October 2006, Vol 96, No. 10 | American Journal of Public HealthSwahn et al. | Peer Reviewed | Research and Practice | 1849Swahn et al. | Peer Reviewed | Research and Practice | 1849
RESEARCH AND PRACTICE
Objectives. We examined the concordance between measures of self-reported
maltreatment and court records of abuse or neglect in a sample of detained
Methods. Data were collected by the Northwestern Juvenile Project and include
interviews from 1829 youths aged 10–18 years. Participants were newly detained
youths in the Cook County Juvenile Temporary Detention Center in Illinois be-
tween 1995 and 1998. Self-reported cases of child maltreatment were compared
with court records of abuse or neglect in the Cook County judicial system.
Results. We found that among detained youths, 16.6% of those who reported
any maltreatment, 22.2% of those who reported the highest level of maltreat-
ment, and 25.1% of those who reported that they required medical treatment as
a result of maltreatment had a court record of abuse or neglect. Among those with
any self-reported maltreatment, girls (vs boys) and African Americans (vs Whites)
were more likely to have a court record (adjusted odds ratio [AOR]=2.18; 95% con-
fidence interval [CI]=1.53, 3.09; and AOR=2.12; 95% CI=1.23, 3.63, respectively).
Conclusions. Official records seriously underestimate the prevalence of mal-
treatment, which indicates that multiple data sources are needed to document the
true prevalence of maltreatment. (Am J Public Health. 2006;96:1849–1853.
(aged 10–18 years) who were arrested and
then detained for delinquency between 1995
and 1998 at the Cook County Juvenile Tem-
porary Detention Center in Chicago.5–8The
random sample was stratified by gender,
race/ethnicity, age, and charge severity.
Within each stratum, a random-numbers
table was used to select names from the
center’s intake log. The final sampling frac-
tions ranged from 0.018 to 0.689. Detainees
were eligible to participate regardless of their
psychiatric morbidity, state of alcohol or
other drug intoxication, or fitness to stand
trial. Of the 2275 youths selected, 1829 par-
ticipated and completed the interview. There
were no statistical significant differences in re-
fusal rates by gender, race/ethnicity, or
age.5,6,8After written assent or consent, and
usually within 2 days of intake, participants
were interviewed in a private area for about
2 to 3 hours. Analyses are restricted to partic-
ipants who completed the child maltreatment
questionnaire (n=1735). Prevalence esti-
mates and inferential statistics are corrected
Concordance Between Self-Reported Maltreatment and
Court Records of Abuse or Neglect Among High-Risk Youths
| Monica H. Swahn, PhD, Daniel J. Whitaker, PhD, Courtney B. Pippen, MPH, Rebecca T. Leeb, PhD, Linda A. Teplin, PhD, Karen M. Abram, PhD, and
Gary M. McClelland, PhD
for the sample design using the SUDAAN sta-
Participants were asked several questions
about the punishments that they have ever
received from parents, step-parents, foster-
parents, or other adults who were in charge
of the participant for at least 6 months. These
questions were based on the Child Maltreat-
ment Interview Schedule—Short Form,10,1 1
which has been used in previous research.12,13
Our analyses examine responses to seven
questions that asked participants if they had
been “pushed, spanked, grabbed, slapped or
shoved,” “hit very hard,” “hit with an object,”
“beaten or kicked,” “locked in a room for 5
hours or more or told you can’t have food for
a whole day or longer,” “hurt by an adult in
charge of you so that you were bruised, had
broken bones, or were severely injured,” or
“severely punished in some other way that we
haven’t talked about” (Cronbach α=0.76).
Response options were “never,” “once,” “2–5
Child maltreatment is a significant problem
in the United States and results in many
injuries, fatalities, and other negative health
outcomes.1In 2003, an estimated 906000
children were confirmed victims of maltreat-
ment according to the National Child Abuse
and Neglect Data System, which collects sta-
tistics from state Child Protective Services
(CPS) agencies.2However, CPS data are an
underestimate of the total incidence of child
maltreatment. Another source of data, the Na-
tional Incidence Study of Child Abuse and
Neglect, reports that only about one third of
children who are neglected and abused come
to the attention of the CPS when also includ-
ing information from community profession-
als (e.g., police and sheriff’s departments, pub-
lic schools, day-care centers, hospitals).3 These
data sources do not obtain information about
self-reported child maltreatment. In fact, less
than 1% of referrals to CPS agencies were
made by the alleged victims.2
Data on self-reported maltreatment is
rarely collected from children and adoles-
cents. Accordingly, there is limited informa-
tion about the extent to which cases of self-re-
ported maltreatment is captured by CPS
agencies. One previous study of adults (aged
18 years and older) found that only 24% of
those who self-reported cases of child mal-
treatment also had court records,4which sug-
gests that there is limited overlap between
self-reported maltreatment and court records
of maltreatment. In this study we examined
self-reported maltreatment in a high-risk pop-
ulation of detained juveniles in order to deter-
mine the proportion of children who reported
maltreatment who also had records of abuse
or neglect in the county court system.
Participants were part of the Northwestern
Juvenile Project, a study of 1829 youths
American Journal of Public Health | October 2006, Vol 96, No. 101850 | Research and Practice | Peer Reviewed | Swahn et al.
RESEARCH AND PRACTICE
TABLE 1—Demographic Characteristics of Youths With Self-Reported and Court-Recorded
Required Because of
Highest Level of
Court Record of
Note.The sample was stratified by gender,age,race/ethnicity,and charge severity,so all prevalence estimates were weighted
to adjust for the detention center population.
TABLE 2—Presence and Absence of Court Records of Abuse or Neglect, by Self-Report of
Court Records of Abuse and Neglect
% of Response,
% of Response,
% of Response,
% of Response,
Column (N) Self-Report No. No.
Highest level of maltreatment
Medical treatment owing to maltreatment
84.3 (1614) 95.1 (1406)
74.9 (116) 4.9 (1406)
aThe sample was stratified by gender,age,race/ethnicity,and charge severity,so all prevalence estimates were weighted to
reflect the detention center population.
times,” “6–10 times,” “11–25 times,” “26–50
times,” or “51 or more times.” A continuous
variable that consisted of the summed re-
sponses to these 7 questions was created;
possible values were 0 to 42. The scores
ranged from 0 to 41 and the mean was 6.7.
Additionally, two dichotomous measures were
created to indicate any child maltreatment
(score ≥1) and the top 10% of those mal-
treated (score ≥16). Finally, participants were
also asked if they were “ever hurt so badly
that you had to see a doctor or go to the hos-
pital.” Participants who answered “yes” or
thought they should have gone to the hospital
were considered to have required medical
Any participant in the study who had a
court record of child abuse or neglect in the
Cook County Court Child Protection Divi-
sion, regardless of the type of charge and
substantiation of that charge, was considered
to have a court-reported case of child abuse
We conducted the analyses in 3 ways. First
we compared the mean maltreatment scores
for participants who stated that they required
medical treatment as a result of maltreatment
with those who did not. We also compared
the mean maltreatment scores for participants
with and without a court record of maltreat-
ment. Second, we compared the percentage
of participants who had a court record of any
maltreatment, who had the highest scores of
maltreatment, and who stated that they re-
quired medical treatment as a result of mal-
treatment. Third, we determined the associa-
tions between the three dichotomous
self-reported measures of child maltreatment
and court records of maltreatment for gender,
age, and race.
The demographic characteristics of the
participants who completed the child mal-
treatment questionnaire are reported in Table
1. In this sample, 82.7% reported any mal-
treatment, 5.5% reported requiring medical
treatment for maltreatment, and 16.3% had
a court record of maltreatment. Table 1
shows the proportions of self-reported and
court-reported maltreatment overall and by
Individuals who required medical treat-
ment as a result of maltreatment had a signifi-
cantly higher mean level of maltreatment
compared with those who did not require
medical treatment (13.9 vs. 6.2, respectively;
t=4.33; P<.0001). There was no statistically
significant difference in the mean level of
maltreatment for participants who had or did
not have a court record of abuse or neglect
(7.3 vs. 6.5, respectively; t=0.78, P=.43).
Table 2 shows the percentage of partici-
pants who had a court record of abuse and
neglect by 3 different measures of self-
reported maltreatment (i.e., any, highest level,
or medical treatment was required as a result
of maltreatment). There were no significant
October 2006, Vol 96, No. 10 | American Journal of Public HealthSwahn et al. | Peer Reviewed | Research and Practice | 1851
RESEARCH AND PRACTICE
TABLE 3—Court Records of Abuse or Neglect Among Participants Reporting Maltreatment,
by Demographic Characteristics,With Crude and Adjusted Odds Ratios (ORs) and 95%
Confidence Intervals (CIs)
Court Record of Abuse or Neglect
OR (95% CI)N Percentagea
Adjusted OR (95% CI)b
Self-report of any maltreatment
Self-report of highest level of maltreatment
1.60 (0.51,5.05) 114
Self-report of medical treatment required because of maltreatment
aThe sample was stratified by gender,age,race/ethnicity,and charge severity,so all prevalence estimates are weighted to
reflect the detention center population.
bORs were adjusted for all 3 demographic characteristics (gender,age,and race/ethnicity).
cAge categories were combined because sample sizes were small.
associations between any of the three self-
reported measures of maltreatment and court
records of abuse or neglect.
We next examined the associations between
demographic characteristics and court records
of abuse or neglect among those who self-re-
ported any maltreatment, those who reported
the highest level of maltreatment, and those
who reported that medical treatment was re-
quired as a result of maltreatment (Table 3).
Among those with any self-reported maltreat-
ment, girls (vs boys) and African Americans (vs
Whites) were more likely to have a court record
(adjusted odds ratio [AOR]=2.18; 95% confi-
dence interval [CI]=1.53, 3.09; and AOR=
2.12; 95% CI=1.23, 3.63, respectively).
Unlike those of most previous studies, our
findings were based on children’s self-report.
However, our findings confirm previous re-
search indicating that only a small proportion
of all incidents of child maltreatment come to
the attention of authorities.3Only 1 in 4
study participants who reported needing
medical treatment as a result of maltreatment
also had a court record of such abuse or neg-
lect. Even fewer children who had the highest
level of maltreatment (22%) or who reported
any maltreatment (17%) had court records of
abuse or neglect. We found no association be-
tween any of the 3 self-reported measures of
maltreatment and court records of abuse or
neglect. Moreover, there were no differences
in the mean level of maltreatment for chil-
dren with and without a court record of
abuse and neglect.
Among participants who reported any mal-
treatment, we found that African American
youths were more likely than Whites to also
have a court record of abuse or neglect. These
findings are consistent with previous research
that documented that African American
youths are overrepresented in CPS records.1 4,15
Moreover, the overrepresentation of minority
youths in child welfare systems is not because
of greater rates of maltreatment in these popu-
lations.16In fact, in our sample, self-reported
severe maltreatment was actually greater in
Whites than in African Americans.
There are several limitations to our study.
First, our analyses examine study participant’s
experiences with maltreatment, which could
have occurred anytime during the youth’s
lifetime. These self-reported experiences may
be biased if participants chose not to disclose
their experiences or if they were unable to re-
call or report the information accurately.
Moreover, not all types of maltreatment, in-
cluding sexual abuse, that participant’s may
have experienced3were assessed, and thus,
our findings likely underestimate the true
American Journal of Public Health | October 2006, Vol 96, No. 10 1852 | Research and Practice | Peer Reviewed | Swahn et al.
RESEARCH AND PRACTICE
prevalence of self-reported maltreatment. Spe-
cifically, only 1 item assessed neglect, the
most common form of maltreatment accord-
ing to CPS records.2
Second, we only obtained records from the
Cook County Court. Participants may have
had court records in other counties; hence
our estimate of the number of youths who
self-reported maltreatment and also had court
records of abuse may be too conservative.
Third, our findings are representative of high-
risk youths who are detained for delinquency;
they may have engaged in violent or delin-
quent behavior, used drugs, traded sex for
money or drugs, or been runaways. The find-
ings may not generalize to maltreated chil-
dren who do not come into contact with the
juvenile justice system, or to children who ex-
hibit primarily internalized problems or few
behavior problems at all.
Fourth, we cannot determine the potential
interactions between self-reported maltreat-
ment, internalized and externalized behav-
iors, service delivery or treatments, and in-
volvement in the criminal justice system.
However, these are all important factors that
may affect the developmental trajectories of
these high-risk youths. Recent studies have
examined the complex association between
maltreatment reports and juvenile incarcera-
tion1 7,18and found that in-home child welfare
services seem to reduce the risk of juvenile
corrections involvement for minority children
who have been reported for maltreatment.18
There are 3 implications of our findings.
First, we must improve identification of child
maltreatment. Seven of 10 detained youths
who self-reported serious maltreatment or
who required medical treatment as a result of
maltreatment were not detected by CPS in
the county that we studied. We need to in-
crease efforts to identify victims of child mal-
treatment and to provide them with the
needed services and protection. Emergency
Department data yield only a few cases that
are not already captured in CPS records.19
Therefore, we need to develop and validate
new screening tools, such as the Screening
Index for Physical Child Abuse20; improve
training21; and increase data sharing.21These
improvements may help nurses and clinicians
detect new cases of physical maltreatment
among pediatric trauma patients. Another
priority should be improving screening and
service delivery in schools, because teachers
and school staff have frequent interactions
with children who may be at risk.22
Second, we must enhance estimates of the
prevalence of child maltreatment. The limited
overlap between court records and self-reports
of child maltreatment indicates that official
records seriously underestimate the preva-
lence of abuse among high-risk youths. This
suggests that multiple data sources need to be
included in efforts to document the true prev-
alence of maltreatment. Comprehensive pro-
spective23and retrospective24, 25self-reported
maltreatment data need to be collected and
should include information about different
forms of maltreatment, notification of mal-
treatment to authorities, services and treat-
ment, and the consequences of maltreatment.
Third, we must increase understanding of
racial/ethnic disparities in official records of
child maltreatment. African American partici-
pants in our study did not self-report severe
maltreatment as frequently as Whites, but
they were more likely to have a court record
of abuse or neglect. Much of the racial varia-
tion in official records of abuse and neglect
can be attributed to racial differences in both
allegations and substantiations.26For exam-
ple, young minority children are more likely
than Whites to be evaluated and reported for
suspected abuse when receiving medical
care.27Thus, there are likely biases at many
levels within the complex set of agencies and
institutions involved with responding to
young victims of crime and violence (e.g., po-
lice, prosecutors, criminal and civil courts,
child protection agencies, children’s advocacy
centers, victim services, and mental health
The vast majority of maltreated high-risk
youths do not seem to receive the protection
and services that they need. Given the many
risky behaviors and adverse health outcomes
associated with maltreatment,1,12,13,29–32pro-
viding appropriate and timely services and
care to these youths needs to be a priority for
both the criminal justice system and for pub-
About the Authors
At the time of the study, Monica H. Swahn and
Courtney B. Pippen were with the Division of Violence
Prevention, National Center for Injury Prevention and
Control, Centers for Disease Control and Prevention,
Atlanta, Ga. Daniel J. Whitaker and Rebecca T. Leeb are
with the Division of Violence Prevention, National Center
for Injury Prevention and Control, Centers for Disease
Control and Prevention. Linda A. Teplin, Karen M. Abram,
and Gary M. McClelland are with the Pyscho-Legal Stud-
ies Program, Feinberg School of Medicine, Department of
Psychology and Behavioral Sciences, Northwestern Univer-
sity, Chicago, Ill.
Requests for reprints should be sent to Monica H.
Swahn, PhD, MPH, Office on Smoking and Health, Na-
tional Center for Chronic Disease Prevention and Health
Promotion, Centers for Disease Control and Prevention,
4770 Buford Hwy, Mail Stop K-50, Atlanta, GA 30341-
3724 (email: email@example.com).
This article was accepted October 9, 2005.
M.H. Swahn originated the study, analyzed the data,
and wrote the article. D.J. Whitaker provided concep-
tual and methodological guidance and helped write the
article. C.B. Pippen helped originate the study and as-
sisted with analyses. R.T. Leeb interpreted analyses and
helped write the article. L.A. Teplin planned the study,
directed the project, originated the study, and com-
mented on the article. K.M. Abram directed the field
study, provided assistance with preparation of data and
their interpretation, and commented on the article.
G.M. McClelland directed the data operation, assisted
with analyses, and reviewed the article.
This work was supported by National Institute of Mental
Health, Division of Services and Intervention Research
and the Center for Mental Health Research on AIDS
(grants R01MH54197 and R01MH59463); and the
Office of Juvenile Justice and Delinquency Prevention
(grant 1999-JE-FX–1001). Major funding was also pro-
vided by the National Institute on Drug Abuse, the Sub-
stance Abuse and Mental Health Services Administra-
tion (Center for Mental Health Services, Center for
Substance Abuse Prevention, Center for Substance
Abuse Treatment), the Centers for Disease Control and
Prevention (National Center for HIV, STD, and TB Pre-
vention and National Center for Injury Prevention and
Control), the National Institute on Alcohol Abuse and
Alcoholism, the National Institutes of Health (NIH) Of-
fice of Research on Women’s Health, the NIH Center on
Minority Health and Health Disparities, the NIH Office
on Rare Diseases, the Department of Labor, The Wil-
liam T. Grant Foundation (grant 2076), and The Robert
Wood Johnson Foundation (grant 041942). Additional
funds were provided by The John D. and Catherine T.
MacArthur Foundation, The Open Society Institute, and
The Chicago Community Trust. We thank all the agen-
cies for their collaborative spirit and steadfast support.
This study could not have been accomplished with-
out the advice of Ann Hohmann, Kimberly Hoagwood,
Heather Ringeisen, Grayson Norquist, and Delores Par-
ron. We thank project staff, especially Amy Lansing,
Amy Mericle, and Lynda Carey, for supervising data col-
lection and preparation. We appreciate the cooperation
of everyone working in the Cook County systems, espe-
cially David Lux, our project liaison, Chief Judge Timo-
thy Evans, Former Chief Judge Donald O’Connell, Judge
William Hibbler, Judge Curtis Heaston, Judge Nancy
Sidote Salyers, Judge Patricia Martin Bishop, Judge
Sophia Hall, Venkata Vallury, James Janik, Warren
October 2006, Vol 96, No. 10 | American Journal of Public Health Swahn et al. | Peer Reviewed | Research and Practice | 1853 Download full-text
RESEARCH AND PRACTICE
Watkins, J.W. Fairman, and the late Mary Kehoe Griffin.
Without the cooperation of Cook County, this study
would not have been possible. We thank our participant
advocate, Michael Mahoney. Finally, we thank our par-
ticipants for their time and willingness to participate.
Note. The findings and conclusions in this report are
those of the authors and do not necessarily represent
the views of the Centers for Disease Control and Pre-
vention or the funding agencies.
Human Participant Protection
This research was approved by the Northwestern Uni-
versity and the Centers for Disease Control and Preven-
tion institutional review boards. We obtained informed
consent from all participants aged 18 and older. For
participants younger than 18, we obtained assent from
the subjects and consent from a parent or guardian
whenever possible; when this was not possible, partici-
pant assent was overseen by a participant advocate rep-
resenting the interest of the youth.
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