Paul Lanier

Geographic variation in racial disparities in child maltreatment: The influence of county poverty and population density

There are documented disparities in the rates at which black children come into contact with the child welfare system in the United States compared to white children. A great deal of research has proliferated aimed at understanding whether systematic biases or differential rates of risk among different groups drive these disparities (Drake et al., 2011). In the current study, county rates of maltreatment disparity are compared across the United States and examined in relation to rates of poverty disparity as well as population density. Specifically, using hierarchical linear modeling with a spatially lagged dependent variable, the current study examined data from the National Child Abuse and Neglect Data System (NCANDS) and found that poverty disparities were associated with rates of maltreatment disparities, and densely populated metropolitan counties tended to have the greatest levels of maltreatment disparity for both black and Hispanic children. A significant curvilinear relationship was also observed between these variables, such that in addition to the most densely populated counties, the most sparsely populated counties also tended to have higher rates of maltreatment disparity for black and Hispanic children.

A Preliminary Examination of Child Well-Being of Physically Abused and Neglected Children Compared to a Normative Pediatric Population

Federal mandates require state child welfare systems to monitor and improve outcomes for children in three areas: safety, permanency, and well-being. Research across separate domains of child well-being indicates maltreated children may experience lower pediatric health–related quality of life (HRQL). This study assessed well-being in maltreated children using the Pediatric Quality of Life Inventory (PedsQL 4.0), a widely used measure of pediatric HRQL. The PedsQL 4.0 was used to assess well-being in a sample of children (N = 129) receiving child welfare services following reports of alleged physical abuse or neglect. We compared total scores and domain scores for this maltreated sample to those of a published normative sample. Within the maltreated sample, we also compared well-being by child and family demographic characteristics. As compared with a normative pediatric population, maltreated children reported significantly lower total, physical, and psychosocial health. We found no significant differences in total and domain scores based on child and parent demographics within the maltreated sample. This preliminary exploration indicates children receiving child welfare services have significantly lower well-being status than the general child population and have considerable deficits in social and emotional functioning. These findings support continued investment in maltreatment prevention and services to improve the well-being of victims of maltreatment.

Comparing primiparous and multiparous mothers in a nurse home visiting prevention program.

BACKGROUND An important yet overlooked feature of prominent prevention programs serving expectant mothers is the exclusion of women with children. This study examines mothers (n = 3,260) participating in a program without parity exclusion criteria, and compares demographic characteristics, risk status, service use, and child maltreatment outcomes. METHODS A longitudinal, prospective study comparing primiparous (n = 1,890) and multiparous (n = 1,370) mothers participating in a nurse home visiting program. Patient groups are compared using bivariate and multivariate methods. RESULTS Comparison by parity shows multiparous mothers had higher cumulative risk scores and individual risk factors related to maternal and child health, behavioral health, and violence exposure. Multiparous mothers were more likely to seek out services themselves and to initiate services later in the postnatal period. A significant trend exists among more children and greater caregiver stress, maternal depression, and child maltreatment. Multivariate models indicate infants of multiparous mothers have a higher risk (hazard ratio = 1.49) for later reports of child maltreatment. CONCLUSIONS As compared with primiparous mothers, multiparous mothers were at higher risk but had similar levels of service use. Programs limited to primiparous mothers are missing a critical opportunity for prevention. Programs serving multiparous mothers should incorporate strategies to directly address caregiver stress and postpartum depression.

Adverse Childhood Experiences and Child Health Outcomes: Comparing Cumulative Risk and Latent Class Approaches

Objectives This study seeks to further the work exploring adverse childhood experiences (ACEs) by proposing a novel approach to understanding the impact of ACEs through applying advanced analytical methods to examine whether combinations of ACEs differentially impact child health outcomes. Methods Using National Survey of Children’s Health data, we use latent class analysis to estimate associations between classes of ACEs and child health outcomes. Results Class membership predicts child poor health, with differences found for specific ACE combinations. A subgroup of children exposed to poverty and parental mental illness are at higher risk for special healthcare needs than all other groups, including children exposed to 3 or more ACEs. Conclusions Different combinations of ACEs carry different risk for child health. Interventions tailored to specific ACEs and ACE combinations are likely to have a greater effect on improving child health. Our findings suggest children who experience specific ACE combinations (e.g., poverty and parental mental illness) are at particularly high risk for poor health outcomes. Therefore, clinicians should routinely assess for ACEs to identify children exposed to the most problematic ACE combinations; once identified, these children should be given priority for supportive interventions tailored to their specific ACE exposure and needs.

Quantifying sources of bias in longitudinal data linkage studies of child abuse and neglect: measuring impact of outcome specification, linkage error, and partial cohort follow-up

BackgroundHealth informatics projects combining statewide birth populations with child welfare records have emerged as a valuable approach to conducting longitudinal research of child maltreatment. The potential bias resulting from linkage misspecification, partial cohort follow-up, and outcome misclassification in these studies has been largely unexplored. This study integrated epidemiological survey and novel administrative data sources to establish the Alaska Longitudinal Child Abuse and Neglect Linkage (ALCANLink) project. Using these data we evaluated and quantified the impact of non-linkage misspecification and single source maltreatment ascertainment use on reported maltreatment risk and effect estimates.MethodsThe ALCANLink project integrates the 2009–2011 Alaska Pregnancy Risk Assessment Monitoring System (PRAMS) sample with multiple administrative databases through 2014, including one novel administrative source to track out-of-state emigration. For this project we limited our analysis to the 2009 PRAMS sample. We report on the impact of linkage quality, cohort follow-up, and multisource outcome ascertainment on the incidence proportion of reported maltreatment before age 6 and hazard ratios of selected characteristics that are often available in birth cohort linkage studies of maltreatment.ResultsFailure to account for out-of-state emigration biased the incidence proportion by 12% (from 28.3%w to 25.2%w), and the hazard ratio (HR) by as much as 33% for some risk factors. Overly restrictive linkage parameters biased the incidence proportion downwards by 43% and the HR by as much as 27% for some factors. Multi-source linkages, on the other hand, were of little benefit for improving reported maltreatment ascertainment.ConclusionUsing the ALCANLink data which included a novel administrative data source, we were able to observe and quantify bias to both the incidence proportion and HR in a birth cohort linkage study of reported child maltreatment. Failure to account for out-of-state emigration and low-quality linkage methods may induce bias in longitudinal data linkage studies of child maltreatment which other researchers should be aware of. In this study multi-agency linkage did not lead to substantial increased detection of reported maltreatment. The ALCANLink methodology may be a practical approach for other states interested in developing longitudinal birth cohort linkage studies of maltreatment that requires limited resources to implement, provides comprehensive data elements, and can facilitate comparability between studies.

Scaling Up: Replicating Promising Interventions with Fidelity

To retain the demonstrated effects of any tested program, interventions must maintain model fidelity at the individual and organizational levels and faithfully replicate the content and process of the intervention’s delivery system. While most agree on the importance of accurate and consistent replication, achieving a high level of fidelity and measuring the degree to which a replication meets model standards is a complex undertaking. Although many interventions share similar components, capturing the unique aspects of a model may require an individualized fidelity monitoring system. This chapter provides an overview of how program fidelity has been addressed in the child welfare system and assesses the current status of such efforts, details the development and monitoring of fidelity in two model interventions (Attachment and Biobehavioral Catch-Up and SafeCare®), and discusses the major questions facing practitioners, administrators, policy makers, and researchers as promising interventions are scaled-up.

Measuring Stigma for Seeking Parenting Help Among Head Start Fathers

Objective: Public stigma impedes marginalized populations from accessing health and social services. However, little is known about public stigma as a potential barrier to engagement with maltreatment prevention programs such as parenting interventions. This study presents an initial examination of the psychometric properties of an adapted version of the Stigma Scale for Receiving Psychological Help (SSRPH) used with a sample of fathers/male caregivers eligible for a parenting support intervention implemented at Head Start. Method: The psychometric properties of the adapted SSRPH were assessed using cognitive interviews, confirmatory factor analysis, and measures of internal consistency. Descriptive statistics from the adapted SSRPH were used to describe the level of stigma experienced in this sample. Results: Consistent findings from cognitive interviews and positive psychometric results [χ2 (5, N = 83) = 6.99, p = .22], TLI = .96, CFI = .98, RMSEA = .07 (90% confidence interval [0.00, 0.18], alpha = .78) support the use of the adapted SSRPH. The total summed scale (range: 0–15) indicates low average perceived public stigma (M = 3.62, SD = 2.59). Conclusions: The modifications made to the SSRPH are supported for use with the sampled fathers. Future research seeking to assess stigma among fathers engaged in parent support programs should consider using this adapted stigma scale. Relative to findings from other studies focused on stigma and receiving psychological help, our findings indicate lower levels of public stigma associated with receiving parenting help in the context of a Head Start program.

Classification of maltreatment-related mortality by Child Death Review teams: How reliable are they?

Accurate estimation of the incidence of maltreatment-related child mortality depends on reliable child fatality review. We examined the inter-rater reliability of maltreatment designation for two Alaskan Child Death Review (CDR) panels. Two different multidisciplinary CDR panels each reviewed a series of 101 infant and child deaths (ages 0-4 years) in Alaska. Both panels independently reviewed identical medical, autopsy, law enforcement, child welfare, and administrative records for each death utilizing the same maltreatment criteria. Percent agreement for maltreatment was 64.7% with a weighted Kappa of 0.61 (95% CI 0.51, 0.70). Across maltreatment subtypes, agreement was highest for abuse (69.3%) and lowest for negligence (60.4%). Discordance was higher if the mother was unmarried or a smoker, if residence was rural, or if there was a family history of child protective services report(s). Incidence estimates did not depend on which panels data were used. There is substantial room for improvement in the reliability of CDR panel assessment of maltreatment related mortality. Standardized decision guidance for CDR panels may improve the reliability of their data.

Examining parenting quality and dyad interactions between female CPS- and/or court-involved partner violence survivors and their young children using observational methods

ABSTRACT Mothers who are intimate partner violence (IPV) survivors are often mandated to parenting services by child protection services (CPS) and/or the courts. Unfortunately, there is limited research regarding the parenting needs and strengths of these system-involved IPV survivors, and existing research tends to rely on self-report parenting data. The purpose of this study was to: (a) assess the feasibility and acceptability of collecting observational data from system-involved mothers who are IPV survivors and have been mandated to a parenting program, (b) assess the feasibility of the Keys to Interactive Parenting Scale (KIPS) in this context, (c) examine the parenting strengths and needs of these IPV survivors, and (d) explore associations between self-report and observational measures of parenting. Among eligible mothers, 49% (n = 25) participated. Observational and self-report data collected at program entry indicated positive parenting. Although associations between KIPS and self-report measures of parenting were low, the KIPS has the potential to be useful tool for assessing parent-child interactions in the context of IPV services.

Maternal Intimate Partner Violence Victimization Before and During Pregnancy and Postbirth Child Welfare Contact A Population-Based Assessment

We conducted a population-based prospective cohort study to help elucidate the predictive relationship between a maternal prebirth selfreported history of intimate partner violence (IPV) and any postbirth reported allegation to Child Protective Services (CPS) by age 2. We linked data from the 2009–2010 Alaska Pregnancy Risk Assessment Monitoring System with CPS data through 2012. Among this cohort, we found that 8.0%w self-reported experiencing IPV 12 months prior or during pregnancy, and 8.0%w of the offspring experienced at least one CPS report of alleged maltreatment during the study period. The predictive relationship varied by maternal educational attainment. Among mothers with 12+ years education completed, the odds of a CPS report were 3.9 times compared to those with no IPV, while among mothers with <12 years education completed, no association was noted. These results suggest that for a subset of Alaskan families, maternal history of IPV is a strong independent predictor of future CPS contact.