Melissa Jonson-Reid

Time to Leave Substantiation Behind: Findings From A National Probability Study

Data from the National Survey of Child and Adolescent Well-being, a national probability study of children and families investigated for child maltreatment, were analyzed to answer the question: Do substantiated and unsubstantiated cases differ in rates of recidivism over 36 months? Recidivism was classified as (a) any re-reports, (b) substantiated re-reports and (c) subsequent foster care placements. Bivariate (survivor functions estimated by the Kaplan-Meier method) and multivariate (Cox regression modeling) analyses were conducted. The results revealed that risk of recidivism was similar regardless of substantiation status of the index investigation. We suggest that the substantiation label be removed from field use. Instead, we suggest that agencies record service needs in the families they serve, and also record whether or not the family meets criteria for referral to the family court. These would be far more practical and meaningful ways to measure child welfare services.

Substantiation and Recidivism

This article reports rates of recidivism among initially substantiated and initially unsubstantiated child maltreatment events to determine if substantiation status is associated with higher risk of recidivism. This is an important question given recent concerns that unsubstantiated cases may have as high or almost as high a risk of recidivism as do substantiated cases. The data are analyzed at both the victim level and the case level, divided by type of maltreatment, and followed for 4.5 years. The data used are administrative and combine a series of state databases with census data. Analyses are performed at the bivariate and multivariate (Cox proportional hazards model) levels. The main finding is that unsubstantiated cases are at high risk for recidivism, in many cases as high a risk as substantiated cases. Implications for practice, policy, and research are presented with a focus on the importance of providing preventative services to unsubstantiated cases.

From placement to prison: The path to adolescent incarceration from child welfare supervised foster or group care

Abstract Previous studies have found a substantial proportion of youth who exit foster or group care experience negative outcomes such as poor mental health or incarceration. Yet, little is known about the increase or decrease in the likelihood of negative outcomes like serious youthful offending according to different pathways in and out of foster care. The present study adds significantly to the scant literature on the outcomes of children served in the foster care system by conducting a prospective examination of adolescent incarceration for serious felony and violent offenses as a post-discharge outcome for children in out-of-home placement. Results indicate that children first placed between the ages of 12 and 15, children with multiple placements and multiple spells in care, and children who have placement experiences supervised by probation following their child welfare involvement had a higher risk of incarceration for a serious or violent offense during adolescence. The risk for different ethnic groups changed according to the type of foster care experience, as well as the gender of the child. Recommendations for future research and service delivery are made.

From maltreatment report to juvenile incarceration: the role of child welfare services

OBJECTIVE This study examined whether children who received child welfare services (e.g., in-home or out-of-home placement) were more or less likely to become incarcerated as serious and violent youthful offenders than those children who were investigated as victims of abuse and neglect but received no further child welfare intervention. METHOD Administrative data on child abuse reporting, foster care, birth records, and juvenile corrections (CYA) were linked to prospectively examine the risk of incarceration as an adolescent following an investigation of abuse or neglect after age 6. The 10 county California sample included 159,549 school-aged children reported for abuse and neglect after 1990. RESULTS About 8 per 1,000 children in the sample were later incarcerated in CYA. African American and Hispanic children who received in-home or foster care services after the index investigation event had a lower risk of incarceration than those whose cases were closed after the investigation. Among females, the rate of incarceration was highest for those who experienced foster or group care placements. Children initially reported for neglect were more likely to be incarcerated than those reported for physical or sexual abuse. CONCLUSIONS Public child welfare services have rarely been assessed in terms of future negative child outcomes. This study finds that one serious negative outcome, CYA involvement, can only be understood when a number of factors are considered. The importance of understanding the differences between how different subpopulations respond to services is highlighted. Specifically, our findings suggest that more attention should be focused on children who are now receiving no services after an investigated child abuse and neglect report, on females, and on victims of child neglect.

Child and Adult Outcomes of Chronic Child Maltreatment

OBJECTIVE: To describe how child maltreatment chronicity is related to negative outcomes in later childhood and early adulthood. METHODS: The study included 5994 low-income children from St Louis, including 3521 with child maltreatment reports, who were followed from 1993–1994 through 2009. Children were 1.5 to 11 years of age at sampling. Data include administrative and treatment records indicating substance abuse, mental health treatment, brain injury, sexually transmitted disease, suicide attempts, and violent delinquency before age 18 and child maltreatment perpetration, mental health treatment, or substance abuse in adulthood. Multivariate analysis controlled for potential confounders. RESULTS: Child maltreatment chronicity predicted negative childhood outcomes in a linear fashion (eg, percentage with at least 1 negative outcome: no maltreatment = 29.7%, 1 report = 39.5%, 4 reports = 67.1%). Suicide attempts before age 18 showed the largest proportionate increase with repeated maltreatment (no report versus 4+ reports = +625%, P < .0001). The dose-response relationship was reduced once controls for other adverse child outcomes were added in multivariate models of child maltreatment perpetration and mental health issues. The relationship between adult substance abuse and maltreatment report history disappeared after controlling for adverse child outcomes. CONCLUSIONS: Child maltreatment chronicity as measured by official reports is a robust indicator of future negative outcomes across a range of systems, but this relationship may desist for certain adult outcomes once childhood adverse events are controlled. Although primary and secondary prevention remain important approaches, this study suggests that enhanced tertiary prevention may pay high dividends across a range of medical and behavioral domains.

Racial bias in child protection? A comparison of competing explanations using national data

OBJECTIVE: Cases of child abuse and neglect that involve black children are reported to and substantiated by public child welfare agencies at a rate approximately twice that of cases that involve white children. A range of studies have been performed to assess the degree to which this racial disproportionality is attributable to racial bias in physicians, nurses, and other professionals mandated to report suspected child victimization. The prevailing current explanation posits that the presence of bias among reporters and within the child welfare system has led to the current large overrepresentation of black children. A competing explanation is that overrepresentation of black children is mainly the consequence of increased exposure to risk factors such as poverty. METHODS: We tested the competing models by using data drawn from national child welfare and public health sources. We compared racial disproportionality ratios on rates of victimization from official child welfare organizations to rates of key public health outcomes not subject to the same potential biases (eg, general infant mortality). RESULTS: We found that racial differences in victimization rate data from the official child welfare system are consistent with known differences for other child outcomes. We also found evidence supporting the presence of cultural protective factors for Hispanic children, termed the “Hispanic paradox.” CONCLUSIONS: Although our findings do not preclude the possibility of racial bias, these findings suggest that racial bias in reporting and in the child welfare system are not large-scale drivers of racial disproportionality. Our data suggest that reduction of black/white racial disproportionality in the child welfare system can best be achieved by a public health approach to reducing underlying risk factors that affect black families.

A prospective analysis of the relationship between reported child maltreatment and special education eligibility among poor children

This study presents data from the first large-scale longitudinal study to track the involvement of children reported for maltreatment in both the special education and child welfare systems. A range of state and local administrative databases were combined and cross-sector service histories were established for 7,940 children who had received Aid to Families With Dependent Children between 1993 and 1994. The authors address the following questions: (a) Is maltreatment associated with entry into special education after controlling for other factors? (b) among maltreated children, does maltreatment type or child welfare service use predict special education eligibility? and (c) what is the relationship between maltreatment type and type of educational disability? Results indicate that child maltreatment system involvement generally predates special education entry and is predictive of entry even after controlling for other factors. A range of other associations between factors such as child and maternal characteristics, services received, maltreatment type, and special education classification are detailed.

Race and child maltreatment reporting: Are Blacks overrepresented?

This paper uses Census and child welfare report data from Missouri (1999, 2000 & 2001) to determine if Whites and Blacks are reported for child maltreatment at similar or different rates while controlling for poverty and racial homogeneity. We do not find evidence for high levels of racial disproportionality once poverty is controlled. Poverty is generally associated with higher rates of reporting for both races. We found some evidence of differential sensitivity, with the relationship between poverty and report rate being somewhat stronger for Whites than for Blacks.

Child Maltreatment and Pediatric Health Outcomes: A Longitudinal Study of Low-income Children

OBJECTIVE To examine if maltreatment predicted increased risk of hospital-based treatment prior to age 18 years for asthma, cardio-respiratory, and non-sexually transmitted infectious disease in a sample of low-income children. METHODS This study used administrative data from multiple systems to follow children for 12-18 years (N = 6,282). Cox regression was used to explore the risk of first hospital treatment by disease category. Negative binomial regression was used to explore the relationship between recurrent maltreatment and total hospital care episodes. RESULTS Controlling for individual, family, and community factors, children with maltreatment reports had a 74-100% higher risk of hospital treatment. Recurrent reports predicted a higher count of hospital care episodes. CONCLUSIONS The negative health impact of maltreatment prior to adulthood supports the need for early prevention and intervention to prevent initial and recurrent child abuse and improve capacity to meet healthcare needs of maltreated children.

Exploring the Relationship Between Child Welfare Intervention and Juvenile Corrections Involvement

This study of school-age children reported for maltreatment investigated whether child welfare services moderated the risk of later juvenile corrections entry and what factors explained juvenile corrections entry among children who received child welfare services. Non-White children who received in-home child welfare services had a lower risk of juvenile corrections than those receiving no services. Among children who received child welfare services, those also receiving mental health services were at higher risk of juvenile corrections entry.