technique used to identify unobserved heterogeneity in a population. Despite mixture models' usefulness in practice, one unresolved issue in the application of mixture models is that there is not one commonly accepted statistical indicator for deciding on the number of classes in a study population. This article presents the results of a simulation study that examines the performance of likelihood-based tests and the traditionally used Information Criterion (ICs) used for determining the number of classes in mixture modeling. We look at the performance of these tests and indexes for 3 types of mixture models: latent class analysis (LCA), a factor mixture model (FMA), and a growth mixture models (GMM). We evaluate the ability of the tests and indexes to correctly identify the number of classes at three different sample sizes (n D 200, 500, 1,000). Whereas the Bayesian Information Criterion performed the best of the ICs, the bootstrap likelihood ratio test proved to be a very consistent indicator of classes across all of the models considered.
The transition to adulthood is marked by new roles and responsibilities in such interrelated domains as education, employment, and family formation. This study investigates the capacity of adolescents on the verge of emancipation from the child welfare system to navigate this transition. To explore heterogeneity in adolescents' preparation for independent living, person-oriented methods are applied to a large, representative sample of youth about to exit foster care. The analysis suggests four subpopulations defined by distinctive profiles on indicators reflecting multiple domains of life experience. Identifying the particular needs and challenges of subpopulations has implications for efforts to match adolescents aging out of the child welfare system with appropriate services.
This research examined linkages between exposure to childhood sexual abuse (CSA) and childhood physical punishment/abuse (CPA) and mental health issues in early adulthood.
The investigation analyzed data from a birth cohort of over 1,000 New Zealand young adults studied to the age of 25.
Exposure to CSA and CPA was associated with increased risks of later mental disorders including depression, anxiety disorder, conduct/anti-social personality disorder, substance dependence, suicidal ideation, and suicide attempts at ages 16-25. Control for social, family, and individual factors reduced the associations between CPA and mental health outcomes to the point of statistical non-significance. However, there was a consistent finding for CSA to remain associated with increased risks of later mental health problems. After adjustment, those exposed to CSA including attempted or completed sexual penetration had rates of disorder that were 2.4 times higher than those not exposed to CSA. Those exposed to harsh or abusive physical punishment had rates of disorder that were 1.5 times higher than those exposed to no or occasional physical punishment. It was estimated that exposure to CSA accounted for approximately 13% of the mental health problems experienced by the cohort. Findings showed that exposure to CPA had only weak effects on later mental health. It was estimated that exposure to CPA accounted for approximately 5% of the mental health problems experienced by the cohort.
Exposure to CSA was associated with consistent increases in risks of later mental health problems. Exposure to CPA had weaker and less consistent effects on later mental health. These findings suggest that much of the association between CPA and later mental health reflects the general family context in which CPA occurs, whereas this is less the case for CSA.
Foster children are at disproportionate risk of adverse outcomes throughout the life course. Public policy prioritizes permanency (exiting foster care through reunification with birth parents, adoption, or legal guardianship) to promote foster youths’ healthy development and well-being, but little empirical evidence indicates that permanency, including its most preferred form—reunification—promotes positive outcomes. Using multi-system, statewide longitudinal administrative data, we employed logistic and mixed-effects regression to examine educational attainment and earnings among former foster youth in early adulthood. We found that youth who aged out of care had significantly higher odds of graduating high school and enrolling in college than did reunified youth and youth who exited to guardianship, and they had similar odds as adopted youth. Earnings were similar across groups. Among aged-out (but not reunified) youth, odds of high school graduation and average earnings were higher for youth who spent more time in foster care prior to age 18. Overall, results suggest that permanency alone is insufficient to promote foster youths’ educational and economic attainment.
Objectives:
To determine if adolescent mothers who were in the care of child protection services (CPS) when they gave birth to their first child are more likely to have that child taken into CPS care before the child's second birthday than adolescent mothers who were not in the care of CPS.
Methods:
Linkable administrative data were used to create a population-based cohort of adolescent mothers whose first child was born in Manitoba, Canada between April 1, 1998, and March 31, 2013 (n = 5942). Adjusted odds ratios (aOR) of having that first child taken into care before their second birthday were compared between mothers who were in care (n = 576) and mothers who were not in care (n = 5366) at the birth of their child by using logistic regression models.
Results:
Adolescent mothers who were in care had greater odds of having their child taken into care before the child's second birthday (aOR = 7.53; 95% confidence interval [CI] = 6.19-9.14). Specifically, their children had higher odds of being taken into care in their first week of life (aOR = 11.64; 95% CI = 8.83-15.34), between 1 week and their first birthday (aOR = 3.63; 95% CI = 2.79-4.71), and between their first and second birthday (aOR = 2.21; 95% CIl = 1.53-3.19).
Conclusions:
Findings support an intergenerational cycle of involvement with CPS. More and better services are required for adolescent mothers who give birth while in care of CPS.
Purpose: Children and youth in out-of-home care have high rates of behavioral health need, and states are increasingly adopting screening protocols to identify and intervene with these youth. This study presents longitudinal analyses of the case flow of youth aged 3–17 in Washington State's foster care system, tracking rates of screening, scoring above or below clinical criteria cutoff scores, and service receipt. This study describes what variables are associated with these three decision points. Results: Eighty-nine percent of eligible youth were screened for behavioral health need soon after entry in to out-of-home care; most of those who were not screened were already receiving behavioral health services. Sixty-one percent scored above criteria on at least one screening measure by at least one respondent. Sixty percent of those who scored above criteria and 33% of those who scored below criteria received at least one behavioral health service within 4 months of entry to care. After controlling for all variables, screening above criteria was related to age, race/ethnicity, county rurality, abuse type, reason for out-of-home placement, past behavioral health service receipt, and type of past diagnosis. Service receipt for those scoring above criteria was related to age, race/ethnicity, county rurality, abuse type, and type of prior behavioral health diagnosis. Conclusions: The role of screening in child welfare is dynamic and influenced by multiple factors. In the current study, youth screening above criteria was related to increased rates of service receipt. However, many children with behavioral health service needs did not receive services. The relatively high rates of youth scoring below criteria but receiving services may indicate a need for ongoing systematic screening in order to identify emergent needs, or additional screening measures at intake. States considering or employing the use of screening tools should weigh a variety of approaches to screening, assessment, and referral to services in order to ensure maximal benefit.
Objective
To examine the prevalence of and factors associated with sexual behavior and pregnancy involvement among adolescents in foster family homes.
Methods
A cross-sectional study was conducted among a random sample of children living in foster family homes. Logistic regression with Firth’s correction was used to determine factors associated with sexual risk behavior and pregnancy involvement (i.e. having been pregnant or gotten someone pregnant).
Results
About half of adolescents (aged 13–18 years) in foster family homes ever had sex, of whom, one third had first sex before the age of 14 and one sixth had two or more sexual partners in the past 3 months. Of adolescents in the study, 9% had ever been pregnant or gotten someone pregnant. Although adolescents in foster family homes had higher rates of sex initiation and pregnancy involvement than those in the general population, the two groups had comparable rates of current sexual risk behavior. Being placed in kin/fictive kin foster homes [odds ratio (OR): 3.04; 95% confidence interval (CI): 1.18–7.80] and number of placement settings (OR: 1.20; 95% CI: 1.02–1.42) were associated with multiple sexual partners, while a history of running away from a foster home (OR: 7.64; 95% CI: 1.87–31.18) was associated with pregnancy involvement.
Conclusions
Efforts targeting placement stability including prevention of running away may reduce sexual risk behavior and pregnancy involvement among adolescents in foster family homes.
Key findings:
•The teen birth rate declined to another historic low for the United States in 2015, down 8% from 2014 to 22.3 births per 1,000 females aged 15-19. •The birth rates for teenagers aged 15-17 and 18-19 declined in 2015 to 9.9 and 40.7, respectively, which are record lows for both groups. •In 2015, birth rates declined to 6.9 for Asian or Pacific Islander, 16.0 for non-Hispanic white, 25.7 for American Indian or Alaska Native, 31.8 for non-Hispanic black, and 34.9 for Hispanic female teenagers aged 15-19. •Birth rates fell to record lows for nearly all race and Hispanic-origin groups of females aged 15-19, 15-17, and 18-19 in 2015. The birth rate for teenagers aged 15-19 has fallen almost continuously since 1991, reaching historic lows for the nation every year since 2009 (1-4). Despite declines in all racial and ethnic groups, teen birth rates continue to vary considerably by race and ethnicity. Moreover, the U.S. teen birth rate remains higher than in other industrialized countries (5). Childbearing by teenagers continues to be a matter of public concern. This report presents the recent and long-term trends and disparity in teen childbearing by race and Hispanic origin.
Chapin Hall examined the experiences and needs of pregnant and parenting youth in foster care in Illinois. The
project that resulted included two components: a quantitative component involving the analysis of
administrative data and a qualitative component involving interviews with service providers who
work with these youth. This final report describes what was learned from both the administrative
data and the qualitative interviews, discusses their policy and practice implications, and raises a
number of questions for future research.
This study found that youth involved with the child welfare system have high rates of sexual risk behaviors and outcomes, including forced sex, early age at first sex, low contraceptive use, and pregnancy, which are more than double those of adolescents from the general population. Caseworkers may need training in how to address sexual risk factors and may need to support caregivers in addressing these issues with their children. Findings highlight the importance for case-workers, caregivers, and others to address the sexual and reproductive health needs of maltreated youth.
Despite the high rate of early parenthood among youth in foster care as well as the increased risk of child maltreatment among children whose adolescent parents have been neglected or abused, very little is known about child welfare services involvement among children whose parents were in foster care when they were born. This study uses administrative data from the Illinois Department of Children and Family Services (DCFS) to examine the occurrence of child abuse and neglect investigations, indicated reports and out of home care placements among the children of youth in foster. Thirty-nine percent of the children were the subject of at least one CPS investigation, 17 percent had at least one indicated report and 11 percent were placed in out of home care at least once before their 5th birthday. Cox proportional hazard models are also estimated to identify characteristics of parenting foster youth and their placement histories associated with the risk of child welfare services involvement. Implications of the findings for policy and practice are discussed.
Copyright © 2015 Elsevier Ltd. All rights reserved.
For teenage mothers in California, we generated population-level estimates of the relationship between maternal history of maltreatment and next-generation abuse and neglect. California birth records for all infants born to primiparous teen mothers in 2006 or 2007 were linked to statewide child protective services (CPS) records. For each birth, we used CPS records to document 1) whether the teen mother had a history of reported or substantiated maternal maltreatment at or after age 10 years and before the estimated date of conception and 2) whether the teen's child was reported or substantiated for maltreatment before age 5 years. We fitted multivariable survival models to examine the association between a teenage mother's CPS involvement and child maltreatment, after adjusting for a range of sociodemographic variables. Our final data set included 85,084 births to first-time mothers aged 15-19 years. Significantly heightened rates of abuse and neglect were observed for children of mothers who had been reported to CPS as possible victims of maltreatment (P < 0.001). After adjustment for other risk factors, a maternal history of either unsubstantiated (hazard ratio = 2.19, 95% confidence interval: 2.06, 2.33) or substantiated (hazard ratio = 3.19, 95% confidence interval: 3.00, 3.39) maltreatment emerged as a strong predictor of maltreatment and CPS involvement in the next generation.
© The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
This article discusses alternatives to single-step mixture modeling. A 3-step method for latent class predictor variables is studied in several different settings, including latent class analysis, latent transition analysis, and growth mixture modeling. It is explored under violations of its assumptions such as with direct effects from predictors to latent class indicators. The 3-step method is also considered for distal variables. The Lanza, Tan, and Bray (2013) method for distal variables is studied under several conditions including violations of its assumptions. Standard errors are also developed for the Lanza method because these were not given in Lanza et al. (2013).
Young mothers in foster care face considerable challenges above and beyond that of their non-foster care peers. Child welfare workers have few resources to guide them in the selection of evidence-informed programs, models, and strategies that address the unique risk factors and needs of youth in foster care who are at risk for rapid repeat pregnancy and inadequate parenting practices. Workers need knowledge of the evidence about which programs are most likely to improve key health and well-being outcomes. The article assesses the evidence-based programs identified and yields a list that reflects the best evidence for efficacy and effectiveness.
Multiple forms of abuse may co-occur, resulting in specific abuse typologies. A stratified random probability survey was conducted in Denmark with 4,718 participants, aged 24, from the 1984 birth cohort. A total of 2,980 interviews were successfully conducted. Latent class analysis was implemented using 20 categorical abuse experience items across four domains of childhood maltreatment. Logistic regression was conducted to ascertain whether abuse typologies could be differentiated by child protection status and gender. Four distinct abuse typologies were revealed: a non-abused group, a psychologically maltreated group, a sexually abused group, and a group experiencing multiple abuse types. Child protection status and female gender were predictive of group membership in certain abused groups compared to a non-abused group.
Although prediction of class membership from observed variables in latent class analysis is well understood, predicting an observed distal outcome from latent class membership is more complicated. A flexible model-based approach is proposed to empirically derive and summarize the class-dependent density functions of distal outcomes with categorical, continuous, or count distributions. A Monte Carlo simulation study is conducted to compare the performance of the new technique to two commonly used classify-analyze techniques: maximum-probability assignment and multiple pseudo-class draws. Simulation results show that the model-based approach produces substantially less biased estimates of the effect compared to either classify-analyze technique, particularly when the association between the latent class variable and the distal outcome is strong. In addition, we show that only the model-based approach is consistent. The approach is demonstrated empirically: latent classes of adolescent depression are used to predict smoking, grades, and delinquency. SAS syntax for implementing this approach using PROC LCA and a corresponding macro are provided.
The purpose of this study is to (1) compare youth entering substance abuse treatment with and without a history of foster care placement to determine any differences in mental health, substance use, and exposure to victimization, and (2) determine if mental health, substance use, and/or exposure to victimization predict past pregnancy among the sample with a history of foster care placement. The pooled dataset consisted of 17,124 adolescents (12–17years of age) who completed the Global Appraisal of Individual Needs at intake for substance abuse treatment in 2009. Of these, 366 (2.1%) reported having been in foster care in the past year. When compared with a non-foster care sample, the foster care sample reported significantly higher internal mental distress scores, behavior complexity scores, and general victimization scores, after controlling for race, gender, and level of care. Problems associated with substance use did not differ between groups, though regular tobacco use was present at a higher rate in the foster care sample. Multivariate logistic regression results revealed that, within the foster care sample, internal mental distress and gender predicted past pregnancy. There may be room for intervention within substance abuse treatment centers for youth with a history of foster care, who may be at risk for pregnancy if their levels of internal mental distress are high.
Objective:
Prospectively track teen childbirths in maltreated and nonmaltreated females and test the hypothesis that child maltreatment is an independent predictor of subsequent teen childbirth over and above demographic characteristics and other risk factors.
Methods:
Nulliparous adolescent females (N = 435) aged 14 to 17 years were assessed annually through age 19 years. Maltreated females were referred by Child Protective Services agencies for having experienced substantiated sexual abuse, physical abuse, or neglect within the preceding 12 months. Comparison females were matched on race, family income, age and family constellation. Teen childbirth was assessed via self-report during annual interviews. Births were confirmed using hospital delivery records.
Results:
Seventy participants gave birth during the study, 54 in the maltreated group and 16 in the comparison group. Maltreated females were twice as likely to experience teen childbirth after controlling for demographic confounds and known risk factors (odds ratio = 2.17, P = 0.01). Birth rates were highest for sexually abused and neglected females. Sexual abuse and neglect were both independent predictors of teen childbirth after controlling for demographic confounds, other risk factors and alternative forms of maltreatment occurring earlier in development.
Conclusions:
Results provide evidence that sexual abuse and neglect are unique predictors of subsequent teen childbirth. Partnerships between protective service providers and teen childbirth prevention strategists hold the best promise for further reducing the US teen birth rate. Additional research illuminating the pathways to teen childbirth for differing forms of maltreatment is needed so that tailored interventions can be realized.
Child maltreatment has been linked to multiple negative health outcomes and many leading causes of death. Statewide population-based evaluations are needed to identify high-risk populations early in life for targeted interventions.
To assess the utility of combining Pregnancy Risk Assessment Monitoring System (PRAMS) data with child protective services (CPS) records to identify risk factors associated with Protective Services Reports (PSR) suggestive of child maltreatment.
This was a retrospective population-based cohort study conducted in the spring of 2010 using weighted survey data from Alaska PRAMS for birth years 1997-1999. PRAMS responses were linked with CPS records for the sampled child. The outcome of interest was any PSR made to CPS after the survey was returned through 48 months after birth. Validation of the PRAMS data set occurred through direct comparison between the total population and PRAMS weighted sample for birth certificate factors. Multivariate logistic regression models were constructed to identify risk groups.
In the final multivariate model among the main effect variables, three of the top five strongest associated factors were derived all or in part from PRAMS. Public aid as a source of income had a significant interaction with Alaska Native status, and among Alaska non-Natives had an AOR of 3.37 (95% CI=2.2, 5.1). Six significant modifiable factors were identified in the multivariate model. Three quarters (75%) of the maltreatment cases occurred among children with two or more of these factors, despite being found in about one third (32%) of the total population.
Although birth certificates remained a valuable source of risk factor information for child maltreatment, PRAMS identified additional risk factors not available from birth certificates.
Maltreated children placed in out-of-home care are at high risk for exhibiting symptoms of psychopathology by virtue of their exposure to numerous risk factors. Research examining cumulative risk has consistently found that the accumulation of risk factors increases the likelihood of mental health problems. The goal of the current study was to elucidate the relation between cumulative risk and mental health symptomatology.
The study consisted of a sample of 252 maltreated youths (aged 9-11) placed in out-of-home care.
Analyses confirmed the high-risk nature of this sample and identified seven salient risk variables. The cumulative risk index comprised of these seven indicators was a strong predictor of mental health symptoms, differentiating between children who scored in the clinical range with regard to mental health symptoms and those who did not. Finally, the data supported a linear model in which each incremental increase in cumulative risk was accompanied by an increase in mental health problems.
This is the first known study to examine cumulative risk within a sample of youths in out-of-home care.
We examined medical, educational and social risks to children of teen mothers and children of nonadolescent mothers with a history of teen birth (prior teen mothers) and considered these risks at both the individual and societal level.
A population-based, retrospective cohort study tracked outcomes through young adulthood for children born in Manitoba, Canada (n = 32 179). chi(2) and logistic regression analyses examined risk of childhood death or hospitalization, failure to graduate high school, intervention by child protective services, becoming a teen mother, and welfare receipt as a young adult.
For children of both teen and prior teen mothers, adjusted likelihoods of death during infancy, school-aged years, and adolescence were more than 2-fold higher than for other children. Risks for hospitalization, high hospital use, academic failure, and poor social outcomes were also substantially higher. At a societal level, only 16.5% of cohort children were born to teen and prior teen mothers. However, these children accounted for 27% of first-year hospitalizations, 34% of deaths (birth to 17 years), 30% of failures to graduate high school, 51% in foster care, 44% on welfare as young adults, and 56% of next-generation young teen mothers.
Children of prior teen mothers had increased risks for poor health and for educational and social outcomes nearly equal to those seen in children of teen mothers. Combined, these relatively few children experienced a large share of the negative outcomes occurring among young people. Our results suggest the need to expand the definition of risk associated with adolescent motherhood and target their children for enhanced medical and social services.
The current study investigated how individual risk factors interact with social contextual-level protective factors to predict problematic substance use among a sample of 12th-grade students (n = 8,879, 53% female). Results suggested six latent classes of substance use: (1) Non-Users; (2) Alcohol Experimenters; (3) Alcohol, Tobacco, and Other Drug (ATOD) Experimenters; (4) Current Smokers; (5) Binge Drinkers; and (6) Heavy Users. Binary logistic regression models provided evidence that individual risk, family, school, and community protective factors were associated with membership in the substance use latent classes. However, the significance of interaction terms suggested that these protective influences differed according to the level of individual risk. Adolescents with high levels of individual risk benefited less from a positive family or neighborhood context than adolescents with low levels of individual risk. These findings suggest that the individual risk factors may undermine the protective effect of parental supervision, discipline, and other family factors, as well as protective aspects of cohesive neighborhoods, among these adolescents. Multi-component and adaptive intervention efforts that account for different levels of ATOD use involvement, as well as distinct profiles of risk and protection, are likely to be most effective in preventing problematic substance use.
Foster children often experience compromising situations such as neglect, physical abuse, or sexual abuse before out-of-home placement. This article aims to give a literature review related to the development and mental health of foster children with special consideration of trauma history.
A computer-based literature search was conducted in the databases Medline, PsycINFO, PSYNDEXplus, and SCOPUS. We determined a time frame from 1998 to 2009.
The literature search resulted in 32 articles reporting empirical data about development and mental health in foster children. Very high rates of exposure to maltreatment, developmental delays and mental disorders were found. A broad spectrum of externalizing as well as internalizing symptoms and a high prevalence of comorbid mental disorders were found.
Foster children exhibit a broad pattern of developmental problems and psychopathology. The etiology of these disorders is discussed in the context of multiple risk factors, especially that of persistent maltreatment.
In the USA, as many as 1 in 6 women nationwide become adolescent mothers, making adolescent pregnancy and childbearing issues a frequently encountered occurrence by pediatricians and adolescent medicine health care providers. Both social and medical programs focus on prevention and management of adolescent pregnancies; however, caring for the adolescent-headed family is less well understood. For many teen parents, various environmental and behavioral risks contributed to early childbearing and parenting. Following delivery of the infant, many of these same psycho-social, environmental, and educational factors continue to play a role in the teen's ability to parent effectively. This review explores these factors in relation to teen parenting as well as describes the limited data available on outcomes of adolescent mothers and their infants. Despite negative social stereotypes regarding adolescent fathers, research suggesting that most fathers desire involvement with their infants and the impact of and factors influencing father involvement is explored. Understanding the dynamics of the coparenting relationship, an expanding field of study, will aid practitioners in strengthening and supporting teen parenting by both mothers and fathers. As most teen parents continue to reside with their families, teen parenting has an important impact on the multi-generational family structure. These relationships can serve both to support and at times to hinder the adolescent parents' development as an individual and as a parent. Successful interventions and programs to support the adolescent-headed family take on various forms but are usually comprehensive and multidisciplinary and consider the developmental status of both the parent and the child. To best care for adolescent-headed families, pediatricians and adolescent medicine providers should understand the psychosocial, developmental, educational, and relationship issues that influence adolescent parenting.
This 15-year prospective, longitudinal study examines adolescent and young-adult female self-reports of traumatic sexual and physical experiences occurring subsequent to substantiated childhood sexual abuse-revictimizations (N=89).
These incidences were contrasted to sexual and physical victimizations reported by a group of non-abused comparison females (N=90).
Abused females were almost twice as likely to have experienced sexual revictimization (odds=1.99+/-2.79, p<.05), and physical revictimization (odds=1.96+/-2.58, p<.05) as compared to victimization rates reported by comparison females. Abused females' revictimizations were also more likely to have been perpetrated by older, non-peers and characterized by physical injury than were victimizations reported by comparison females.
Early childhood sexual abuse may provide information regarding the level of risk for recurrent sexual and physical victimization.
There is a growing acceptance of a holistic, interactionistic view in which the individual is seen as an organized whole, functioning and developing as a totality. This view emphasizes the importance of patterns of operating factors. Within this framework, a standard variable-oriented approach, focusing on the variable as the main theoretical and analytical unit, has limitations. A person-oriented approach would often be preferable, where the main theoretical and analytical unit is the specific pattern of operating factors. Such an approach is presented here, focusing on individual development and psychopathology. A brief theoretical and methodological overview is given and a classification approach is emphasized. Empirical examples concerning the longitudinal study of adjustment problems illustrate a number of issues believed to be important to development and psychopathology: problem gravitation, the significance of single variables and of patterns, the developmental study of syndromes (= typical patterns), and the detection of "white spots" in development.
Despite a sizable amount of research addressing the relationship between violence and women's reproductive health, it has not been shown whether there is sufficient evidence of a causal link between childhood maltreatment and subsequent adolescent pregnancy.
Three databases (Medline, PsychiNFO and SocioFile) were searched for studies published between 1980 and 2000 relating maltreatment and adolescent pregnancy. The review was limited to empirical studies; theoretical articles and those with no women who were aged 21 or younger during the research period or when they experienced maltreatment were excluded.
Fifteen articles on the topic were found All were published after 1989; all but one were cross-sectional, were retrospective and relied on recall. All of the studies dealt with sexual maltreatment, either alone or in combination with other types of maltreatment; few covered emotional abuse or neglect. The studies lacked consistent definitions of the various types of maltreatment. Only one examined adolescent mothers' relationships with men, and none examined relationships with perpetrators. Few dealt with racial and ethnic differences related to violence. All lacked a specific theoretical approach. Ten of the studies supported a link between maltreatment and adolescent pregnancy, and five eitherdid not support a link or qualified the relationship. Substance abuse, poor mental health and promiscuity were among the mediating variables examined.
Because recent studies have reached conflicting findings, had methodological weaknesses and lacked theoretical grounding, whether a causal link exists between maltreatment and adolescent pregnancy remains an unanswered question.
This study extends previous research (Dixon, Browne, & Hamilton-Giachritsis, 2004) by exploring the mediational properties of parenting styles and their relation to risk factors in the intergenerational cycle of child maltreatment. Families with newborns where at least one of the parents was physically and/or sexually abused as a child (AP families) were compared, in terms of parents' attributions and behaviour, to families where the parents had no childhood history of victimization (NAP families).
Information was collected from 4351 families (135 AP families) by community nurses as part of the 'health visiting' service. The same health visitor visited each family twice at home when the child was 4 to 6 weeks and 3 to 5 months of age, to assess behavioural indicators of positive parenting.
Within 13 months after birth, 9 (6.7%) AP families were referred for maltreating their own child in comparison to 18 (.4%) NAP families. Assessments found a significantly higher number of risk factors and measures indicating poor parenting for AP families. Mediational analysis found that intergenerational continuity of child maltreatment was explained to a larger extent (62% of the total effect) by the presence of poor parenting styles together with the three significant risk factors (parenting under 21 years, history of mental illness or depression, residing with a violent adult). The three risk factors alone were less explanatory (53% of the total effect).
This study provides an explanation for why a minority of parents abused in childhood go on to maltreat their own infant, evidencing poor parenting styles and mediating risk factors. Hence, prevention may be enhanced in AP families by the promotion of 'positive parenting' in addition to providing additional support to young parents, tackling mental illness/depression and domestic violence problems.
Adoption and Foster Care Analysis and Reporting System: A Rule by the Children and Families Administration on 12/14
Federal Register (2016). Adoption and Foster Care Analysis and Reporting System: A Rule by the Children and Families Administration on 12/14/2016Retrieved January 26, 2018
fromhttps://www.federalregister.gov/documents/2016/12/14/2016-29366/adoption-and-foster-care-analysis-and-reporting-system.
The science of early childhood development: Closing the gap between what we know and what we do
- L K Muthén
- B O Muthén
Muthén, L. K., & Muthén, B. O. (2012). Mplus user's guide (seventh edition). Los Angeles, CA: Muthén & Muthén.
National Scientific Council on the Developing Child (2007). The science of early childhood development: Closing the gap between what we know and what we do. Retrieved fromwww.
developingchild.harvard.edu.
Cumulative risk of child protective service involvement before age 5: A population-based examination
- E Putnam-Hornstein
- M Mitchell
- I Hammond
Putnam-Hornstein, E., Mitchell, M., & Hammond, I. (2014). Cumulative risk of child protective service involvement before age 5: A population-based examination. Retrieved February
20, 2018 fromhttp://www.datanetwork.org/research/cumulative-risk-of-child-protective-service-involvement-before-age-5-a-population-based-examination/.