Foster Care Placement Research Articles

The functional patterns of adolescent mothers leaving foster care: Results from a cluster analysis

AbstractFew studies have explored the outcomes of adolescent mothers leaving foster care, especially using person‐oriented methods. The current study employed a cluster analysis to identify unique patterns of functioning among adolescent mothers aged 19 (n = 777). Data from the National Youth in Transition Database and the Adoption and Foster Care Analysis and Reporting System were utilized. Findings revealed five subpopulations characterized by distinct constellations of outcomes at age 19. The largest group (43%) exhibited competent functioning across all the domains studied—its members were connected to school and/or employment and did not experience homelessness, substance abuse referrals, or incarceration during the past 2 years (i.e., “resilient”). A relatively small group (12%) exhibited challenges across all the above‐referenced domains, whereas the remaining groups presented challenges in some domains, but not in others. Follow‐up analyses revealed that adolescent mothers classified as resilient at age 19 had the lowest rates of congregate care placements and the highest rates of nonrelative foster care placements at age 17. Moreover, they had lower placement instability and higher rates of extended foster care as compared with members of the other clusters. Implications for practice, policy, and research are discussed.

Sleep in Young Adults: Comparing Foster Care Alumni to a Low-Income Sample

While low-income young adults are known to be at high risk for sleep problems, sleep in foster care alumni has not been closely examined. These young adults face not only the challenges of poverty, but struggle with past maltreatment and removal from their family of origin, and frequently demonstrate mental health and substance use disorders. The current study compares risk factors and sleep in a sample of foster care alumni and low-income young adults aged 18–24 (N = 185). Multiple regression analyses were calculated with foster care experience, maltreatment, trauma exposure, anxiety, depression, marijuana use, and alcohol use predicting three measures of sleep (total sleep hours, sleep onset latency, and number of nighttime awakenings). Both groups reported similar rates of childhood maltreatment. Foster care alumni reported more trauma exposure, anxiety symptoms, and marijuana use than low-income young adults. They also showed significantly fewer sleep hours, a longer sleep onset latency, and more nighttime awakenings. Regression results revealed that a previous placement in foster care was related to all three sleep elements in the total sample, and a history of child maltreatment predicted fewer sleep hours. Anxiety and depression were associated with fewer sleep hours and anxiety was associated with more nighttime awakenings. Marijuana use was related to a shorter sleep onset latency and more nighttime awakenings. Interventions to reduce sleep problems can improve other outcomes as well and may be viewed as less stigmatizing than efforts that directly target mental health or substance use.

Maintaining culture and supporting cultural identity in foster care placements

This article reports on an exploratory study about maintaining and supporting the cultural identity of children from culturally and linguistically diverse family backgrounds in foster care placements. In this study, we spoke with foster carers and caseworkers who respectively live and work with children from culturally and linguistically diverse backgrounds in the state of New South Wales. Foster care is one of the most common placement types in out-of-home care where a child or young person is placed with an alternative caregiver on a temporary or long-term basis, usually due to neglect or abuse. The importance of nurturing a sense of belonging through cultural, linguistic and religious affiliations is recognised in Australian curriculum policies that guide teachers in early childhood and school settings. Teachers, however, may not be fully aware of their potential contribution in supporting these children to maintain their connections with their cultural heritage. Our findings provide evidence for extending the public discourse on cultural responsiveness and supporting cultural maintenance in foster care placements. We consider implications for foster care practice and future research involving key stakeholders such as children and young people in care, as well as teachers in early childhood and school settings.

Foster homes for neglected children with severe obesity-Debated but rarely studied.

To explore current research and theoretical articles on foster home placement of children with severe obesity. An integrative literature review. Literature searches in six electronic databases included theoretical, quantitative and qualitative articles and case reports published in English (2008-2018) on the topic of severe childhood obesity and foster home placement. Seventeen selected papers included six theoretical articles, nine quantitative studies, one qualitative study and one case report. Eight of the nine quantitative studies did not specify the grading of obesity in children in foster care. The case report and the qualitative study showed distinct and sustainable body mass index (BMI) reductions after a child had been placed in foster care. Five theoretical articles justified foster care placement when chronic parental neglect led to severe obesity in the child, while one article emphasised the opposite. Parental and societal neglect of children with severe obesity placed in a foster home is rarely studied or the exclusive aim of research. The views of the children themselves are lacking in research articles, as well as the child's right to health obligations concerning children with severe obesity.

Exploring Emotional Intelligence and IQ as Predictors of Success of Foster Care Alumni

The most common reason for foster care placement is child maltreatment. Sadly, once in the foster care system over 17% of children in the United States continue to experience multiple forms of maltreatment. After they “age out”, these alumni are particularly vulnerable to a host of adverse situations, such as low educational success and homelessness. The primary aim of this study was to explore individual characteristics that could predict the quality of life and level of distress of foster care alumni. Specifically, we were interested in the predictive ability of emotional intelligence (EI) and general intelligence (IQ) on quality of life and distress. Two multiple regression models were evaluated for the primary analyses. Both models included general intelligence and emotional intelligence as predictors, with one model containing quality of life and the other model level of distress as the criterion variables. The analyses demonstrated that general intelligence was not a significant predictor of quality of life or level of distress when controlling for emotional intelligence. In contrast, emotional intelligence was a significant predictor of improved quality of life and decreased level of distress when controlling for general intelligence. Emotional intelligence appears to be a characteristic that is amenable to change and a predictor of positive outcome among foster care alumni. Moreover, emotional intelligence may bolster resiliency against the higher levels of instability and stress experienced by foster care children.

The Impact of the Opioid Epidemic on Children and Adolescents

Although an epidemic of opioid-related overdose deaths has continued to increase in the United States for 2 decades, the impact of opioid use disorders (OUDs) on children and families receives minimal attention. The purpose of this commentary was to provide an overview of the impact of the opioid epidemic on children and adolescents, as well as to summarize challenges to improving outcomes for children. Children and adolescents who grow up in households with opioid misuse and OUDs may experience a myriad of adverse consequences, including: increased risk of mental health problems and drug use; accidental opioid poisoning; increased risk of developing a substance use disorder; and family dissolution that results from parents' incarceration, foster care placement, or loss of parent to an opioid overdose. Parental drug use may result in child neglect or deficits in parent–child attachment, and parents with an OUD may be less likely to be reunified with their children. OUD treatment is effective at reducing parental opioid use and improving child outcomes; however, stigma and cross-system collaboration may limit access to treatment and timely reunification of families. Children are the most vulnerable witnesses of the opioid epidemic, and further research is urgently needed to expand prevention interventions.

Child protection inequalities in Aotearoa New Zealand: Social gradient and the ‘inverse intervention law’

Contact with child protection systems are a key site of the expression of social inequalities, yet research into the size and nature of this relationship remains sparse in the Aotearoa New Zealand system context. This article reports on a study of the relationships between child protection system contact and small area-level deprivation. Using a national linked dataset including all children with system contact in 2013–14, (n = 13,851 children) it found there is a marked relationship between deprivation and system contact, and significant differences between regions for all three outcomes of interest. Compared to children living in the least deprived quintile of small areas, children in the most deprived quintile had, on average, 13 times the rate of substantiation, 18 times the rate of a family group conference, and 6 times their chance of placement in foster care. There was limited evidence for the ‘inverse intervention law’ that proposes that children in similarly deprived small areas have higher rates of child protection system contact if they live in less deprived regions (larger areas). The pattern of placements showed the strongest support for this law, with children in similarly deprived small areas having, on average, almost twice the rate of placement if they lived in less deprived regions compared to more deprived regions. These findings have implications for policy, as they suggest a need to apply an inequalities perspective to child protection similarly to health inequities. Specifically, action is needed to address the causes of deprivation, provide services that respond to families living in poverty, address biases, and undertake further research to examine the interactions between demand and supply of services between similar deprivation levels.

The long-term effects of institutional rearing, foster care intervention and disruptions in care on brain electrical activity in adolescence.

Exposure to early psychosocial deprivation as a result of institutional care disrupts typical brain development. The Bucharest Early Intervention Project (BEIP) is the first longitudinal study to investigate the neurodevelopment of institutionalized infants randomized to a foster care (FCG) intervention versus care as usual (CAUG). Here, we present findings from a follow-up assessment of brain electrical activity as indexed by resting EEG at age 16years. In addition, we examined the effects of disruption of foster care placement (e.g. the number of moves among foster care placements) on brain electrical activity. Resting-state EEG was collected from 48 CAUG, 46 FCG and 48 never institutionalized (NIG) control participants. Absolute (µV2 ) and relative (proportion) power were computed from eyes closed, resting EEG data for theta, alpha and beta frequency bands. The CAUG displayed higher relative theta and lower relative alpha power compared to the FCG at 16years of age. The FCG showed brain activity comparable to the NIG. The results further showed that disruptions following the original foster care placement had an adverse effect on brain electrical activity. Within the foster care group, there were no effects of age of placement on EEG power. Placement of children who have experienced early institutional rearing into stable foster care settings ensure long-term improvement in brain functioning.

Experiences of Adolescents’ Independent Living after the Termination of Foster Care Placement

Experiences of Adolescents’ Independent Living after the Termination of Foster Care Placement

Outcomes of the Iowa Parent Partner program evaluation: Stability of reunification and re-entry into foster care

In an effort to facilitate family engagement with services, improve reunification outcomes, and empower the families they serve, child welfare agencies across the country have developed and implemented programs designed to provide peer mentoring. These programs work to identify parents who have successfully navigated the child welfare system in the past and train them to mentor parents who are currently in the system. The current study used a quasi-experimental design and propensity score matching to examine the outcomes for children of families served by the Iowa Department of Human Services Parent Partner program, one of the earliest and most established programs in the country. Results indicated that the children of program participants were significantly more likely to return home at discharge from their foster care placement than the children of matched non-participants. Additionally, Iowa Parent Partner program participants were significantly less likely to have a subsequent child removal within 12 months of the child returning home than matched non-participants. No significant differences were found between the children of program participants and children of matched non-participants in the total time in out of home care or subsequent child removal within 24 months of returning home. These results suggest that participating in the Iowa Parent Partner program can meaningfully improve the outcomes of children and families. Limitations and implications of the current study, as well as recommendations for future research, are discussed.

Participation of Children, Birth Parents and Foster Carers in the Matching Decision. Paternalism or Partnership?

Participation of children, birth parents and foster carers in matching decision‐making has the potential to improve the outcomes of a foster care placement. When practitioners choose which foster family is the best fit for a foster child, those affected by the foster care placement should be involved in decision‐making when possible. This research paper examines the influence of children, birth parents and foster carers on the matching decision from a practitioner's perspective. Semi‐structured interviews were conducted with 22 practitioners from 17 of the 28 foster care organisations in the Netherlands responsible for matching children with foster families. The analysis identified three themes that diminished the influence of children, birth parents and foster carers on the matching decision: assumptions, timing and feasibility. The findings emphasise that the influence of stakeholders on the matching decision is highly contextual. In the matching process, practitioners can be seen as key figures in facilitating the influence of stakeholders, yet they are also confronted with the difficulty of dealing with more than one stakeholder, who can have opposing interests, in an often compromised setting with limited choices.‘Examines the influence of children, birth parents and foster carers on the matching decision from a practitioner's perspective’Key Practitioner Messages Despite policy to stimulate the involvement of children, birth parents and foster carers in decisions, their influence on the matching decision is sometimes futile. Assumptions made by practitioners, timing in the matching process and a compromised setting diminish the stakeholders' influence on the matching decision. Practitioners are key figures in improving participatory practice to make sure that stakeholders feel understood, valued and taken seriously.

A Quasi-Experimental Effectiveness Study of Triple P on Child Maltreatment

We examined the impact of the implementation of The Triple P-Positive Parenting Program in North Carolina (NC) on reducing child maltreatment, a serious public health problem in the US with lasting harmful effects on children. In 2012 and 2013, 34 of 100 counties in NC implemented Triple P. A panel data set with county-level child welfare data and emergency department (ED) discharge data from 2008 to 2015 for 100 counties in NC was constructed. A quasi-experimental design using difference-in-differences analysis estimated the association between the implementation of Triple P and the rate of (1) investigated child maltreatment reports; (2) entry into foster care; and (3) ED visits concerning for child maltreatment. Implementation of Triple P was associated with in a 4% decrease in the county rate of investigated reports of child maltreatment (RR = 0.96, 95% CI [0.93, 0.99]) and a 7% decrease in the county rate of children in foster care (RR = 0.93, 95% CI [0.88, 0.98]). Each of these findings was robust to one but not both sensitivity tests performed. There was no reduction in county-level rates of ED visits with ICD-9-CM codes concerning for child maltreatment. Implementation of Triple P in NC outside of the parameters of scientific study is associated with small reductions in the rates of child maltreatment reports and foster care placements. Additional research is needed to understand whether such small reductions justify the substantial investment communities are making in Triple P.

Exploring the Relationship Between Foster Care Experiences and HIV Risk Behaviors Among a Sample of Homeless Former Foster Youth.

Recent research shows high rates of poor behavioral health outcomes among homeless former foster youth, including increased risk for HIV-risk behaviors. In the current study, data were collected from 184 youth at drop-in centers in Los Angeles using behavioral health questionnaires to explore the relationships between specific aspects of foster care experiences and engagement in HIV-risk behaviors. Results indicated that youth whose first homelessness experience occurred before leaving foster care were significantly more likely to engage in drug use with sex and exchange sex than those whose first homelessness experience occurred after leaving foster care. Intervention services targeting HIV-risk behaviors should consider the aspects of foster care placements that may increase the risk of these behaviors, such as long periods of placement or experiencing homelessness before exiting foster care, as well as those that may decrease the risk of these behaviors, such as exiting placement at an older age.

General Cognitive Ability as an Early Indicator of Problem Behavior Among Toddlers in Foster Care.

Children who have experienced maltreatment and subsequent placement in foster care are at increased risk of problem behavior. Increased knowledge of the development of problem behavior in this population, particularly during toddlerhood, can greatly inform preventive intervention efforts. This study examined variability in problem behavior among toddlers entering new foster care placements and identified related child and parenting characteristics. Ninety-one toddlers in foster care (mean = 2.26 years) and their caregivers completed an initial assessment and were reassessed 6 months later. A child's general cognitive ability was assessed via performance on a standardized developmental measure, and child problem behavior, parenting stress, frequency of family routines, and harsh discipline were assessed via caregiver report. Upon entering a new foster care placement and 6 months after placement, respectively, 38% and 25% of the toddlers were within the borderline clinical or clinical range in terms of problem behavior when assessed using the Child Behavior Checklist. There was not a significant difference in problem behavior over this 6-month period, suggesting that problem behavior was quite stable among the toddlers as a group. However, general cognitive ability was a significant predictor of individual differences in change in problem behavior, with toddlers with lower general cognitive ability displaying increased problem behavior over this period. An increased number of toddlers in foster care displayed clinically significant levels of problem behavior, further demonstrating that these children are an extremely high-risk group. The association between general cognitive ability and change in problem behavior highlights the importance of early developmental screenings, which may help identify children at greatest risk of problem behavior and most in need of preventive intervention efforts.

Are sexual minority youth overrepresented in foster care, child welfare, and out-of-home placement? Findings from nationally representative data.

Preliminary evidence suggests that sexual minority (e.g. lesbian, gay, bisexual, and same-sex attracted) youth are overrepresented in child welfare services. Yet, no study to date has been able to test this hypothesis with national data. Using a two-study design, we test whether sexual minority youth are overrepresented in child welfare, foster care, and out-of-home placement using nationally representative data from the United States. Study 1 data are from the National Longitudinal Study of Adolescent to Adult Health (n = 14,154; Mean age = 15.4). Study 2 data are from wave three of the National Survey of Child and Adolescent Well-Being II (n = 1309; Mean age = 15.0). For Study 1, we use adjusted logistic regression models to test differences in lifetime foster care involvement between sexual minority and heterosexual youth. In Study 2, we calculate a Disproportionality Representation Index (DRI) - a ratio of sample prevalence relative to the general population - to estimate whether sexual minority youth were overrepresented in child welfare and out-of-home care. Study 1 results indicate that sexual minority youth are nearly 2.5 times as likely as heterosexual youth to experience foster care placement (aOR = 2.43, 95% CI 1.40, 4.21, p = .002). Results from Study 2 show that sexual minority youth were largely overrepresented in child welfare services (DRI = 1.95-2.48) and out-of-home placement (DRI = 3.69-4.68). Findings are the first to demonstrate sexual minority youth's overrepresentation in child welfare, foster care, and out-of-home placement using nationally representative data and emphasizes the need for focused research on sexual minority youth involved in the child welfare system.

Comparison of Institutionally Reared and Maltreated Children on Socioemotional and Biological Functioning

The current study compared behavioral and adrenocortical functioning of maltreated (N = 91) and comparably aged (1.5-3 years) institutionally-reared children soon after (1.5-2.5 months) placement in foster care or adoptive homes, respectively. Foster and adoptive parents reported on the children's socioemotional competence and behavior problems, experimenters scored fear and positive affect to laboratory tasks, and diurnal cortisol measures were obtained. We sought to address whether these early contexts, characterized by different types of neglect and deprivation, have differential effects on young children's development. We found little support for the argument that either context results in uniformly poorer functioning soon after removal from adversity. Maltreated children were less fearful and more positive when exposed to both positive and novel events than institutionally-reared children. However, maltreated children were reported to have more behavior problems than did institutionally-reared children, and institutionally-reared children showed more typical declines in cortisol throughout the day than the maltreated children. These findings increase our ability to construct more targeted and effective interventions for these populations.

Long-term effects of institutional rearing, foster care, and brain activity on memory and executive functioning

Children experiencing psychosocial deprivation as a result of early institutional rearing demonstrate many difficulties with memory and executive functioning (EF). To date, there is scant evidence that foster care placement remediates these difficulties during childhood. The current study examined longitudinal trajectories of memory and EF from childhood to adolescence in the Bucharest Early Intervention Project, a randomized controlled trial of foster care for institutionally reared children. We demonstrate that both ever- and never-institutionalized children show age-related improvements on several measures of memory and EF from age 8 to 16. Distinct patterns were observed for different domains of functioning: (i) Early-emerging disparities in attention and short-term visual memory, as well as spatial planning and problem solving, between ever- and never-institutionalized children persisted through adolescence; (ii) the gap in spatial working memory between ever- and never-institutionalized children widened by adolescence; and (iii) early difficulties in visual-spatial memory and new learning among children in foster care were mitigated by adolescence. Secondary analyses showed that higher resting EEG alpha power at age 8 predicted better EF outcomes in several domains at age 8, 12, and 16. These results suggest that early institutional rearing has enduring consequences for the development of memory and EF, with the possibility of catch-up among previously institutionalized children who start out with higher levels of problems. Finally, interindividual differences in brain activity relate to memory and EF across ages, thus highlighting one potential biological pathway through which early neglect impacts long-term cognitive functioning.

Evaluation of Serum Vitamin D Levels in Foster's Children Care Center

Vitamin D, the sunshine vitamin, is now recognized not only for its importance in promoting bone health in children and adults, but also for its other health benefits, including reducing the risk of chronic diseases such as autoimmune diseases, common cancer, and cardiovascular diseases. Ultraviolet radiation of the sun with wavelengths of 290-310 nm penetrates into the skin and converts 7-dehydrocholesterol to previtamin D3, which quickly transforms to vitamin D3. Vitamin D (D represents either D2 or D3) made in the skin or ingested through diet is biologically inert and requires two successive hydroxylations first in the liver on carbon 25 to form 25-hydroxyvitamin D 25(OH)D and then in the kidney for a hydroxylation on carbon 1 to form the biologically active form of vitamin D, 1,25-dihydroxyvitamin D (1,25(OH)2D) 1, 2, 14, 19. The concentration of the produced 25-hydroxy vitamin D in blood circulation is 1,000 times more than 1,25-dihydroxy vitamin D 4, and it is regarded as a standard indicator of vitamin D status in humans 3. 25-hydroxy vitamin D half-life is about 2-3 weeks and it is regulated by calcium (Ca), phosphorus (P), and serum parathyroid hormone (PTH) to some extent. 25-hydroxy vitamin D content also reflects the amount of vitamin D produced in the skin after exposure to sunlight or received through food intake 5, 6. Guidelines for vitamin D insufficiency/deficiency defined by serum 25(OH)D concentrations have been published from many countries and regions all over the world 7, 8, 9, 10, 11. Vitamin D deficiency is a pandemic problem. According to global estimations, more than one billion people around the world suffer from vitamin D deficiency. Among Iranian population, the incidence of vitamin D deficiency varies from 2.5 to 98.5% based on geographic area 12, 13. Various factors may give rise to vitamin D deficiency, including skin pigments, low levels of vitamin D in diet (insufficient fish oil and egg yolk intake), malnutrition, genetic factors, exclusive breast feeding, vitamin D deficiency of mother during pregnancy, prematurity, chronic use of drugs (e.g., anticonvulsants, aluminum-containing anti-acids, rifampcin, isoniazid, antifungal drugs, antiviral drugs, and glucocorticoids), winter and obesity 1, 13. Cultural habits, the need for full body coverage during outdoor activities and the lack of sunlight programs are the risk factors for low vitamin D levels in women 15, 16, 17. Children enter foster care due to early childhood adverse experiences such as poor prenatal and infant health care, food insecurity, chronic stress, and the effects of abuse and neglect. As a result, they are at higher risk for poor physical, psychological, neuroendocrine and neurocognitive outcomes compared to others. Foster children are at risk for growth and nutritional deficiencies due to their poor nutritional environment prior to placement in foster care. Insufficient caloric intake results in growth deficiencies. Evidence showed that the risk of stunting and underweight is high in this population 18. The risk of developing hypovitaminosis D was significantly higher in children living in foster homes. One reason is that they are at higher risk of child abuse, emotional deprivation and physical neglect than children living with their families. Moreover, these children most likely do not spend much time outdoors and they lack adequate sun exposure. Another reason is that as children grow up in institutional care, they shift from a diet of vitamin D–fortified formula milk to cooked food, which may not be fortified with vitamin D 1. Iranian government has made some efforts to apply efficient interventions to reduce the prevalence of vitamin D deficiency, and the country’s healthcare system should be managed through accurate planning. Yet, in this country, studies on vitamin D deficiency in children living in foster homes are very limited, and given that timely diagnosis and treatment of this deficiency is vital, this research is conducted in Ali Asghar foster home in Mashhad, Iran.

No youth left behind to human trafficking: Exploring profiles of risk.

The objective of this study was to analytically identify risk profiles for juvenile human trafficking (JHT) based on adverse childhood experiences (ACEs) and health risk behaviors. First, the study examined which types of ACEs and health risk behaviors were more prevalent among trafficked adolescents using a sample of 913 male and female juvenile-justice-involved adolescents with suspected or verified JHT abuse reports documented between 2009 and 2015 and a comparison group (matched by age, gender, race, ethnicity, and location). Second, latent class analysis was used to identify profiles of risk for JHT. Finally, associations between JHT risk profiles and demographic characteristics provided a more comprehensive depiction of various types of trafficked adolescents. Study findings indicate that adolescents with JHT abuse reports were more likely to report child maltreatment and internalizing health risk behaviors reflective of self-harm and attempts to cope with trauma. Trafficked youth were less likely to report externalizing health risk behaviors related to violence or harming others. Six distinctive profiles of risk for JHT were identified. Three JHT risk profiles were characterized by extensive child maltreatment and health risk behaviors and were differentiated by placement in foster care and substance use. Three JHT risk profiles were characterized by less extensive histories of child maltreatment and were differentiated by drug use. In conclusion, these findings highlight that the current depictions of adolescent victims of human trafficking are too narrow and may lead to critical health care and service provision disparities for many trafficked adolescents. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Human trafficking victimization among youth who run away from foster care

Domestic minor human trafficking (HT) is a growing social justice concern, particularly among youth in the child welfare system. This paper uses administrative data to describe the characteristics and experiences of a population of youth in the child welfare system considered to be at particularly high risk of victimization: youth who have run away from foster care. Analyses are based on nearly 37,000 youth with at least one foster care placement in Florida at age 10 or older between 2011 and 2017. We examine the characteristics of youth with and without at least one foster care runaway episode, and the characteristics and experiences of youth with and without one or more HT allegations while on runaway status. Of the youth with at least one foster placement at age 10 or older, approximately 19% (n = 7039) had at least one foster care runaway episode, and of these youth, 7% (n = 542) had an HT allegation while on runaway status. Youth with HT allegations (compared to those without) during a foster care runaway episode were more likely to: be female, experience prior physical, psychological and sexual abuse, run from care at a younger age, experience more foster care placements since entry into the child welfare system, and experience more foster care runaway episodes. For most (70%) youth with a HT allegation during runaway status, the first identified trafficking allegation occurred during a foster care runaway episode. Most (67%) youth did not have another HT allegation up to a year later. Implications for research and child welfare policy and programs are discussed.