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An estimated 1 in 3 U.S. children will be the subject of a child protective services (CPS) investigation during their lifetime, typically for allegations of neglect. Whether and how an initial report of neglect is addressed may place children on divergent trajectories for safety and stability throughout childhood. The purpose of this study is to track subsequent CPS contact among children born in California in 2000 who were first investigated by CPS for neglect allegations alone (no co-occurring abuse) and not permanently separated from their families of origin (i.e., not removed or reunified if removed). We estimated the rates of subsequent CPS referrals, substantiated maltreatment, placement in foster care, and allegations of physical and sexual abuse by age 18. We assessed how rates of subsequent contact varied by initial CPS response and age at first investigation. Supplemental analyses disaggregated data by race and ethnicity. Results indicate that 64% of children initially investigated for neglect alone were re-referred to CPS by age 18 and 16% experienced a subsequent removal; however, these estimates varied greatly by age. Four out of five (79% to 83%) of children initially investigated as infants had one or more subsequent CPS referrals during childhood. Children were not only re-referred for allegations of neglect; more than half of children re-referred were reported for allegations of physical or sexual abuse, indicating that abuse risk was either missed during the initial CPS investigation or escalated afterward. The failure to address maltreatment risks when children first present to the system is a complex problem with no easy solution. Our findings document that a majority of children initially referred for neglect experience future CPS involvement, often for allegations of physical or sexual abuse.

ObjectivesConcerns have been raised that parents with intellectual and/or developmental disabilities (IDD) interact with child protective services (CPS) at disproportionate rates than the general population as a result of bias and discrimination. However, there has been little empirical evidence to ascertain if these concerns are grounded. This study’s objectives were to identify (a) the prevalence and sociodemographic characteristics of children born to mothers diagnosed with IDD diagnoses, (b) how many of these children interact with CPS (reports and removals) and (c) when these CPS interactions are occurring.MethodsThe dataset was comprised of linked administrative birth, hospital discharge, and CPS records for all children born in one U.S. state between 1999 and 2013 (N = 1,271,419). CPS records were available through the first quarter of 2018 and CPS reports and removals at the child’s first and fourth birthdays were identified. We conducted chi-square tests and multivariate survival Cox regression models.ResultsA total of 567 children were identified as born to mothers with IDD diagnoses, which is 4.5 per 10,000 births. Of these children, 21.7% were the subject of a CPS report within 1 year and 35.8% within 4 years. In terms of removals, 6.5% experienced removals by 1 year and 8.6% by 4 years.Conclusions for PracticeThis study provides population-based knowledge about how and when the children born to mothers diagnosed with IDD interact with CPS. These children have higher rates of CPS interactions than the general population, but these rates are not as high as previously reported.

Statement of PurposeChild maltreatment has lifelong impacts on health and well-being, which can result in serious injuries and death. The objective of this study was to identify the incidence and risk factors of child maltreatment-related injuries resulting in hospitalizations for children under three for the population of Washington State.Methods/ApproachA prospective cohort study utilizing retrospective linked administrative data for all children born in Washington State between 1999 and 2013 (N=1,271,419). The data set comprised of linked birth discharge and hospitalization records for the entire state. Child maltreatment-related hospitalizations were identified using ICD-9 codes, both specifically attributed to and suggestive of maltreatment. Incidence rates were calculated for the overall population, by year, sex, maltreatment type, and child age. Risk and protective factors were identified using hierarchical linear modeling to test community-level poverty/disadvantage simultaneously with sociodemographic variables from the birth record.ResultsA total of 4,078 hospitalizations related to child maltreatment were identified for an incidence rate of 3.21 per 1,000 births. More than half of all hospitalizations were related to neglect. Children whose mother resided in a census tract with high concentrated disadvantage at the time of the child’s birth experienced child maltreatment-related hospitalizations at 1.2 times the rate of children who did not reside in high concentrated disadvantage census tracts.ConclusionsHospitalizations can be a useful source of population-based child maltreatment surveillance.These population-based data suggest that the community context, in addition to individual-level factors, contributes to the risk of a child being hospitalized for child maltreatment-related reasons.Significance and Contributions to Injury and Prevention ScienceThe identification of neglect-related hospitalizations as the most common sub-type, and likely the result of supervisory neglect, are important findings for the development and implementation of prevention programming.

The latest Child Abuse Prevention and Treatment Act reauthorization bill would change the way families of substance-exposed infants are treated. The Biden administration could also leverage prevention and public health systems to achieve the policy’s objectives.

During the COVID-19 pandemic, reports to child abuse and neglect hotlines have dropped significantly across the United States. Yet, during this same period, calls to domestic violence hotlines have increased. The purpose of this study was to examine if there have been measurable changes in domestic violence-related reports to child abuse and neglect hotlines. Using administrative child protection records from California, we plotted counts and proportions of child maltreatment reports with and without domestic violence allegations before and through the onset of school closures associated with the COVID-19 pandemic. We used an interrupted time series analysis to evaluate whether or not there was a change in domestic violence allegations in child protection reports corresponding to the COVID-19 pandemic. We document that during the first two quarters of 2020 there was a 14.3% drop in the overall number of child protection reports. Despite a decline in maltreatment reporting overall, there was a 25% increase in the proportion of reports with allegations of domestic violence. Our findings suggest both the count and composition of reports to child protection agencies were affected by the COVID-19 pandemic. The current analyses also showcase the seasonality of CPS reports generally, and reports with DV allegations, specifically.

Child maltreatment is a pervasive public health problem with well-documented impacts on a child's well-being. The connection between social , determinants , of health and child maltreatment is well established, particularly economic stability and mobility, education, and health care. Prevention and aftercare networks (P&A) use a community-based approach to offer volun tary services to address social determinants of health through collaborative approaches to supporting and strengthening families in their communities. The three core strategies of P&A are to provide economic opportunities and support self-sufficiency, decrease social isolation, and increase access to a broad range of existing community-based resources, supports, and services. The current study leveraged administrative child protection system (CPS) records and P&A program data from Los Angeles County to document the relationship between P&A referrals and CPS involvement following service engagement among families with screened-out CPS reports between January 1, 2016, and December 31, 2019 (N = 52,353). Overall, 6,895 (13.2%) families were referred for P&A services and 748 (1.4%) successfully completed P&A services. Weighted Cox analyses showed families who completed P&A services were less likely to enter foster care compared to families never referred to P&A services (HR = 0.51; 95% CI = 0.33, 0.78). Results suggest that offering voluntary, community-based services may prevent out-of-home placement, especially if families engage in and successfully complete services.

Despite the breadth of the identified impacts and costs of child maltreatment, a primary challenge in our understanding of child maltreatment is that we still do not have solid numbers of children who experience it. Further, despite child protection systems (CPS) being reliant on mandated reporters to bring concerns of child maltreatment to their attention, there is little information about how systems respond to concerns of child maltreatment. Informed by the public health approach and ecological systems theory, this dissertation utilizes a novel linked administrative dataset of birth, hospital discharge, and CPS records to provide new knowledge about hospitalizations related to child maltreatment. It does so in three ways: identifying the incidence and prevalence of child maltreatment-related hospitalizations, the risk and protective factors of these hospitalizations, and the systems responses to these hospitalizations, as measured by CPS reports and removals by CPS. Results indicate that most common form of child maltreatment-related hospitalizations was neglect and, more specifically, supervisory neglect. Identified risk factors included child’s low birth weight, mothers who were teenagers at the time of birth, non-first born children, maternal residence in zip codes with high concentrated disadvantage, and a prior CPS report. System responses were dependent on the subtype of maltreatment and type of diagnostic code used. Specifically, physical abuse and codes specifically related to maltreatment had higher rates of CPS reports and removals compared to the other maltreatment subtypes and diagnostic codes not specifically related to maltreatment. These results provide new knowledge regarding child maltreatment. The results can be used to target prevention programming, which are identifiable at birth, increasing their utility. The new knowledge identified through this study has important implications for our understanding of child maltreatment, how we can prevent it, and how current systems are responding to it.