National Child Abuse Research Articles

Network Analysis to Visualize Qualitative Results: Example From a Qualitative Content Analysis of The National Child Abuse Hotline.

Data visualization, such as figures created through network analysis, may be one way to present more complete information from qualitative analysis. Segments of qualitatively coded data can be treated as objects in network analysis, thus creating visual representations of the code frequency (i.e., nodes) and the co-occurrence (i.e., edges). By sharing an example of network analysis applied to qualitative data, and then comparing our process with other applications, our goal is to help other researchers reflect on how this approach may support their interpretation and visualization of qualitative data. A total of 265 de-identified transcripts between help-seekers and National Child Abuse Hotline crisis counselors were included in the network analysis. Post-conversation surveys, including help-seekers' perceptions of the conversations, were also included in the analysis. Qualitative content analysis was conducted, which was quantified as the presence or absence of each code within a transcript. Then, we divided the dataset based on help-seekers' perceptions. Individuals who responded that they "Yes/Maybe" felt more hopeful after the conversation were in the "hopeful" dataset, while those who answered "No" were in the "unhopeful" dataset. This information was imported to UCINET to create co-occurrence matrices. Gephi was used to visualize the network. Overall, code co-occurrence networks in hopeful conversations were denser. Furthermore, the average degree was higher in these hopeful conversations, suggesting more codes were consistently present. Codes in hopeful conversations included information, counselor support, and problem-solving. Conversely, non-hopeful conversations focused on information. Overall, network analysis revealed patterns that were not evident through traditional qualitative analysis.

The Hispanic paradox in child maltreatment: Does it fade over time?

BackgroundThe “Hispanic Paradox” refers to a commonly noted tendency for Hispanic immigrants to have good health outcomes relative to risks faced. This paper demonstrates the presence of the Hispanic Paradox relative to child maltreatment, with a focus on how it appears to “fade” generationally. ObjectivesTo use national child maltreatment and census data to determine if the protective effects of the Hispanic Paradox are weaker (“fade”) for counties with fewer foreign-born Hispanics. DesignCensus data, including the percentage of Hispanics in a county who were foreign-born, was used to predict child maltreatment rates as observed in the National Child Abuse and Neglect Data System. The analysis was done at a county level and included a number of covariates (e.g. Hispanic Median Income, Rural/Urban status…). Participants and settingWe included national child maltreatment data at the county level. ResultsA negative binomial mixed effects model showed that for each point of increase in the percentage of the Hispanic foreign-born population of a county, the county Hispanic child maltreatment rate was expected to drop by 1 %. Variation in Hispanic national origin (i.e. Puerto Rico) was found to significantly moderate this relationship. ConclusionCounties with higher percentages of foreign-born Hispanics have lower child maltreatment rates after controlling for other factors. This is consistent with emerging findings in the child mortality data and suggests that for child maltreatment, the Hispanic Paradox may fade generationally.

U.S. State rates of newborns reported to child protection at birth for prenatal substance exposure

BackgroundIn the U.S., the opioid epidemic has revitalized national attention to newborns with prenatal substance exposure (PSE). These newborns and their caregivers have specific health and treatment needs and frequently interact with multiple systems, including child protection systems (CPS). MethodsThis study calculated rates of newborns (less than 15 days old) reported to CPS per 1,000 births due to PSE by state and year using data from the National Child Abuse and Neglect Data System (NCANDS). Given the lack of a clear definition of PSE reports in the data, we calculated rates using three different definitions. To examine the relationship between different state laws regarding the mandated reporting of PSE and PSE reports rates, we used panel data analysis. ResultsRates of newborn reports more than doubled between 2011 and 2019. There was extensive state variability of rates including some states that were consistently more than 100 % greater than and others consistently more than 150 % less than the annual national mean. Reporting rates were not associated with state requirements to report PSE, but were positively associated with rates of diagnosed neonatal abstinence syndrome. ConclusionState-level inconsistencies in identification, reporting, and CPS responses prevent a clear understanding of the scope of the affected population and service needs.

Rapport Building in Written Crisis Services: Qualitative Content Analysis.

Building therapeutic relationships and social presence are challenging in digital services and maybe even more difficult in written services. Despite these difficulties, in-person care may not be feasible or accessible in all situations. This study aims to categorize crisis counselors' efforts to build rapport in written conversations by using deidentified conversation transcripts from the text and chat arms of the National Child Abuse Hotline. Using these categories, we identify the common characteristics of successful conversations. We defined success as conversations where help-seekers reported the hotline was a good way to seek help and that they were a lot more hopeful, a lot more informed, a lot more prepared to address the situation, and experiencing less stress, as reported by help-seekers. The sample consisted of transcripts from 314 purposely selected conversations from of the 1153 text and chat conversations during July 2020. Hotline users answered a preconversation survey (ie, demographics) and a postconversation survey (ie, their perceptions of the conversation). We used qualitative content analysis to process the conversations. Active listening skills, including asking questions, paraphrasing, reflecting feelings, and interpreting situations, were commonly used by counselors. Validation, unconditional positive regard, and evaluation-based language, such as praise and apologies, were also often used. Compared with less successful conversations, successful conversations tended to include fewer statements that attend to the emotional dynamics. There were qualitative differences in how the counselors applied these approaches. Generally, crisis counselors in positive conversations tended to be more specific and tailor their comments to the situation. Building therapeutic relationships and social presence are essential to digital interventions involving mental health professionals. Prior research demonstrates that they can be challenging to develop in written conversations. Our work demonstrates characteristics associated with successful conversations that could be adopted in other written help-seeking interventions.

Trends in the Annual Incidence Rates of Child Sexual Abuse and Child Maltreatment over the Past 25 Years in the United States

AbstractExperiencing child sexual abuse is associated with increased risk for a range of short‐ and long‐term negative effects. This short report defines and explores the annual incidence rates of child sexual abuse in the United States over 25 years between 1996 and 2021 (the most recent data released) and, comparatively, annual incidence rates of child maltreatment, more generally. A retrospective trend analysis of Child Maltreatment Reports, produced by the Department of Health and Human Services with data from the National Child Abuse and Neglect Data System, was conducted to compile and analyse rates of child sexual abuse and child maltreatment over time. In general, the rates of reported child maltreatment and child sexual abuse have declined, on average, since the 1990s. We, then, discuss these trends in connection with research documenting societal and family factors that may have contributed to these declines.

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.

Advanced child tax credit payments and national child abuse hotline contacts, 2019–2022

BackgroundChildren in households experiencing poverty are disproportionately exposed to maltreatment. Income support policies have been associated with reductions in child abuse and neglect. The advance child tax credit (CTC) payments...

Child Maltreatment Types by Age: Implications for Prevention.

Child maltreatment is a global public health issue known to affect an average of 600,000 U.S. children of all ages (0-18 years old) annually. However, a preponderance of preventive programs target children on the younger end of the spectrum, specifically those aged 0-5. Annual reports of the prevalence of maltreatment provide opportunities to analyze trends, but in 2009, these reports stopped reporting the ages of victims for each type of maltreatment (i.e., neglect, physical abuse, emotional abuse, and sexual abuse). This omission limits the ability to match (or design) prevention programs responsive to the ages of those at greatest risk. Using data from the National Child Abuse and Neglect Data System (NCANDS) from 2011-2020, this secondary data analysis describes trends for four types of maltreatment by age from an epidemiological perspective. Implications for practice (i.e., prevention) and policy are presented. The findings of this study offer the first step in what is hoped to be a line of research that seeks to identify, match, and/or develop evidence-based programs to prevent child maltreatment among the populations at highest risk.

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.

Does a child maltreatment report source predict differences in immediate and subsequent report outcomes?

BackgroundMandated reporting policies, a core response to the identification of child maltreatment, are widely debated. Currently, there are calls to abolish or scale back these policies to include only certain professionals. These calls warrant evaluation of whether there are any differences in child welfare outcomes based on report source. ObjectiveTo determine if the initial report source predicts immediate and long-term risk of re-referral, substantiation, and placement. Participants and settingWe used yearly National Child Abuse and Neglect Data System (NCANDS) hotline report and placement data. Children (0-14y) with a first ever hotline report in 2012–2014 were followed for three years. The final sample included 2,101,397 children from 32 states. MethodsWe use descriptive and bivariate statistics to show initial report outcomes by reporter source type and logistic regression models to evaluate the effect of report source on immediate and subsequent report outcomes. ResultsProfessional sources varied in levels of substantiation and placement, with law enforcement, medical, and social service sources showing much higher rates. Reports from professional sources have higher odds of initial report substantiation and foster care entry, and slightly lower odds of later re-report than nonprofessional sources. We found no differences between professional and nonprofessional sources in subsequent foster care entry. ConclusionsReports from professional, nonprofessional, and unclassified sources have varying levels of risk in some of their short- and long-term outcomes. To the degree that child protective services embrace a long-term preventative role, reports by nonprofessional report sources may provide opportunities for prevention.

Substance Use-Associated Infant Maltreatment Report Rates in the Context of Complex Prenatal Substance Use Policy Environments.

State responses to substance use during pregnancy have included policies designed to increase access to substance use treatment as well as punish such substance use. Prior research has found that punitive policies are associated with increased rates of child maltreatment reporting, but it is unclear if the presence of punitive-promoting policies also moderate the association between access-promoting polices and maltreatment reports. Using data from the National Child Abuse and Neglect Data System and state-level fixed effects models, this study investigates how interactions between access-promoting and punitive prenatal substance use policies are associated with rates of substance use-associated maltreatment reports among infants. In states with punitive policies, access-promoting policies were associated with smaller decreases in these reports than in states without punitive policies. In some cases, access-promoting policies were associated with greater increases in these reports when punitive policies were also present than when only one type of policy was adopted. Interactions between prenatal substance use policies may result in unintended and counterproductive consequences for maternal and child health and the child welfare system.

Adolescents with substance use referred to child protective services: Does substance use treatment prevent foster care entry?

AbstractAdolescent substance use has been linked to several negative outcomes, which can be exacerbated by exposure to adversity such as child maltreatment. However, few studies have examined the intersection of adolescent substance use and child protective service (CPS) involvement. This study examined the relationship between substance use treatment and entries into foster care among adolescents referred to CPS for maltreatment. Data for this study came from the National Child Abuse and Neglect Data System (NCANDS), an annually reported database that contains information on all CPS reports screened for investigation. NCANDS was merged with county‐level data from the American Community Survey to explore the relationship between treatment and foster care entry while adjusting for contextual factors. Our sample included 2326 adolescents who were referred to CPS in fiscal year (FY) 2018 and were followed until FY 2019 to examine correlates of foster care entry. A series of multilevel logistic regressions were conducted. Approximately 1 in 20 adolescents entered foster care during the study period and 1 in 10 used treatment services prior to foster care entry. Substance use treatment increased the odds of foster care entry (adjusted odds ratios = 2.30, p < 0.05), while adolescents residing in counties with higher percentages of non‐Hispanic White residents had lower odds of foster care entry (adjusted odds ratios = 0.67, p < 0.05). Among adolescents with substance use referred to CPS, substance use treatment increases the likelihood of foster care entry. This may highlight the need to provide services earlier and to ensure that adolescents can access treatment without entering state custody. Future research should explore these relationships in more depth.

Stress, child-caregiver disability, and family dysfunction characteristics contributing to child abuse and maltreatment recurrence: a structural equation model

ABSTRACT Child abuse, neglect, and maltreatment (CANM) represents a significant public health threat. The study’s goal was to identify factors contributing to CANM and its high recurrence. We utilized 2019–2020 National Child Abuse data to test a structural equation model of Child/Caregiver Disability variables; Home Instability variables; and CANM recurrence. We hypothesized a six-factor model with Home Instability as a mediator. Of 1,221,176 victims, 29.9% had a prior victimization. A four-factor, mediational structural equation model showed strong fit (GFI = 0.946, NFI = 0.919) and was superior to alternative models. The study provides a framework for community leaders to reduce CANM.

Medical Professional Reports and Child Welfare System Infant Investigations: An Analysis of National Child Abuse and Neglect Data System Data.

Medical professionals are key components of child maltreatment surveillance. Updated estimates of reporting rates by medical professionals are needed. We use the National Child Abuse and Neglect Data System (2000-2019) to estimate rates of child welfare investigations of infants stemming from medical professional reporting to child welfare agencies. We adjust for missing data and join records to population data to compute race/ethnicity-specific rates of infant exposure to child welfare investigations at the state-year level, including sub-analyses related to pregnant/parenting people's substance use. Between 2010 and 2019, child welfare investigated 2.8 million infants; ∼26% (n=731,705) stemmed from medical professionals' reports. Population-adjusted rates of these investigations stemming doubled between 2010 and 2019 (13.1-27.1 per 1000 infants). Rates of investigations stemming from medical professionals' reports increased faster than did rates for other mandated reporters, such as teachers and police, whose reporting remained relatively stable. In 2019, child welfare investigated ∼1 in 18 Black (5.4%), 1 in 31 Indigenous (3.2%), and 1 in 41 White infants (2.5%) following medical professionals' reports. Relative increases were similar across racial groups, but absolute increases differed, with 1.3% more of White, 1.7% of Indigenous, and 3.1% of Black infants investigated in 2019 than 2010. Investigations related to substance use comprised ∼35% of these investigations; in some states, this was almost 80%. Rates of child welfare investigations of infants stemming from medical professional reports have increased dramatically over the past decade with persistent and notable racial inequities in these investigations.

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.

Who makes the call? Examining the relationship between child maltreatment referral sources and case outcomes in the United States, 2008-2018

BackgroundResearch shows general increases in child maltreatment reports in the U.S. However, less is understood about how reporting varies across states and changes over time, from a perspective of referral sources. While recent studies during COVID-19 reported a reduction in maltreatment referrals, predominantly school referrals, little research has examined changes in maltreatment referrals by referral sources before the pandemic and how different referral sources are associated with case outcomes, particularly out-of-home placement. ObjectivesThis study examined 1) variations across states and changes over time in maltreatment reporting by referral source and 2) the relationship between referral sources type and two case outcomes: substantiated maltreatment and out-of-home placement. Participants and settingWe used 2008–2018 data (N = 24,349,293) from the National Child Abuse and Neglect Data System. MethodsWe used descriptive trend analysis and pooled, fixed effects binary logistic regression. ResultsWe found gradual increases in reporting during 2008–2018, with substantial variations across states and referral sources. States rely differently on certain reporter types, while we see the largest increase in education referrals and a small decrease in social services referrals. Regression results showed that education referrals were less likely to result in out-of-home placement; law enforcement referrals were most likely to be substantiated, while social service referrals were most likely to result in out-of-home placement. ConclusionThis study makes unique contributions to literature by expanding our knowledge of referral sources and examining the likelihood of substantiation and out-of-home placement by referral source type. We provide child welfare policy and practice implications.

Housing circumstances of disabled parents within the child welfare system

Parents with disabilities are more likely than their nondisabled counterparts to have child welfare system involvement. Furthermore, once they are involved in the child welfare system, parents with disabilities have disproportionately high rates of poor outcomes, including termination of parental rights. Inadequate housing is also associated with heightened risk for child welfare system involvement, and yet no study has explored the housing circumstances of parents with different types of disabilities within the child welfare system.The present study aims to fill these gaps by providing a national-level examination of the housing circumstances of parents with disabilities involved in the child welfare system, including parents from racial and ethnic minorities. Using data from data the 2018 National Child Abuse and Neglect Data System (NCANDS), Poisson regression analyses yielded risk ratios, which were used to compare the housing circumstances of parents with and without disabilities. Interaction terms were used to explore the compounding effects of race and disability.Results show that parents with disabilities compared to parents without disabilities experience heightened risk for inadequate housing. The risk is compounded for Black parents with disabilities. These findings indicate the need to prioritize housing supports for disabled parents with child welfare system involvement.

Poverty or Racism? A Re-Analysis of Briggs et al. 2022

Purpose: This paper presents a re-analysis of the National Child Abuse and Neglect Data System (NCANDS) data presented by Briggs et al. (2022). Methods: We review five components of that article: The aims, variables, analytic strategy, analysis, and conclusions. Results: We conclude that several of the NCANDS variables used are invalid at the national level, and that this is sufficient to call the research into question. We find concerning issues in analytic strategy and analysis as well, many stemming from a failure to account for the serious underreporting of services in NCANDS, and the wide variability in data quality and consistency across states. We also found what we consider to be issues with their statistical analysis. Discussion: The reanalysis presented in this article shows no pattern of disparate within Child Protective Services (CPS) outcomes by race and, therefore, no support for the Briggs et al. claim of pervasive anti-Black racism within the CPS system.

Poverty Indicators in the National Child Abuse and Neglect Data System Child File: Challenges and Opportunities

Purpose: The National Child Abuse and Neglect Data System (NCANDS) Child File, the only national dataset cataloging child maltreatment reports. It includes variables representing economic distress frequently used in published research. At the national level, these variables are demonstrably implausible, substantially underestimating economic distress. Method: This paper reviews recent work using these variables, analyzes the NCANDS data directly, demonstrates why the economic variables in NCANDS are unusable at a national level, and provides recommendations for incorporating economic measures using NCANDS. Results: We find 19 articles that have used these variables within the past 10 years. Most states provide implausible estimates. Economic measures can be incorporated into NCANDS data by either subsetting to s states with plausible estimates of these variables in given years, or appending county-level economic Census data. Discussion: Without addressing these variables’ issues in plausibility, use of them will yield biased estimates.

Family support services and reunification across diverse racial/ethnic groups: A survival analysis utilizing administrative child welfare data

Background/ObjectiveContrary to their intention, family support services may increase the likelihood of foster care placement. Yet, few studies have examined what happens to children placed into care after receiving these in-home services, which is particularly concerning for children of color who often face disparities in successful outcomes. Using data from the Adoption and Foster Care Analysis and Reporting System (AFCARS) and the National Child Abuse and Neglect Data System (NCANDS), this study examined the relationship between family support service utilization and reunification across diverse racial/ethnic groups.MethodData for this study come from the AFCARS and the NCANDS. All children who entered foster care in 2015 in states that reported utilization of family support services (29 states and DC) were included in this analysis (n = 178,366 children) and were tracked for four years. We conducted multivariate survival analyses to examine the likelihood of reunification depending on family support service use and race/ethnicity, among other covariates.ResultsApproximately half of the sample (50.51%) reunified during the study period. White, Hispanic, and Multiracial children had the highest utilization of family support services. After adjusting for other factors, family support services (HR = 0.95, 95% CI = 0.94–0.96) decreased the hazards of reunification. The interaction between race/ethnicity and family support services was not significantly associated with reunification.DiscussionFamily support services are not achieving their intended goal either prior to, or after removal, regardless of racial/ethnic identity. Implications are explored for policy related to reunification and for future research to explore the relationship between receipt of family support services and reunification.