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Objectives. To investigate whether a newborn home visiting program for primiparous adolescent mothers (aged 16–20 years at childbirth) reduced recurrence of child maltreatment in child protective services (CPS) reports. Methods. We conducted a randomized controlled trial of Healthy Families Massachusetts, a statewide home visiting program for young parents. A total of 704 first-time young mothers were randomly assigned to a home visiting group, or to a control group who we referred to other services and who received child development and parenting information. The outcome variable was CPS reports (2008–2016) available for 688 families—specifically, rereports following an initial report (up to mean child age of 7 years). Results. Of the 52% of families who experienced initial CPS reports, 53% experienced additional CPS reports. Children of mothers in the home visiting group were less likely to receive a second report and had a longer period of time between initial and second reports. Conclusions. The home visiting program reduced the recurrence of CPS maltreatment report by 32% and increased the length of time between initial and additional CPS reports. Home visiting parenting support and prevention programs may reduce the likelihood of recurrent maltreatment following completion of program services.

Child maltreatment is a prominent public health concern affecting 20% to 50% of children worldwide. Consequences for mental and physical health have been reported, but population-level estimates of risk of death during childhood that are adjusted for confounders have not been published to date. To estimate the association of documented child protection concerns regarding maltreatment with risk of death from infancy to 16 years of age. This case-control study was nested in a population birth cohort of 608 547 persons born in South Australia, Australia. Case children were those who died between 1 month and 16 years of age (with the death registered by May 31, 2019). Control children were randomly selected individuals from the same population who were alive at the age at which the case child died, matched 5:1 for age, sex, and Aboriginal status. Data were analyzed from January 2019 to March 2021. Children were assigned to 1 of 4 child protection concern categories (child protection system notification[s] only, investigation[s] [not substantiated], substantiated maltreatment, and ever placed in out-of-home care) based on administrative data from the South Australia Department for Child Protection or were classified as unexposed. Mortality rate ratios for death before 16 years of age, by child protection concern category, were estimated using conditional logistic regression, adjusted for birth outcomes, maternal attributes, and area-based socioeconomic status. Patterns of cause of death were compared for children with vs without child protection concerns. Of 606 665 children included in the study, 1635 were case children (57.9% male [when sex was known]; mean [SD] age, 3.59 [4.56] years) and 8175 were control children (57.7% male; mean [SD] age, 3.59 [4.56] years [age censored at the time of death of the matched control child]). Compared with children with no child protection system contact, adjusted mortality rate ratios among children who died before 16 years of age were 2.69 (95% CI, 2.05-3.54) for children with child protection system notification(s) only; 3.16 (95% CI, 2.25-4.43) for children with investigation(s) (not substantiated); 2.93 (95% CI, 1.95-4.40) with substantiated maltreatment; and 3.79 (95% CI, 2.46-5.85) for children ever placed in out-of-home care. External causes represented 136 of 314 deaths (43.3%) among children with a documented child protection concern and 288 of 1306 deaths (22.1%) among other children. Deaths from assault or self-harm were most overrepresented, accounting for 11.1% of deaths in children with child protection concerns but just 0.8% of deaths among other children. In this case-control study, children with documented child protection concerns, who were known to child protection agencies and were typically seen by clinicians and other service providers, had a higher risk of death compared with children with no child protection service contact. These findings suggest the need for a more comprehensive service response for children with protection concerns.

Objectives. To document the cumulative childhood risk of different levels of involvement with the child protection system (CPS), including terminations of parental rights (TPRs). Methods. We linked vital records for California’s 1999 birth cohort (n = 519 248) to CPS records from 1999 to 2017. We used sociodemographic information captured at birth to estimate differences in the cumulative percentage of children investigated, substantiated, placed in foster care, and with a TPR. Results. Overall, 26.3% of children were investigated for maltreatment, 10.5% were substantiated, 4.3% were placed in foster care, and 1.1% experienced a TPR. Roughly 1 in 2 Black and Native American children were investigated during childhood. Children receiving public insurance experienced CPS involvement at more than twice the rate of children with private insurance. Conclusions. Findings provide a lower-bound estimate of CPS involvement and extend previous research by documenting demographic differences, including in TPRs. Public Health Implications. Conservatively, CPS investigates more than a quarter of children born in California for abuse or neglect. These data reinforce policy questions about the current scope and reach of our modern CPS.

This article provides county-level estimates of the cumulative prevalence of four levels of Child Protective Services (CPS) contact using administrative data from the 20 most populous counties in the United States. Rates of CPS investigation are extremely high in almost every county. Racial and ethnic inequality in case outcomes is large in some counties. The total median investigation rate was 41.3%; the risk for Black, Hispanic, and White children exceeded 20% in all counties. Risks of having a CPS investigation were highest for Black children (43.2 to 72.0%). Black children also experienced high rates of later-stage CPS contact, with rates often above 20% for confirmed maltreatment, 10% for foster care placement, and 2% for termination of parental rights (TPR). The only other children who experienced such extreme rates of later-stage CPS interventions were American Indian/Alaska Native children in Middlesex, MA; Hispanic children in Bexar, TX; and all children except Asian/Pacific Islander children in Maricopa, AZ. The latter has uniquely high rates of late-stage CPS interventions. In some jurisdictions, such as New York, NY, (0.2%) and Cook, IL (0.2%), very few children experienced TPR. These results show that early CPS interventions are ubiquitous in large counties but with marked variation in how CPS systems respond to these investigations.

ObjectivesTo determine any change in referral patterns and outcomes in children (0–18) referred for child protection medical examination (CPME) during the COVID-19 pandemic compared with previous years.DesignRetrospective observational study, analysing routinely collected clinical data from CPME reports in a rapid response to the pandemic lockdown.SettingBirmingham Community Healthcare NHS Trust, which provides all routine CPME for Birmingham, England, population 1.1 million including 288 000 children.ParticipantsChildren aged under 18 years attending CPME during an 18-week period from late February to late June during the years 2018–2020.Main outcome measuresNumbers of referrals, source of disclosure and outcomes from CPME.ResultsThere were 78 CPME referrals in 2018, 75 in 2019 and 47 in 2020, this was a 39.7% (95% CI 12.4% to 59.0%) reduction in referrals from 2018 to 2020, and a 37.3% (95% CI 8.6% to 57.4%) reduction from 2019 to 2020. There were fewer CPME referrals initiated by school staff in 2020, 12 (26%) compared with 36 (47%) and 38 (52%) in 2018 and 2019, respectively. In all years 75.9% of children were known to social care prior to CPME, and 94% of CPME concluded that there were significant safeguarding concerns.ConclusionsSchool closure due to COVID-19 may have harmed children as child abuse has remained hidden. There needs to be either mandatory attendance at schools in future or viable alternatives found. There may be a significant increase in safeguarding referrals when schools fully reopen as children disclose the abuse they have experienced at home.

BackgroundPrevious research shows that maternal mental illness is an important risk factor for child maltreatment. This study aims to quantify the relationship between maternal mental health and risk of child maltreatment according to the different types of mental health diagnoses.MethodsThe study used a retrospective cohort of children born in Western Australia between 1990 and 2005, with deidentified linked data from routine health and child protection collections.ResultsNearly 1 in 10 children (9.2%) of mothers with a prior mental health contact had a maltreatment allegation. Alternatively, almost half the children with a maltreatment allegation had a mother with a mental health contact. After adjusting for other risk factors, a history of mental health contacts was associated with a more than doubled risk of allegations (HR=2.64, 95% CI 2.50 to 2.80). Overall, all mental health diagnostic groups were associated with an increased risk of allegations. The greatest risk was found for maternal intellectual disability, followed by disorders of childhood and psychological development, personality disorders, substance-related disorders, and organic disorders. Maltreatment allegations were substantiated at a slightly higher rate than for the general population.ConclusionsOur study shows that maternal mental health is an important factor in child protection involvement. The level of risk varies across diagnostic groups. It is important that mothers with mental health issues are offered appropriate support and services. Adult mental health services should also be aware and discuss the impact of maternal mental health on the family and children's safety and well-being.

Objectives. To document, via linked administrative data, the cumulative prevalence among New Zealand children of notifications to child protective services (CPS), substantiated maltreatment cases, and out-of-home placements. Methods. We followed all children born in New Zealand in 1998 until the end of 2015 (an overall sample of 55 443 children). We determined the cumulative frequencies of notifications, substantiated maltreatment cases (by subtype), and first entries into foster care from birth through the age of 17 years. We also decomposed CPS involvement by gender. Results. We found that almost 1 in 4 children had been subject to at least 1 report to CPS at age 17 years (23.5%), and 9.7% had been a victim of substantiated abuse or neglect. We also found that 3.1% had experienced out-of-home placements by age 17 years, with boys being more affected. Conclusions. Both notifications and substantiated child maltreatment are more common in New Zealand than is generally recognized, with the incidence of notifications higher than the incidence of medicated asthma among children and the prevalence of substantiations similar to the prevalence of obesity.

Background Parental contact with child protective services (CPS) has been linked to deteriorating health among parents. Capturing rates of CPS contact among parents is therefore important for understanding inequities in exposure and their potential role in amplifying racial inequities in health and wellbeing. Though an extensive body of research in North America has provided population-level analyses of CPS contact among children, a disproportionate percentage of whom are Indigenous, no studies to date have extrapolated estimates to account for contact in parent populations, leading to a fragmented view of the system’s reach and impact beyond the child-level. In order to advance health equity-oriented research in this domain, our study calculated previously unexplored population-level estimates of CPS contact among First Nations and non-First Nations parents. Methods We used whole-population linked data from Manitoba (Canada) to identify 119,883 birthing parents (13,171 First Nations; 106,712 non-First Nations) who had their first child between 1998 and 2019. We calculated prevalence rates, rate differences, and rate ratios of parental contact with different levels of CPS by First Nations status (categorization used in Canada for Indigenous peoples who are members of a First Nation), including ever had an open CPS file for child(ren), ever had out-of-home placement of child(ren), and ever had termination of parental rights (TPR). Results Overall, 49.6% of First Nations parents had a CPS file open for their child(ren) (vs. 13.1% among non-First Nations parents), 27.4% had out-of-home placement of their child(ren) (vs. 4.7% among non-First Nations parents), and 9.6% experienced TPR (vs. 1.8% among non-First Nations parents). Conclusions CPS contact was high among parents and prevalence was almost 4 times higher among First Nations parents, where 1 out of 2 were intervened upon by CPS. Findings reinforce significant concerns about the system’s scope and the crucial importance of considering its role in compounding health inequities and sustaining colonialism in Canada. First Nations-led interventions are needed to reduce CPS disruption to the lives of First Nations peoples.

ObjectivesTo quantify developmental vulnerability at age 5 by child protection contacts before school in two Australian states.MethodsAll children with birth, child protection and/or 2009, 2012, 2015 and 2018 Australian Early Development Census (AEDC) data in New South Wales (NSW) and South Australia (SA) were grouped according to child protection contact before school: no contact, child protection reports, screened-in reports, investigations, substantiations and out-of-home care (OOHC). The outcome was developmental vulnerability on ≥1 AEDC domains or medically diagnosed conditions with support needs at school entry.Results56 650 (14.2%) NSW children and 12 617 (15.6%) SA children had ≥1 child protection contact before school. Developmental vulnerability on ≥1 domains or medically diagnosed conditions was lowest in the no child protection group (NSW, 21–22%; SA, 24–25%), with progressively higher risk in the child protection report (NSW, 35%; SA, 41–46%) through to the OOHC (NSW, 50–54%; SA, 59–66%) groups in all AEDC years. Developmental risk was higher among children aged <2 years at first contact and those with more reports. Children with only one child protection report before school had approximately 65% higher developmental risk than the no child protection group in both states.ConclusionsA single child protection report before school was an early indicator of higher developmental risk at age 5, with higher developmental risks among children with earlier, more serious and frequent child protection contacts. Beyond child safety screening, child protection reports represent an opportunity to mobilise early health and social support for children with developmental support needs.

Correspondence to Dr Sunil Bhopal, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK; sunil.bhopal@newcastle.ac.uk Infection with SARS-CoV-2 does not, thankfully, appear to be harming children in great numbers at this point of the COVID-19 pandemic.1 Concerns have however been raised that necessary social distancing and particularly ‘lockdown’ measures are having negative, often unintended, consequences for the health and well-being of babies, children and young people. Table 1 Child Protection Medical Examinations across four local authority areas of the North East of England, by month in each of 2018, 2019, 2020 Area 1 Area 2 Area 3 Area 4 Total Jan Feb Mar Apr Jan Feb Mar Apr Jan Feb Mar Apr Jan Feb Mar Apr 2018 7 10 14 10 16 12 8 24 0 3 3 4 6 12 11 12 152 2019 10 15 15 12 18 17 17 9 2 2 3 4 6 13 8 5 156 2020 7 5 7 3 15 14 15 6 0 0 0 0 4 13 6 4 99 We are concerned by our findings. All authors contributed to data collection and data analysis.