Child Protective Services Involvement Research Articles

Child Protection Intervention and the Sexual and Reproductive Health of Female Adolescents Ages 13 to 17 Years

Child maltreatment adversely affects health and development, but evidence is needed regarding whether and how Child Protective Services (CPS) interventions may mitigate risks. To assess whether different forms of CPS intervention are associated with sexual and reproductive health outcomes among female adolescents investigated by CPS for suspected exposure to maltreatment during childhood. This cohort study used linked, longitudinal, statewide administrative data from Wisconsin, including medical assistance and CPS records, to examine the rates and correlates of sexual and reproductive health outcomes (sexual transmitted infections, pregnancies, births, and high-risk sexual behavior) among 9392 female adolescents tracked from age 13 through 17 years who were investigated by CPS for suspected exposure to maltreatment prior to their 13th birthday. The study assesses how these outcomes were associated with types and frequency of CPS involvement and intervention and with adolescent and family demographic characteristics. Participants were female adolescents born from 2000 through 2002 who were investigated by Wisconsin CPS for suspected exposure to maltreatment before 13 years of age and who were covered by medical assistance at least 85% of the time from 13 to 17 years of age. Varying levels and intensities of CPS interventions, ranging from a single investigation to adoption from foster care. Dependent variables were pregnancy, birth, sexually transmitted infection, and an aggregate measure of sexual health concerns from 13 to 17 years of age. Primary explanatory variables were the intensity of CPS intervention (investigation only, in-home services, and foster care) and frequency of maltreatment concerns (number of investigations, continued involvement during adolescence). Logistic regression was used to assess the association of CPS measures with differences in sexual health outcomes. Data were analyzed from March 1 to October 12, 2021. This cohort study included 9392 female adolescents, among whom 3156 (33.6%) were born in 2000, 3064 (32.6%) in 2001, and 3173 (33.8%) in 2002; 2501 adolescents [26.6%] were Black, 1568 [16.7%] were Hispanic, 1024 [10.9%] were multiracial, 4024 [42.8%] were White, and 275 [2.9%] were listed as other [which included American Indian, Asian or Pacific Islander, or unknown race or ethnicity]). By 18 years of age, sizable proportions of maltreated female adolescents had at least 1 concerning sexual health outcome (23.5%), including diagnoses of gonorrhea, chlamydia, or trichomoniasis (8.4%), pregnancy (11.2%), and parenthood (6.1%). Compared with CPS investigation without formal intervention, foster care was associated with lower odds of pregnancy (adjusted odds ratio, 0.82; 95% C, 0.69-0.98) and live birth (adjusted odds ratio, 0.78; 95% CI, 0.61-0.99). Recurrent and ongoing CPS involvement was associated with adverse sexual health outcomes. This cohort study found that maltreated girls face increased risks of adverse sexual health outcomes in adolescence, but CPS interventions were associated with limited influence. More effective interventions are needed to help maltreated girls avoid teen pregnancy, sexually transmitted infections, and risky sexual behaviors in adolescence.

Risk of Postneonatal Infant Mortality Associated With Prior Founded Allegations of Child Abuse

This study examined the association between prior reports of child abuse and subsequent postneonatal death and differences by cause of death, using data from the Chicago Infant Mortality Study (CIMS). CIMS included all sudden, unexplained infant deaths up to 1year of age in Chicago (November 1993-April 1996), and age, race-ethnicity, and birthweight-matched living controls. Information on prior child abuse reports and outcomes was obtained through the Illinois Department of Children and Family Services (DCFS) State Central Registry for each case and control. Conditional logistic regression modeling determined the odds of postneonatal death when there was a founded prior allegation. Families with founded allegations were almost 4 times more likely to have a child die during the postneonatal period (aOR = 3.79, 95% CI, 1.56, 9.10). Child protective services involvement is an opportunity for education on safe sleep messaging to help reduce the incidence of potentially preventable infant deaths.

Predictive model for intra-familial child maltreatment re-reports and recurrence in South Korea: Analysis of national child protection services case records

BackgroundChild maltreatment recurrence has a significant negative impact on child well-being and may indicate low effectiveness of child protection services (CPS). In South Korea, 10.4% of child maltreatment cases in 2016 had previous CPS involvement. Identifying and understanding significant predictors of child maltreatment re-reports and recurrence has been a critical task in maltreatment research. However, this task has rarely been attempted in South Korea. ObjectiveThis study aimed to examine child maltreatment re-reports and recurrence among children involved in CPS in Korea, identify correlates of child maltreatment re-reports and recurrence with predictors, and explore the consistency or inconsistency of correlates between re-reports and recurrence. MethodsThe present study analyzed 5349 case records from the National Child Maltreatment Data System, which included information collected by Korean CPS regarding maltreatment, child, parent or perpetrator, and service characteristics. ResultsResults showed that the recurrence rate was 5.9% over the two-year period. In contrast to previous studies, neglect was not found to be a significant predictor of recurrence. Perpetrators' problem-solving skills and survival stress, as well as children's disability status, were significant predictors of recurrence. Receiving welfare assistance was a significant predictor of re-reports (AOL = 1.42, p < 0.01) but not a significant predictor of recurrence. ConclusionCompared to other empirical studies conducted in several countries, we found similarities and differences regarding predictors of child maltreatment re-reports and recurrences. The results reiterate the importance of family intervention to prevent maltreatment recurrence.

Re-referrals to Child Protective Services for children born to young parents

BackgroundChildren of teenage parents are at increased risk for child maltreatment but there is limited information about the risks teenage parenthood poses for maltreatment recurrence after prior Child Protective Service (CPS) involvement. ObjectiveDetermine whether children born to teenage parents are at increased risk of maltreatment re-referral to CPS compared to children born to older parents. Participants and settingChildren under 6 years with substantiated reports of parental maltreatment between 2002 and 2018 were identified from National Child Abuse and Neglect Data System (NCANDS) data. MethodsYoungest known parental age at child's birth, in years, was categorized as <20, 20–24, 25–29, or ≥30 (referent group). The number of re-referrals within 5 years was the outcome of interest. Negative binomial regression analyses assessed whether being born to a teen parent was associated with a greater risk of re-referral. ResultsIn a study population of 2,680,961 children, having a teen parent, one aged 20–24 years, or 25–29 years at birth was associated with 19% (95% CI 1.18–1.19), 16% (95% CI 1.16–1.17), and 11% (95% CI 1.11–1.12) greater risk of re-referral compared to having a parent aged 30 years or older adjusting for child age, gender, race-ethnicity, state, and initial maltreatment type. ConclusionThe small, but significant increased risk for re-referral to CPS for child maltreatment in young children with at least one teenage or young parent at the time of birth compared to children with older parents suggests that specifically targeting young parents with appropriate services when initially referred to CPS may help reduce the risk of maltreatment recurrence.

Associations between cortical thickness and anxious/depressive symptoms differ by the quality of early care.

A variety of childhood experiences can lead to anxious/depressed (A/D) symptoms. The aim of the present study was to explore the brain morphological (cortical thickness and surface area) correlates of A/D symptoms and the extent to which these phenotypes vary depending on the quality of the parenting context in which children develop. Structural magnetic resonance imaging (MRI) scans were acquired on 45 children with Child Protective Services (CPS) involvement due to risk of not receiving adequate care (high-risk group) and 25 children without CPS involvement (low-risk group) (rangeage = 8.08-12.14; Mage = 10.05) to assess cortical thickness (CT) and cortical surface area (SA). A/D symptoms were measured using the Child Behavioral Checklist. The association between A/D symptoms and CT, but not SA, differed by risk status such that high-risk children showed decreasing CT as A/D scores increased, whereas low-risk children showed increasing CT as A/D scores increased. This interaction was specific to CT in prefrontal, frontal, temporal, and parietal cortical regions. The groups had marginally different A/D scores, in the direction of higher risk being associated with lower A/D scores. Results suggest that CT correlates of A/D symptoms are differentially shaped by the quality of early caregiving experiences and should be distinguished between high- and low-risk children.

Economic instability and child maltreatment risk: Evidence from state administrative data

BackgroundThe effects of economic instability and the role of economic conditions preceding child protective services (CPS) involvement have not been fully considered in the child welfare literature. ObjectiveThis paper investigates the link between earnings instability and CPS involvement. Specifically, it examines whether adequate access to safety net programs mitigates the likelihood of child welfare involvement when families encounter negative earnings shocks. MethodologyThe study used quarterly administrative data from a sample of at-risk families for CPS involvement in Wisconsin. Event history analysis was employed to estimate the relationship between earnings instability and subsequent child maltreatment investigations. ResultExperiencing a negative earnings shock of 30% or more increases the likelihood of CPS involvement by approximately 18%. The effect diminishes and becomes nonsignificant when an earnings decline is compensated by benefit receipt. Each additional earnings drop is associated with a 15% greater likelihood of CPS involvement. Each consecutive quarter with stable income is associated with 5% lower probability of a CPS report. The results are more pronounced for abuse than neglect and are marginally significant for neglect reports. ConclusionUnfavorable economic instability is linked to greater CPS-involvement risk, particularly for child abuse. Moreover, accessing sufficient social benefits as supplemental income when negative earnings shocks occur serves to effectively buffer against the risk of child maltreatment, particularly among families with young children (ages 0–4).

A Review of Screened-Out Families and Child Protective Services Involvement: A Missed Opportunity to Prevent Future Maltreatment With Community-Based Services.

The objective of this article is to frame, understand, and draw implications from existing research on families screened out by child protective services (CPS) after a referral alleging child maltreatment. We review descriptive and outcome data together with emerging intervention research amidst a developing consensus that the current reactive role of CPS should be supplemented by supportive and preventative services that primarily address poverty. State-level data indicate that screened-out families are at high risk of re-referral and similar to higher-risk families reported to CPS. Intervention research is scant and mixed, but there is indication that providing community-based services may reduce future CPS involvement. Considering that screened-out referrals present an opportunity to prevent future maltreatment, CPS should identify and collaboratively engage screened-out families in community-based services. More research on the outcomes of these community responses is needed to identify best practices related to engagement and service provision.

Concomitant Pediatric Burns and Craniomaxillofacial Trauma.

This study is the first to investigate pediatric craniomaxillofacial (CMF) trauma patients that present with concomitant burns. The authors aim to identify differing etiologies, presentations, facial fracture patterns, interventions, and outcomes between pediatric CMF trauma patients with versus without concomitant burns. In this retrospective cohort study of a tertiary care center between the years 1990 and 2010, concomitant burns were identified among pediatric patients presenting with CMF fractures. Patient charts were reviewed for demographics, presentation, burn characteristics (total body surface area %, location, and degree), imaging, interventions, involvement of child protective services, and long-term outcomes. Data were analyzed using two-tailed Student t tests and chi-square analysis. Of the identified 2966 pediatric CMF trauma patients (64.0% boys; age 7 ± 4.7 years), 10 (0.34%) patients presented with concomitant burns. Concomitant burn and CMF traumas were more likely to be due to penetrating injuries (P < 0.0001) and had longer hospital lengths of stay (13 ± 18.6 versus 4 ± 6.2 days, P < 0.0001). 40% were due to child abuse, 40% due to motor vehicle collisions, and 20% due to house fires. All four child abuse patients presented in a delayed fashion; operative burn care was prioritized and 70% of the CMF fractures were managed nonoperatively. Concomitant burn and CMF trauma is a rare injury pattern in pediatrics and warrants skeletal surveys with suspicious injury patterns. Future research is necessary to develop practice guidelines.

607 Characteristics of Pediatric Burn Patients with Child Protective Services Involvement at an Academic Children’s Hospital

Abstract Introduction Pediatric burns are typically accidental, but burns caused by caregiver abuse/neglect represent a significant proportion of patients. Literature on risk factors most associated with these injuries include younger age, male, African American, and larger burns. This study examined child and burn injury factors that were associated with Child Protective Services (CPS) involvement at an urban, academic children’s hospital. Methods At this institution, decision to report a burn patient to CPS is determined by a multi-disciplinary medical team. Criteria for referral is multifactorial and may include burn patterns consistent with forced immersion, a reported mechanism that does not match the burn pattern or the patient’s developmental capabilities, concern for lack of supervision, or a delay in seeking medical care. Data from inpatient admissions over a 3-year period (July 2016 – June 2019) were extracted from hospital charts, and analyses (chi-square, t-tests) examined age, sex, total body surface area (TBSA), burn severity, length of stay, insurance type, race/ethnicity, and whether a CPS report was made (i.e., yes/no). Records for the outcome and disposition of the CPS case, such as whether the CPS investigation confirmed the abuse/neglect allegations, were not readily available as the law requires confidentiality. Results 389 children were admitted for burn treatment. 80% had partial-thickness burns; 33% White, 43% Black, 62% male; 10% had CPS involvement. 72% had Medicaid/other government insurance, 23% had private/commercial, 4% were uncovered, and 1% insurance status unknown. Medicaid/government insurance was overrepresented among burns compared to other inpatients at the hospital (72% vs 51%). Consistent with previous findings, CPS reports involved children who were younger (2.8 vs 4.8 years), had greater TBSA (8.4% vs 4.9%), and had longer admissions (7.5 vs 3.0 days). Children with Medicaid/governmental or no insurance were more likely to have CPS reports than commercial/private insurance (97% vs 3%). Importantly, contrary to prior findings, child sex, child ethnicity, and burn thickness were not significantly different between children with and without CPS reports. Conclusions Younger children with bigger burns and longer admissions were most associated with CPS involvement. Historical findings on risk factors of male sex, African American ethnicity, and greater burn thickness were not replicated. Prior literature may not be generalizable to many settings; the current study provides an important update. Further research is needed to examine outcomes of CPS involvement and long-term patient health outcomes. Findings are limited to only urban, inpatient pediatric burns.

602 Concomitant Pediatric Burns and Craniomaxillofacial Trauma: A Pediatric Burn Center’s Experience over 20 Years

Abstract Introduction Recent progress in pediatric burn care has reduced the mortality rate by 48.1% (Armstrong, 2020). Although it is well understood that mortality increases with increased number of systems involved, prior studies have not documented the effect of concomitant pediatric burn and craniomaxillofacial (CMF) trauma in pediatric patients. This retrospective cohort study is the first known to characterize presentation, management, and long-term outcomes of concomitant burns with CMF trauma in pediatric patients. Methods We performed a retrospective cohort study of all pediatrics patients who presented at a tertiary care center between the years 1990 to 2010 with CMF fractures and burns. Patient charts were reviewed for demographics, mechanism of injury, burn characteristics (TBSA %, location, and degree), imaging and interventions, involvement of child protective services, and long-term outcome. Data was analyzed using two-tailed Student’s t tests and chi square analysis. Results Of the 2,966 pediatric CMF trauma patients (64.0% boys; average age 7 ±4.7 years) that were identified, a total of 10 (0.34%) patients were identified to have concomitant burn injuries. Patients with concomitant burn and CMF injuries were less likely to have sustained blunt injuries (P &amp;lt; 0.0001) and had longer hospital lengths of stay (13 □ 18.6 vs 4 □ 6.2 days, P &amp;lt; 0.0001). Approximately 60% of CMF fractures were upper-third injuries. The CMF fractures of all 10 cases (100%) were managed non-operatively. 40% were due to child abuse, 40% due to motor vehicle collisions, and 20% due to house fires. Of the four patients who presented due to child abuse, CMF trauma was incidentally found on imaging. One (13 months, female) child-abuse case was found to have 32% TBSA 2nd and 3rd degree burns to bilateral lower extremities after being submerged in hot bathwater and had concomitant orbit/skull fractures. Two other child abuse cases presented with hand burns and concomitant nasal/skull fractures. All four child abuse patients presented in a delayed fashion. Conclusions Concomitant burns and CMF trauma is rare injury pattern in pediatric populations and is associated with longer hospital lengths of stay. Child abuse and motor vehicle accidents caused 80% of the cases.

The enduring effects of adverse childhood experiences (ACES) on mood dysregulation in children: A literature review

IntroductionBehavioral dysregulation is a common presentation of children in the Emergency-Room (ER)1. A 10-year-old African-American boy with attention-deficit/hyperactivity disorder, oppositional defiant disorder with poor treatment adherence, two previous psychiatric hospitalizations and multiple ER visits, presented with dysregulation and aggressive behavior. He had inconsistent parenting and poor attachment with present involvement of child protective services. We did a systematic review to interpret associations between adverse childhood experiences (ACEs) and the development of behavioral dysregulation in later life.ObjectivesTo see associations between ACEs and the development of behavioral dysregulation in later life.Methods We searched PsycINFO, APA PsycNet, PubMed, and Medline. Among 35 articles, five were included: 1) a meta-analysis of health consequences and ACEs1; 2) a data analysis of 64,329 youth from the Florida Department of Juvenile Justice that focused on suicide attempts and ACEs2; 3) a systematic review of 42 articles related to ACEs 3; 4) data from 22,575 youth for childhood abuse, trauma and neglect 4 and 5) a multimodal logistic regression study on 64,000 juvenile offenders focused on ACE scores and latent trajectory.5ResultsThere is increased risk of substance use, mental and physical health problems, and violence associated with ACEs1, 2. The relationship between childhood difficulties and suicide is interceded by adolescent’s maladaptive behaviors3. By age 35, ACEs increase the risk of becoming a serious juvenile offender4. Increased exposure to ACEs differentiates early-onset and sustained criminality from other forms of criminality5.ConclusionsACEs can affect the development of a child in multiple ways including suicidal behavior, aggression, impulsivity, criminality, academic difficulties and substance abuse

Predictors of Adverse outcomes in patients with systemic lupus erythematosus transitioning to adult care

Background: The transition from pediatric to adult care is a vulnerable period for individuals with chronic diseases. We sought to identify risk factors associated with poor outcomes in patients with childhood-onset systemic lupus erythematosus (cSLE) who have transitioned to adult care. Methods: A retrospective analysis of cSLE patients was performed. Outcomes of interest were development of end-stage renal disease (ESRD) or death and time to first hospitalization following final pediatric rheumatology visit. Multivariable logistic and Cox regression models were used. Results: Of 190 patients with cSLE, 21 (11%) developed ESRD and 9 (5%) died following the final pediatric rheumatology visit. In logistic regression, public insurance, history of Child Protective Services involvement, and an unscheduled hospitalization during the final year in pediatric care were predictive of ESRD or death (odds ratio (95% confidence intervals (CI)) 6.7 (1.5–30.7), 6.6 (2.3–19.1), and 3.2 (1.3–8.3), respectively). Among 114 patients with healthcare utilization data, 53% had a hospitalization in adult care. In Cox regression analysis, a pediatric outpatient opioid prescription was associated with shorter time to adult hospitalization and White or Asian race was associated with longer time to adult hospitalization (hazard ratio (CI) 3.5 (1.7–7.0) and 0.1 (0.03–0.4), respectively). Conclusions: Risks factors associated with poor outcomes in adult care amongst patients with cSLE include public insurance, history of Child Protective Services involvement, unscheduled care utilization in pediatric care, pediatric outpatient opioid prescription, Black race and Hispanic ethnicity. Efforts to improve long-term outcomes among patients with cSLE should focus on these populations.

Prenatal Substance Exposure and Child Maltreatment: A Systematic Review.

State and federal policies regarding substance use in pregnancy, specifically whether a notification to child protective services is required, continue to evolve. To inform practice, policy, and future research, we sought to synthesize and critically evaluate the existing literature regarding the association of prenatal substance exposure with child maltreatment. We conducted a comprehensive electronic search of PubMed, Web of Science, PsycInfo, CHINAL, Social Work Abstracts, Sociological Abstracts, and Social Services Abstracts. We identified 30 studies that examined the association of exposure to any/multiple substances, cocaine, alcohol, opioids, marijuana, and amphetamine/methamphetamine with child maltreatment. Overall, results indicated that substance exposed infants have an increased likelihood of child protective services involvement, maternal self-reported risk of maltreatment behaviors, hospitalizations and clinic visits for suspected maltreatment, and adolescent retrospective self-report of maltreatment compared to unexposed infants. While study results suggest an association of prenatal substance exposure with child maltreatment, there are several methodological considerations that have implications for results and interpretation, including definitions of prenatal substance exposure and maltreatment, study populations used, and potential unmeasured confounding. As each may bias study results, careful interpretation and further research are warranted to appropriately inform programs and policy.

Mandated Reporters: The Ethical Education of Medical Students on Pediatrics Clerkship

Medical students are taught to cherish the ethical mandate to “do no harm.” However, the competency to actualize this mandate – or at least theorize how – is not always available to students on pediatrics clerkship when they encounter situations suspicious for child abuse. Mandated reporter training for medical students is largely perfunctory and does not prepare students to identify or document instances of suspected child abuse. Such training approaches students from the threatening angle that they can face punitive measures if they fail to report suspected abuse. In the absence of more thorough, ethics-driven training, students learn informally about their responsibilities as mandated reporters by observing pediatricians communicate about their own interactions with Child Protective Services (CPS), if the topic arises during clerkship. The theoretical premise of child protection is that all involved parties act in accordance with implicitly understood and shared ethical principles to safeguard the wellbeing of children [3]. Despite this assumption of accord, very little standardization exists throughout the process of identifying and reporting suspected child abuse, with the exception of some specific situations that explicitly require CPS referral. Families of color, especially Black families, are disproportionately reported to CPS for child abuse, revealing a major consequence of subjective bias in assessing parental adequacy [2]. A pediatrician may, for example, misattribute a parent’s confusion about a child’s treatment plan to noncompliance and medical neglect [1]. A CPS referral in such an instance draws a line between the medical treatment team – in the role of benevolent advocate of the child’s wellbeing – and the obstructionist, perhaps abusive parent. The medical student, as part of the treatment team, has proximity to the power-holder in the situation, the physician. The student is incentivized to neglect an ethical obligation to explore whether this dynamic is causing harm to the patient. The student does not learn to interrogate the etiology of challenges faced by the parent, or to consider that CPS involvement itself may have deleterious effects on the family [4]. A more intentional and expansive approach to the ethics of mandated reporting throughout medical school would better prepare students to understand and exercise ethical judgment.

Suicide, Overdose Are Significant Contributors to Pregnancy-Related Maternal Deaths

Suicide, Overdose Are Significant Contributors to Pregnancy-Related Maternal Deaths

How Much More Data Do We Need? Making the Case for Investing in Our Children.

* Abbreviations: ACE — : adverse childhood experience CPS — : Child Protective Services Child maltreatment is well recognized as one of the most significant contributors to pediatric morbidity and mortality throughout the world.1,2 The effect of child maltreatment on morbidity and mortality in older adults has been documented for >20 years as demonstrated by the Adverse Childhood Experiences (ACEs) study.3 The impact of maltreatment on teenage suicide and other mental health diagnoses is also well known.4,5 To date, however, a direct relationship between maltreatment specifically, rather than the broader risk of ACES, and mortality in teenagers and young adults had not been reported. In this issue of Pediatrics , Segal et al6 evaluated this potential relationship by linking >50 administrative data sets from South Australia that included data from >300 000 children born between 1986 and 2003 who survived to age 16. The authors examined the relationship among multiple demographic factors, Child Protective Services (CPS) involvement, and mortality from 1990 to 2019. For the 20% of children with CPS contact before age 16, the nature of the contact was divided into 7 categories, which included “investigation only,” “substantiation,” and “removal to … Address correspondence to Rachel Berger, MD, MPH, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA 15224. E-mail: rachel.berger{at}chp.edu

Prevalence, Patterns, and Correlates of Pain in Medically Hospitalized Pediatric Patients With Somatic Symptom and Related Disorders.

Somatic symptom and related disorders (SSRDs) and pain are highly comorbid in the pediatric population. Little is known about the prevalence of pain and factors that may predispose and perpetuate pain in hospitalized youth with SSRD. To describe the prevalence of pain and widespread pain symptoms in hospitalized youth with SSRD and describe differences between patients who endorsed limited (1-4 sites) versus widespread (5-8 sites) pain. Retrospective chart reviews were conducted of pediatric patients with SSRD seen over a 32-month period at a tertiary pediatric hospital and assessed by the psychiatry consultation service. During admission, patients completed the Childhood Somatization Inventory, which assessed pain and other physical symptoms. Descriptive statistics, one-way analysis of variances, Pearson's χ2, stepwise linear regressions, and internal consistency analyses were used. Of the 219 patients (aged 8-18 y), 97% reported pain symptoms, and of those reporting pain (n= 213), 48% reported widespread pain. Patients with widespread pain had greater rates of comorbid depression (P= 0.012), neglect (P= 0.016), family psychiatric history (P= 0.013), diagnostic tests/procedures (P= 0.012), and prescribed opioid use (P= 0.016), when other medical and demographic factors were considered. When compared dichotomously to youth with limited pain, there was no difference in prevalence of medical conditions; however, patients with widespread pain had higher rates of trauma and stressor-related disorders (P= 0.017), sexual abuse (P= 0.031), emotional abuse (P= 0.041), and prior child protective service involvement (P= 0.011). Pain symptoms and widespread pain are common in medically hospitalized youth with SSRD, with unique psychiatric and psychosocial factors associated with widespread pain.

Abolish Family Policing, Too

Abolish Family Policing, Too Dorothy Roberts (bio) Imagine if there were an arm of the state that sent government agents to invade Black people's homes, kept them under intense and indefinite surveillance, regulated their daily lives, and forcibly separated their families, often permanently. the left would put toppling this regime high on its agenda, right? this racist structure exists in the United States today, and yet the left pays little attention to it. the child welfare system–the assemblage of public and private child protection agencies, foster care, and preventive services–is a crucial part of the carceral machinery in Black communities. Many Americans view the child welfare system as a benign social service provider that safeguards children from abuse and neglect in their homes. though it may bungle its responsibilities, they tell themselves, it is an essential safety net for children whose parents are unable to care for them. the left should be contesting, not buying into, this misguided perspective. The child welfare system is a powerful state policing apparatus that functions to regulate poor and working-class families–especially those that are Black, Latinx, and Indigenous–by wielding the threat of taking their children from them. In 2018 alone, Child Protective Services (CPS) received referrals of nearly 8 million children suspected to be victims of maltreatment. Intake workers weeded out reports regarding 4.3 million of these children as inappropriate for CPS involvement. But the screening process still leaves millions of families subject to state investigation each year. In cities across the nation, CPS surveillance is concentrated in impoverished Black neighborhoods, where all parents are ruled by the agencies' threatening presence. Fifty-three percent of Black children in America will experience a CPS investigation at some point before their eighteenth birthday. During CPS investigations, caseworkers may inspect every corner of the home, interrogate family members about intimate details of their lives, strip-search children to look for evidence, and collect confidential information from schools, healthcare providers, and social service programs. If caseworkers detect a problem, like drug use, inadequate medical care, [End Page 67] or insecure housing, they will coerce families into an onerous regimen of supervision that rarely addresses their needs. More disruptive still is the forcible family separation that often follows CPS investigations. Every year child welfare agencies take over 250,000 children from their parents and put them in the formal foster care system. At the same time, these agencies informally separate an estimated 250,000 more children from their parents each year based on so-called "safety plans"–arrangements parents are pressured to agree to in lieu of a formal court proceeding. In 2019, the national foster care population stood at 423,997. Hundreds of thousands more children were removed from their homes and kept in foster care at some point during the year. Black children have long been grossly overrepresented in the national foster care population: although they were only 14 percent of children in the United States in 2019, they made up 23 percent of children in foster care. Most of the money spent on child welfare services goes to keeping children away from their families. In 2019, the federal government alone devoted $8.6 billion to maintaining children in foster care–more than ten times the amount allocated to services aimed at keeping families together. While President trump's cruel policy of separating migrant children from their parents at the Mexican border drew national condemnation, hardly anyone on the left connected it to the far more widespread family separation that takes place every day in Black neighborhoods. For centuries, the United States has wielded child removal to terrorize, control, and disintegrate racialized populations–enslaved Africans whose children were considered white people's property and sold away at will, European immigrant children swept up from urban slums by elite charities and put to work on farms, and Indigenous children kidnapped and confined to boarding schools under a federal campaign of tribal decimation. today's child welfare system still revolves around an ideology that confuses poverty with child neglect and attributes the suffering caused by structural inequities to parental pathologies. It then prescribes useless therapeutic remedies in place of radical social change...

The Link Between Early Involvement with Child Protection System and Youth Offending: A Multi-Agency Data-Linkage Study in Northern Territory, Australia

IntroductionNumerous studies have reported a link between child maltreatment and subsequent youth offending leading to calls for early intervention programs focussed on children in contact with child protection services (CPS) as a strategy to reduce the risk offending. While the overlap between child maltreatment and youth offending is well recognised, there have been few studies of the dimensions of CPS involvement that can inform early intervention programs. Whole-of-population linked data provides the opportunity to better understand the characteristics of CPS involvement that predict the risk of offending. Objectives and ApproachThis retrospective cohort study investigated the association between the level of CPS involvement (no CPS contact through to out-of-home care) for children, before age 10, with youth offending. The study used linked, individual-level records from multiple agencies including birth records, CPS records and youth justice (court) data for 10,438 Aboriginal children born in the NT between 1999 and 2006. ResultsThere was a gradient of increasing risk of youth offending as the level of CPS involvement increased from ‘no report of maltreatment’ to ‘out-of-home care’. There was a similar risk of offending for children with a record of either ‘unsubstantiated’ or ‘substantiated notifications’. Timing of maltreatment (at age 0-4, age 5-9 or both periods) was more strongly associated with offending than whether a notification was substantiated or unsubstantiated. Conclusion / ImplicationsThe increased risk of offending associated with different levels of involvement with CPS provides early opportunities for differentiated interventions aimed at reducing the risk of youth offending. Although children with unsubstantiated reports of child maltreatment do not meet the criteria for a statutory response for child protection the increased risk of subsequent youth offending among these children indicates the need to engage families in preventive interventions.

Risk Assessments at Birth Predict Kindergarten Achievement and Involvement with Child Protective Services.

Screening for family risk factors at birth is one way that early childhood programs and practitioners can identify families who might benefit from prevention efforts. Some prevention programs currently use cumulative risk (i.e., total number of risk factors present) to determine eligibility for services. More recently, however, person-centered approaches that take into account combinations of risk (versus cumulative risk) have emerged as an approach that could complement current risk assessment methods and illuminate the extent to which classes of family risk are associated with different outcomes in early childhood. Grounded in ecological theory, we tested cumulative family risk and latent classes of family risk at birth as predictors of kindergarten outcomes and mother-reported involvement with Child Protective Services (CPS). Families in the Fragile Families and Child Well-being Study were included in this study if they had medical records data available at the child's birth as well as children's age 5 kindergarten outcomes (N = 757). Cumulative risk was positively associated with children's attention problems, letter-word recognition skills, CPS involvement, and both covariates (i.e., child's diagnosed disability status and mother's ethnicity/race), but not aggression or social skill problems. In terms of latent classes, children from higher risk classes tended to fare significantly worse on kindergarten outcomes and were more likely to have reported involvement with CPS when compared to the lower risk classes. Implications are discussed related to primary prevention, the merits of screening for risk, and comparisons between cumulative risk and classes of risk approaches.