Child Protective Services Investigation Research Articles

Estimating the incidence of substance exposed newborns with child welfare system involvement

BackgroundPrenatal substance use can have negative health consequences for both mother and child and may also increase the likelihood of child welfare involvement. The rate of newborns with substance exposure has increased dramatically. As of 2016, federal law requires notification of all infants to child welfare agencies so that a plan of safe care can be developed and referrals to services can be offered. ObjectiveChild welfare agencies have not historically collected consistent, systematic data identifying substance exposed newborns. We utilized a unique strategy to identify substance exposed newborns with child welfare involvement. Participants & settingWe used data from the National Child Abuse & Detection System (NCANDS) which captures N = 3,189,034 unique child protective services investigations for children under the age of 1 between 2004 and 2017. MethodsWe calculated the incidence of substance exposed newborns investigated by child welfare agencies and compared with other administrative data on prenatal substance exposure. We also analyzed this rate by infant demographic characteristics (race/ethnicity, sex, rurality). ResultsBetween 2004 and 2017, approximately 13 % of infants reported to child protective services were likely reported because of substance exposure at birth, and the rate of substance exposed newborns with child welfare involvement increased from 3.79 to 12.90 per 1000 births, an increase of 240 %, over this period. ConclusionsUnderstanding the extent of the substance use crisis for child welfare involvement is important for policymakers to support children and families.

Public Benefit Programs and Differential Associations With Child Maltreatment by Race and Ethnicity

Public benefit programs, including state spending on local, state, and federal-state partnership programs, have consistently been associated with overall reductions in child protective services (CPS) involvement. Inequities in eligibility and access to benefit programs may contribute to varying associations by race and ethnicity. To determine whether associations between state spending on benefit programs and rates of CPS investigations differ by race and ethnicity. This cross-sectional ecological study used repeated state-level measures of child maltreatment from the National Child Abuse and Neglect Data System and population estimates from the US Census Bureau for all Black, Hispanic, and White children. All 50 US states from October 1, 2009, through September 30, 2019 (fiscal years 2010-2019), were included. Data were collected and analyzed from May 13, 2022, to March 2, 2023. Annual state spending on benefit programs per person living below the federal poverty limit, total and by the following subcategories: (1) cash, housing, and in-kind; (2) housing infrastructure; (3) child care assistance; (4) refundable earned income tax credit; and (5) medical assistance programs. Race- and ethnicity-specific rates of CPS investigations. Generalized estimating equations, with repeated measures of states, an interaction between race and spending, and estimated incidence rate ratios (IRRs) and 95% CIs for incremental changes in spending of US $1000 per person living below the federal poverty limit were calculated after adjustment for federal spending, race- and ethnicity-specific child poverty rate, and year. A total of 493 state-year observations were included in the analysis. The association between total spending and CPS investigations differed significantly by race and ethnicity: there was an inverse association between total state spending and CPS investigations for White children (IRR, 0.94 [95% CI, 0.91-0.98]) but not for Black children (IRR, 0.98 [95% CI, 0.94-1.02]) or Hispanic children (IRR, 0.99 [95% CI, 0.95-1.03]) (P = .02 for interaction). Likewise, inverse associations were present for only White children with respect to all subcategories of state spending and differed significantly from Black and Hispanic children for all subcategories except the refundable earned income tax credit (eg, IRR for medical assistance programs for White children, 0.89 [95% CI, 0.82-0.96]; P = .005 for race and spending interaction term). These results raise concerns that benefit programs may add relative advantages for White children compared with Black and Hispanic children and contribute to racial and ethnic disparities in CPS investigations. States' eligibility criteria and distribution practices should be examined to promote equitable effects on adverse child outcomes.

An examination of re-referrals and substantiations among families referred to home-based, differential response services and a comparison group: Does successful completion matter?

Although some studies have examined child maltreatment recidivism following participation in a home-based, differential response program (HBDR) after a child protective services (CPS) investigation, they often do not include adequate comparison groups, are limited to one outcome, and do not examine outcomes by successful completion. Using administrative data from a Southwestern state including children whose families received HBDR services following an allegation of maltreatment, this study compared families who received HBDR services (n = 4,079) to families that were investigated but did not receive HBDR services (n = 4,221) using two indicators of CPS recidivism (i.e., re-reports and substantiation) over a period of 4 ½ to 7 years.Bivariate analyses indicated that families who received HBDR services had an average substantiation rate of 7.9% using a revised federal methodology, which was slightly higher than the comparison group; the substantiation rate for HBDR families during the entire study period was 14.5%. However, HBDR families had lower re-report rates at one year and during the overall study period relative to the comparison group. In contrast, the re-report and substantiation rate for HBDR families who successfully completed services was lower than the comparison group. Multivariable analyses indicated that successful completion of HBDR was associated with lower re-referral rates and substantiation rates after adjusting for demographic and case characteristics. These findings suggest that prevention programs offering HBDR could make a short-term and long-term impact on the re-referral and substantiation rates among high-risk families after a child abuse investigation and emphasize the importance of ensuring that participants successfully complete HBDR as this was associated with reductions in recidivism.

Using Child Abuse Specialists to Reduce Unnecessary Child Protective Services Reports and Investigations

This Viewpoint informs clinicians of the potential harms of unnecessary reporting of child abuse and highlights the possibility of consulting a child abuse pediatrician prior to reporting in a subset of cases in which the concern for child abuse is low.

Female perpetrators of child sexual abuse in the United States

PurposeResearch on women who sexually abuse children is relatively scarce and tends to rely on small or unrepresentative convenience samples. The purpose of the current descriptive study is to examine characteristics female perpetrators of child sexual abuse using a large and contemporary dataset.Design/methodology/approachThis study analyzes data collected by the National Child Abuse and Neglect Data System, which is a census of all child protective services investigations or assessments conducted in all 50 states, as well as in the District of Columbia and Puerto Rico from October 1, 2018, to September 30, 2019.FindingsOnly substantiated cases of sexual abuse were analyzed (n = 51,442 cases). Overall, 7.6% of the perpetrators were female, though the percentage of female perpetrators varied dramatically across states from less than 1% to over 36%. Female perpetrators tended to have younger victims than did male perpetrators. For children aged 2 or less, female perpetrators constituted approximately 20% of the abusers. Female perpetrators were more likely to victimize male and female children, whereas male perpetrators predominantly had female victims. More female perpetrators had a prior finding of maltreatment than did male perpetrators (32.3% vs 23.5%).Research limitations/implicationsThese findings add to the limited research base on female perpetrators of child sexual abuse and highlight avenues for further research into the differences between male and female sexual abusers.Originality/valueThis study is a replication of previous research but also provides additional novel findings.

State expansion of Supplemental Nutrition Assistance Program eligibility and rates of foster care entries

BackgroundState expansion of Supplemental Nutrition Assistance Program (SNAP) eligibility under broad-based categorical eligibility (BBCE) is associated with decreases in household poverty and food insecurity, child protective services investigations, and mental health and substance use disorders among adults, key contributors to foster care entry. ObjectiveTo examine the association of state expansion of SNAP eligibility under BBCE with rates of foster care entries. ParticipantsFoster care entries among children ages <18 years. MethodsWe used 2005–2019 data from the SNAP Policy Database and the Adoption and Foster Care Analysis and Reporting System (AFCARS). We conducted difference-in-differences analyses and generated event study plots adjusting for state economic conditions (percent population unemployed, median household income) and policies (minimum wage, refundable Earned Income Tax Credits, maximum Temporary Assistance for Needy Families benefit for a family of 3). ResultsOn average, there were 1.8 fewer foster care entries (95 % confidence interval (CI) −2.8, −0.8) per 1000 children per year in states that expanded SNAP eligibility than there would have been if they had not expanded eligibility. Average decreases in foster care entries were similar among young (−1.7 per 1000 children per year, 95 % −3.1, −0.3) and school-age (−1.8 per 1000 children per year, 95 % CI −2.7, −0.8) children and larger among Black non-Hispanic (−5.6 per 1000 children per year, 95 % CI −9.1, −2.0) than among White non-Hispanic (−1.4 per 1000 children per year, 95 % CI −2.2, −0.6) children. The magnitude of these decreases increased with greater time since policy adoption. ConclusionsResults add to growing evidence that programs and policies that support and stabilize household economic and material conditions may contribute to reductions in foster care entries at the population-level.

The influence of youth’s social environments and experiences on inflammation and cardiovascular disease risk

Large numbers of youth grow up experiencing serious adversity, for example in the form of growing up in poverty, which impacts nearly 1 out of every 6 children in the US, or by experiencing child maltreatment, with roughly 1 out of every 3 children in the US experiencing a child protective services investigation before reaching the age of 18. Although the exact mechanisms connecting such early experiences to poorer later life health and well-being are not fully understood, research increasingly supports the role of inflammation in these associations. Early work is further suggesting that disease risk can be actively reduced through the use of psychosocial interventions. This talk will provide an overview of some family-level influences that moderate the effect of exposure to adversity on youth inflammation; the potential of a psychosocial intervention to actively alter cardiovascular disease risk among youth; and present preliminary baseline data on markers of inflammation in youth recently recruited into a large, state-wide prospective cohort designed to elucidate the long-term health impacts of experiences of child maltreatment.

Lifetime rates and types of subsequent child protection system contact following a first report of neglect: An age-stratified analysis.

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.

Incidence of Newborn Drug Testing and Variations by Birthing Parent Race and Ethnicity Before and After Recreational Cannabis Legalization

Thirty-seven US states and the District of Columbia mandate reporting newborns with suspected prenatal substance exposure to the state, and punitive policies that link prenatal substance exposure to newborn drug testing (NDT) may lead to disproportionate reporting of Black parents to Child Protective Services. The impact of recreational cannabis legalization on racial disproportionality in NDT is unknown. To examine variations in the incidence and results of NDT by birthing parent race and ethnicity, variables associated with variation, and changes after statewide legalization of recreational cannabis. This retrospective cohort study was conducted from 2014 to 2020 with 26 366 live births to 21 648 birthing people who received prenatal care at an academic medical center in the Midwestern United States. Data were analyzed from June 2021 to August 2022. Variables included birthing parent age, race, ethnicity, marital status, zip code, insurance type, prenatal and newborn diagnoses codes, and prenatal urine drug test orders and results. The primary outcome was an NDT order. Secondary outcomes were substances detected. Among 26 366 newborns of 21 648 birthing people (mean [SD] age at delivery, 30.5 [5.2] years), most birthing parents were White (15 338 [71.6%]), were non-Hispanic (20 125 [93.1%]), and had private insurance coverage (16 159 [74.8%]). The incidence of NDT ordering was 4.7% overall (1237 newborns). Clinicians ordered more NDTs for Black compared with White newborns (207 of 2870 [7.3%] vs 335 of 17 564 [1.9%]; P < .001) when the birthing parent had no prenatal urine drug test, a presumably low-risk group. Overall, 471 of 1090 NDTs (43.3%) were positive for only tetrahydrocannabinol (THC). NDTs were more likely to be positive for opioids in White compared with Black newborns (153 of 693 [22.2%] vs 29 of 308 [9.4%]; P < .001) and more likely to be positive for THC in Black compared with White newborns (207 of 308 [67.2%] vs 359 of 693 [51.8%]; P < .001). Differences remained consistent after state recreational cannabis legalization in 2018. Newborn drug tests were more likely to be positive for THC after legalization vs before legalization (248 of 360 [68.9%] vs 366 of 728 [50.3%]; P < .001) with no significant interaction with race and ethnicity groups. In this study, clinicians ordered NDTs more frequently for Black newborns when no drug testing was done during pregnancy. These findings call for further exploration of how structural and institutional racism contribute to disproportionate testing and subsequent Child Protective Services investigation, surveillance, and criminalization of Black parents.

The Effects of Child Poverty Reductions on Child Protective Services Involvement

In this study, we use microsimulation methods to estimate the reduction in child protective services (CPS) involvement resulting from implementation of three of the policy packages from a recent National Academy of Sciences proposal to reduce child poverty, including the introduction of a child allowance and expansions to the earned income tax credit, the Supplemental Nutrition Assistance Program, and the federal minimum wage. We find that the policy packages have the potential to reduce CPS investigations by 11.3–19.7 percent annually. Moreover, our results are suggestive of a substantial reduction in racial disproportionality in CPS involvement. We estimate an 18.7–28.5 percent reduction in investigations for Black children and 13.3–24.4 percent for Hispanic children, compared with 6.7–13.0 percent for White children. Our results indicate that the nontrivial improvements in child safety accruing from any of the three policy packages should be considered in the calculus of policy implementation.

State-level variation in the cumulative prevalence of child welfare system contact, 2015–2019

BackgroundPrior estimates of the cumulative risks of child welfare system contact illustrate the prominence of this system in the lives of children in the United States (U.S.). However, these estimates report national data on a system administered at the state and local levels and are unable to detail potential simultaneous geographic and racial/ethnic variation in the prevalence of these events. MethodsUsing 2015–2019 data from the National Child Abuse and Neglect Data System and Adoption and Foster Care Analysis and Reporting System, we use synthetic cohort life tables to estimate cumulative state- and race/ethnicity-specific risks by age 18 of experiencing: (1) a child protective services investigation, (2) confirmed maltreatment, (3) foster care placement, and (4) termination of parental rights for children in the U.S. ResultsIn the U.S., state-level investigation risks ranged from 14% to 63%, confirmed maltreatment risks from 3% to 27%, foster care placement risks from 2% to 18%, and risks of parental rights termination from 0% to 8%. Racial/ethnic disparities in these risks varied greatly across states, with larger disparities at higher levels of involvement. Whereas Black children had higher risks of all events than white children in nearly all states, Asian children had consistently lower risks. Finally, ratios comparing risks of child welfare events show these prevalences did not move in parallel, across states or racial/ethnic groups. ContributionThis study provides new estimates of spatial and racial/ethnic variation in children’s lifetime risks of maltreatment investigation, confirmed maltreatment, foster care placement, and termination of parental rights in the U.S., as well as relative risks of these events.

Risk factors and neglect subtypes: Findings from a nationally representative data set.

Child neglect is a multidimensional concept encompassing various forms. Prior studies suggest that risk factors differ by neglect subtypes such as physical or supervisory neglect, but few studies address how risk factors vary between other neglect subtypes. This study aimed to examine how risk factors were related to neglect subtypes such as physical neglect, lack of supervision, exposure to domestic violence, substance-abusing parent, and mixed neglect. This study used secondary data from a nationally representative sample of children (National Survey of Child and Adolescent Well-Being-II, N = 5,872), and 786 children with a first-time child protective services investigation for neglect allegations alone were selected. Multinomial logistic regression analysis was used to explore how individual, family, and community risk factors may be associated with specific neglect subtypes. Five risk factors were able to discriminate between subtypes of neglect. For example, being a young child is associated with a greater risk of experiencing multiple forms of neglect. Caregiver's mental health problem is associated with a higher likelihood of being referred for multiple forms of neglect, particularly as compared with the risk of being referred for lack of supervision. Having poor social support is associated with a higher risk of physical neglect, and caregiver high stress is related to a higher risk of domestic violence. While most intervention programs target risk factors for overall child neglect, not specific neglect subtypes cases, our findings suggest that the intervention approach based on an understanding of the heterogeneity in risk factors between neglect subtypes is advisable. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Examining the effects of the Eckerd rapid safety feedback process on the occurrence of repeat maltreatment among children involved in the child welfare system

BackgroundThe Eckerd Rapid Safety Feedback Process (ERSF) is an approach to child welfare practice that combines predictive risk modeling (PRM) with real-time quality assurance and staff coaching during a child protective services investigation. During the case investigation, quality assurance (QA) reviewers provide guidance to staff by assessing key dimensions of their investigative practices and providing coaching sessions as needed. ObjectiveTo determine to what degree ERSF reduced the incidence of children who experienced high severity physical, sexual, or neglect maltreatment (HS-CAN) among children known to a state child welfare agency, within 12 months of the agency's involvement in a previous investigation. MethodsThis multi-year quasi-experimental study evaluated the impact of the ERSF Process on risk of repeat high severity maltreatment among children and youth identified by a PRM algorithm as high risk for experiencing repeat maltreatment and receiving the additional QA intervention, compared to those receiving the usual standard of care. ResultsThe ERSF Process did not lower the rate of HS-CAN among children identified as high risk. The joint odds ratio for receiving ERSF given being high risk was 1.05, i.e. a point estimate indicating higher probability of future HS-CAN. ConclusionsIn this statewide implementation of ERSF, we did not find a positive effect of this particular PRM-based intervention. Future maltreatment, even within 12 months of a prior investigation, may be too distal an outcome for a PRM and QA process designed to produce a high-quality CPS investigation and safety plan.

What Does Child Protective Services Investigate as Neglect? A Population-Based Study.

Most child protective services (CPS) investigations involve allegations of neglect. Broad and vague definitions have led to concerns that CPS-investigated neglect is driven by poverty-based material hardship. In a representative sample of 295 neglect investigations in California in 2017, structured data and narrative text fields were used to characterize the types of neglect and concurrent parental risk factors investigated by CPS and to assess the rate and nature of investigated physical neglect, defined as inadequate food, housing, or hygiene. The most common types of neglect were inadequate supervision (44%) and failure to protect (29%), followed by physical neglect (14%). Common risk factors identified in neglect investigations were parental substance use (41%), domestic violence (21%), mental illness (18%), and co-reported physical or sexual abuse (29%). Nearly all investigations of physical neglect (99%) included concerns related to substance use, domestic violence, mental illness, co-reported abuse or an additional neglect allegation (i.e., abandonment). Given concerns identified in neglect investigations, economic supports are likely insufficient without an array of behavioral-health supports.

Association Between State Supplemental Nutrition Assistance Program Policies, Child Protective Services Involvement, and Foster Care in the US, 2004-2016

Public assistance policies may play a role in preventing child maltreatment by improving household resources among families of low incomes. The Supplemental Nutrition Assistance Program (SNAP) is one of the largest public assistance programs in the US. However, the association of state SNAP policy options to Child Protective Services (CPS) outcomes has not been rigorously examined. To model the association of state SNAP policies with changes in CPS and foster care outcomes in the US over time. This cohort study used panel data to examine the association between SNAP policy options and study outcomes from 2004 to 2016 for 50 US states and the District of Columbia in 2-way fixed-effects regression models. The count of SNAP policies was used as an instrument for SNAP caseloads in instrumental variables models. Data analysis was conducted in November 2021. The adoption of 1 or more state SNAP income generosity policies that improves or stabilizes household resources for SNAP participants. Reports of child maltreatment accepted for CPS investigation, children in substantiated reports, and children receiving foster care services for all forms of maltreatment, and specifically for child neglect per 100 000 child population. The mean (SD) number of SNAP income generosity policies increased from 1.47 (0.95) in 2004 to 2.37 (0.94) in 2010, to 2.49 (0.86) in 2016 across states; the median increased from 1 to 3 (range, 0-4) over the same period. A count of state income generosity policies was associated with large reductions in reports accepted for CPS investigation (-352.6 per 100 000 children; 95% CI, -557.1 to -148.2). Income generosity policy was associated with -94.8 (95% CI, -155.6 to -34.0) fewer substantiated reports and -77.0 (95% CI, -125.4 to -28.6) fewer reports substantiated for neglect per 100 000. Each additional income generosity policy adopted by a state was associated with -45.1 (95% CI, -71.6 to -18.5) to -42.3 (95% CI, -64.8 to -19.8) fewer total foster care placements per 100 000 children. State SNAP policies that improve and stabilize household resources appear to be associated with reductions in CPS involvement and use of foster care. The number of policies implemented had cumulative outcomes beyond individual policy outcomes.

Transphyseal Distal Humeral Fractures: A 13-Times-Greater Risk of Non-Accidental Trauma Compared with Supracondylar Humeral Fractures in Children Less Than 3 Years of Age.

The transphyseal distal humeral fracture has been well described as a concerning fracture pattern for non-accidental trauma (NAT) in young pediatric patients. Because of the infrequent presentation of this fracture, the association historically has been anecdotal. The purpose of this study was to determine and compare the incidence of NAT among displaced transphyseal distal humeral fractures and displaced supracondylar humeral fractures in children <3 years of age. All displaced transphyseal distal humeral fractures and displaced supracondylar humeral fractures in patients <3 years of age admitted because of injury during an 18-year period were reviewed retrospectively for inclusion. Patient demographics, mechanisms of injury, results of child protective services investigations, and medical records were reviewed. A chi-square test was utilized to analyze significance for categorical data; p values of <0.05 were defined as significant. The charts of 23 transphyseal distal humeral and 205 supracondylar humeral fracture cases were reviewed. NAT was the cause for 6 (26%) of the displaced transphyseal distal humeral fractures and 4 (2%) of the displaced supracondylar fractures. The associated risk of NAT was 13 times greater (95% confidence interval [CI], 4.05 to 43.7; p < 0.001) for children admitted for operative management of displaced transphyseal distal humeral fractures compared with those admitted for operative management of displaced supracondylar humeral fractures. The classic 1980 paper by DeLee et al. sensitized the orthopaedic community to the relationship between transphyseal distal humeral fractures and child abuse. Our study is the first, to our knowledge, to bring statistical weight to this association. We found a 13-times-greater risk of NAT for children <3 years of age who sustain a displaced transphyseal distal humeral fracture compared with a displaced supracondylar fracture. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

APA Files Another Amicus Brief in Ongoing Texas Case on Banning Trans Care for Youth

APA Files Another Amicus Brief in Ongoing Texas Case on Banning Trans Care for Youth

504 Starting a Pediatric Burn Center: Challenges Faced in an Underserved Patient Population

IntroductionBurn injury is the third most common cause of childhood injury resulting in death. The CDC recognizing the South as having the highest rate of pediatric burn deaths in the U.S. Unfortunately, 10% of all child abuse cases involve burn injuries and 20% of all pediatric burn admissions are due to nonaccidental trauma. Our study demonstrated that aftercare was a major challenge in starting a pediatric burn center. We analyzed the rate of lost to follow-up in burn-injured children following surgery and our steps to address this need in our community through key partnerships within our state.MethodsOur study is a single center review of pediatric burn-injured children undergoing surgery from 01/01/2021 through 09/30/2021. Lost to follow-up was defined as three or more consecutive months without clinic or telemedicine visits despite three of more documented communication attempts by attending surgeons and/or clinic staff. Children requiring child protective services (CPS) for suspected nonaccidental trauma were compared to those where nonaccidental trauma was not suspected. All children sustained burn injuries of sufficient severity to require excision and autograft with follow-up in the outpatient clinic. Families were provided with an after-visit summary reviewing the clinic appointment, transportation and meal assistance, and they received a call prior to clinic to remind them of the scheduled appointment.ResultsA total of 35 children required surgery with outpatient follow-up per protocol. 23% of the patients required CPS investigations. We reviewed 151 subsequent clinic visits and the associated cancellations, rescheduled appointments, and no-show visits. Children under the care of CPS had a higher rate of being lost to follow-up (50%) compared to other children (17%). Parents undergoing CPS investigation were 4x less likely to provide cancellation notice. Children placed in foster care had no cancellations, reschedules appointments, or missed visits despite a higher number of clinic visits overall.ConclusionsChildren suffering nonaccidental injuries represent an exceptionally vulnerable portion of our population. Burn injuries often are a public and personal reminder of severe trauma. CPS works to find a balance in securing a safe home while attempting to maintain a family unit. Our work demonstrated an unacceptably high rate of loss to follow-up for children requiring surgical intervention after injury especially in those with concerns for nonaccidental etiologies. As a result, our burn surgeons led an initiative with statewide burn directors and our state’s emergency response network to engage the state’s CPS department. Our goal was to raise awareness and increase education for CPS social workers and foster families on burn injury and aftercare needs.

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.

Differential Response and the Reduction of Child Maltreatment and Foster Care Services Utilization in the U.S. From 2004 to 2017.

By 2014, the majority of U.S. states had implemented differential response (DR), a system policy that seeks to serve families of low-to moderate-risk for child maltreatment through family engagement, diversion from formal child protective services investigations, and service provision. However, the effects of DR programs on child welfare dynamics have yet to be evaluated nationally using causal methods. Using a quasi-experimental study design with data drawn from the National Child Abuse and Neglect Data System from 2004 to 2017, we found states with DR programs had approximately 19% fewer substantiated reports, 25% fewer children substantiated for neglect, and a 17% reduction in foster care services utilization when compared to states without DR programs. We find these estimates to be robust to the opioid epidemic and incarceration rates. Additional research is needed to better characterize DR programs and isolate the effects of DR programs geographically.