Prior Child Protective Services Research Articles

Disparities in Child Protective Services Reporting Among Pregnant Patients With Positive Urine Drug Screening at Delivery Hospitalization [ID 2683555

INTRODUCTION: This study assesses predictors of Child Protective Services (CPS) reporting among patients with a positive urine drug screening (UDS) during delivery hospitalization. METHODS: Patients receiving prenatal care and delivering at any UCHealth location between 2015 and 2022 with a positive UDS at delivery were included. Patient demographics, medical history, UDS, infant toxicology, and CPS reporting were collected from medical records. T-tests or nonparametric equivalents for continuous variables and χ2 or Fisher's exact tests for categorical variables were used to compare patients with and without CPS reporting. RESULTS: We found 523 patients with a positive UDS during their delivery hospitalization, with CPS reporting for 71%. CPS reporting was more common in younger patients (26 versus 28 years; P<.01), patients with prior CPS involvement (15% versus 5%; P<.01), patients with an antenatal UDS positive for any substance (46% versus 29%; P<.01), and any positive neonatal toxicology (87% versus 58%; P<.01). Patients positive for cannabis (78% versus 57%; P<.01) or amphetamines (6% versus 1%; P=.03) were more likely to be reported to CPS, while patients positive for barbiturates (12% versus 1%; P<.01) and benzodiazepines (6% versus 2%; P<.01) were less likely. Hospitals located in large (>400k pop.) or small cities (<100k pop.) were less likely to be reported to CPS than mid-sized cities (>100–399k pop.) (66% and 65% versus 76%; P=.03). CONCLUSION: Differences in CPS reporting depended on the substance that tested positive, infant positivity, and delivery location. Future research should explore reasons for no CPS reporting among patients with a positive UDS during delivery hospitalization.

Child Protective Services Reports After Reunification: An Examination of the Risk of Being Rereported to Child Protective Services After Returning Home From Foster Care.

While a number of studies have examined the risk of reentry after exiting foster care, few studies have examined the risk of rereport to Child Protective Services (CPS) in the United States. Understanding more about rereports may help identify targets for supportive services that prevent reentry and promote safety. This study is the first to use nation-wide linked data to examine the risk of rereport for reunified children. The sample included children reunified after experiencing their first episode in foster care with at least one CPS report prior to care. With a 2000-day observation period, flexible parametric survival models with time varying hazard ratios were used to model the hazard or rereport conditional on prior CPS and foster care characteristics. Over 50% of the sample experienced a rereport after reunification. Results indicate that children entering foster care following a history of multiple CPS reports prior to placement were at substantially increased risk of rereport after returning home. A group of children with shorter stays in care had a high risk of recurrence within the first month, but this was not true over time. Implications for future research as well as permanency planning and addressing the needs of families with chronic reports are discussed.

What Proportion of Foster Care Children Do Not Have Child Protective Services Reports? A Preliminary Look.

It is perhaps surprising that we lack complete national information about why children enter foster care. While the annual Adoption and Foster Care Analysis Reporting System (AFCARS) report is informative, it leaves many questions unanswered, particularly "how many children enter foster care by means other than Child Protective Services (CPS) reports?" Drawing from a unique new integrated dataset, we examined foster care data (AFCARS) and CPS report data (National Child Abuse and Neglect Data System Child File). The linked dataset included 210,062 children with foster care placements in 2017 and no placements in the prior 5years. We categorized each placed child along two dimensions of four levels each: Time since prior CPS report (if any) and stated AFCARS placement reason, ranging from clearly maltreated to clearly not maltreated. We also tracked the siblings of placed children, to see if non-maltreated children entered care because of maltreated siblings. We find that between 8-35% of children enter foster care for reasons other than maltreatment, depending how thresholds are set. These numbers decline somewhat when siblings are considered. A meaningfully large number of children are placed in foster care for reasons other than maltreatment investigated by CPS. Further research into these children is warranted to better inform foster care policy.

Adolescent Mother Maltreatment Perpetrators’ Past Experiences with Child Protective Services

The experience of childhood maltreatment is associated with pregnancy during adolescence and increased risk for maltreating one’s own child or children. However, adolescent mothers who have been identified by child protective services (CPS) both as perpetrators and alleged victims carry a unique burden of trauma and are seldom the focus of retrospective studies. This study examines the extent to which adolescent mother perpetrators have prior experience with CPS as alleged victims and how their current perpetrator characteristics are associated with their prior CPS experience. We constructed a study sample of adolescent mother perpetrators reported to the National Child Abuse and Neglect Data System (NCANDS) by 27 states for federal fiscal years (FFYs) 2016–2018 (N = 8205) and determined whether they had any prior CPS experience as alleged victims since 2005. Characteristics of the participants as both perpetrators and alleged victims were examined, and associations between these were analyzed using odds ratios. Nearly two-thirds (62%) of adolescent mother perpetrators had prior experience with CPS. Analyses revealed significant associations of prior CPS experiences and perpetrator age, race, and connection with additional perpetrators. The types of maltreatment allegations that adolescent mothers experienced as children were significantly associated with the type of maltreatment they perpetrated. Key conclusions highlight the importance in understanding the link between childhood CPS experience and later maltreatment perpetration by adolescent mothers which will in turn help target prevention services to break the cycle of intergenerational maltreatment. Limitations and future research directions are discussed.

Healthcare Utilization Patterns Among Children With a History of Child Protective Services Investigations.

Examine whether children with a prior child protective services (CPS) investigation had different healthcare utilization compared to children without a history of CPS investigations. The Children's Health Assessment and Planning Survey assessed 6,492 primary caregivers of children ages 0-17 years residing in North Texas in 2015. Caregivers reported prior CPS investigations and child healthcare utilization (emergency department [ED] use, unmet medication needs, and unmet medical care needs). A total of 408 (5%) caregivers reported their child had a CPS investigation. Children with CPS investigations had greater odds of visiting the ED (OR = 1.9; 95% CI: 1.4, 2.5) and not receiving necessary medical care (OR = 1.9; 95% CI: 1.4, 2.8) compared to children without a CPS investigation. Prior CPS investigation was associated with disparities in receipt of necessary medical care and ED utilization for children.

Incidence and Risk Factors for Abusive Head Trauma: A Population-Based Study.

Previous studies on Abusive Head Trauma (AHT) suggest incidence may vary by geographic location and there is limited information regarding population-based risk factors on this form of child maltreatment. This study provides new knowledge regarding these two aspects using the population of the US state of Washington born between 1999 and 2013. We used a linked administrative dataset comprised of birth, hospital discharge, child protective services (CPS) and death records to identify the scale and risk factors for AHT for the state population using quantitative survival methods. We identified AHT using diagnostic codes in hospital discharge records defined by the US Centers for Disease Control. A total of 354 AHT hospitalisations were identified and the incidence for the state was 22.8 per 100 000 children under the age of one. Over 11 per cent of these children died. Risk factors included a teenaged mother at the time of birth, births paid for using public insurance, child's low birth weight, and maternal Native American race. The strongest risk factor was a prior CPS allegation, a similar finding to a California study on injury mortality. The practice and policy implications of these findings are discussed.

Prior opportunities to identify abuse in children with abusive head trauma

Infants with minor abusive injuries are at risk for more serious abusive injury, including abusive head trauma (AHT). Our study objective was to determine if children with AHT had prior opportunities to detect abuse and to describe the opportunities. All AHT cases from 7/1/2009 to 12/31/2011 at four tertiary care children's hospitals were included. A prior opportunity was defined as prior evaluation by either a medical or child protective services (CPS) professional when the symptoms and/or referral could be consistent with abuse but the diagnosis was not made and/or an alternate explanation was given and accepted. Two-hundred-thirty-two children with AHT were identified; median age (IQR) was 5.40 (3.30, 14.60) months. Ten percent (22/232) died. Of the 232 patients diagnosed with AHT, 31% (n=73) had a total of 120 prior opportunities. Fifty-nine children (25%) had at least one prior opportunity to identify abuse in a medical setting, representing 98 prior opportunities. An additional 14 (6%) children had 22 prior opportunities through previous CPS involvement. There were no differences between those with and without a prior opportunity based on age, gender, race, insurance, mortality, or institution. Children with prior opportunities in a medical setting were more likely to have chronic subdural hemorrhage (48 vs. 17%, p<0.01) and healing fractures (31 vs. 19%, p=0.05). The most common prior opportunities included vomiting 31.6% (38/120), prior CPS contact 20% (24/120), and bruising 11.7% (14/120). Improvements in earlier recognition of AHT and subsequent intervention might prevent additional injuries and reduce mortality.

Child Torture as a Form of Child Abuse

This paper describes clinical findings and case characteristics of children who are victims of severe and multiple forms of abuse; and proposes clinical criteria that indicate child abuse by torture. Medical records, investigation records, and transcripts of testimony regarding a non-consecutive case series of 28 children with evidence of physical abuse, neglect, and psychological maltreatment, such as terrorizing and isolation, were reviewed for types of injuries, duration of maltreatment, medical and physical neglect, social and family history, and history of prior Child Protective Services (CPS) involvement. The median age was 7.5 years (9 months to 14.3 years). Thirty-six percent died. Duration of abuse ranged from 3.5 months to 8 years (median 3 years). Ninety-three percent of children were beaten and exhibited cutaneous injury; 21 % had fractures. There were 25 victims of isolation (89 %), as well as 61 % who were physically restrained and 89 % who were restricted from food or water. All of the children were victims of psychological maltreatment; 75 % were terrorized through threats of harm or death to themselves or loved ones and 54 % were degraded and/or rejected by caregivers. Nearly all children were medically neglected. Half had a history of prior referrals to CPS. The children in this case series were physically abused, isolated, deprived of basic necessities, terrorized, and neglected. We define child torture as a longitudinal experience characterized by at least two physical assaults or one extended assault, two or more forms of psychological maltreatment, and neglect resulting in prolonged suffering, permanent disfigurement or dysfunction, or death.

Time till death study: How soon after “first contact” is a non-biologically related male likely to kill his partners child?

Non-biologically related males who are intimate partners of women with young children are the most likely perpetrators of homicidal violence against these children. The primary objective of this study is to determine the usual time interval between first child/unrelated adult male contact and the child's death. The secondary objective is to examine possible predisposing factors. First contact is defined as the time when the child initially interacted or met with the unrelated adult male, whether or not they lived together and for the purposes of this study is based on the length of the mothers relationship with her partner before the child was killed. The coroners office database in Indianapolis, Indiana was examined for records of child homicides from which victim data (age, sex, race and cause of death) was recovered. The associated child protective services (CPS) reports were examined to create a forensic epidemiologic profile including in particular, the length of time the unrelated adult male had known or lived with the child and when the child was killed.Over a period of 14 years, 79 cases of homicides were recovered in children aged 5 years and younger. Of these, there were 15 cases in which all relevant data was recorded. The time interval from first contact to death ranged from 14 to 240 days with a median of 75 days. Approximately 80% of all victims were killed within 90 days. The victims included 12 males and 3 females with an age range of 2–61 months. The median age was 22 months. There were 10 white, 4 black, and 1 Hispanic victim. Blunt force trauma to the head was the cause of death in 13 of 15 deaths. Forty percent (6/15) had prior CPS contact. Young children are most likely to be killed within 90 days of first unsupervised contact with a non-biologically related male. Most victims were male and blunt force trauma to the head was the leading cause of death.

A developmental approach to the risk of a first recurrence in child protective services

The objective of this study is to estimate the risk of a first recurrence over a five-year period following initial child protective services (CPS) intervention and identify the characteristics associated with the risk of recurrence for three different age groups. Recurrence is defined as the first substantiated report within the observation period after initial services have ended. The study involved a cohort of 25,897 Quebec children who received postinvestigation services for the first time and whose cases were closed between 2005 and 2009. Survival analysis was used to estimate the five-year risk of recurrence and Cox regression to model the risk of recurrence for three age groups. The covariates introduced into the regression analyses were characteristics of the child and initial services. The risk of recurrence in the five years following termination of initial CPS services was 36% for the entire cohort and varied depending on the child's age at the time of case closure. Children aged 6–11 when their cases were closed had the highest risk of recurrence. Although Aboriginal descent and prior CPS investigations have a consistent effect on the risk of recurrence in all three age groups, the effects of other covariates, such as out-of-home placement and court involvement, vary or are even reversed, depending on the child's age. These findings highlight the need to adopt a differential approach that takes into account the child's age, both in the provision of protective services and in research involving the population receiving such services.

Perceptions of the Acceptability of Parent Training Among Chinese Immigrant Parents: Contributions of Cultural Factors and Clinical Need

Parent training (PT) is well established for reducing child externalizing problems; however, lower rates of engagement in PT among ethnic minority/immigrant families have been found. We assessed PT acceptability among Chinese immigrant parents and explored clinical and cultural factors that may be associated with acceptability. Participants were a community sample of 145 Chinese immigrant parents (84% mothers) between the ages of 32 and 65years (M=43.3years, SD=6.2) who had children (84 boys, 59 girls) between the ages of 4 and 17years (M=10.7years, SD=3.6). Results suggest that parents found positive reinforcement techniques significantly more acceptable, less problematic, and more likely to be supported by others than punishment-based techniques. Parents who endorsed the Chinese child-rearing value of shaming were less likely to find PT acceptable. Parents who reported greater dysfunction in parent–child interactions rated PT as more acceptable, and families with prior Child Protective Services (CPS) involvement rated PT as less acceptable. However, previous mental health treatment appears to bolster acceptability among parents with prior CPS involvement. Clinical implications for addressing barriers to PT engagement and future research directions are discussed.

Identifying children at high risk for a child maltreatment report

Objective To help professionals identify factors that place families at risk for future child maltreatment, to facilitate necessary services and to potentially help prevent abuse and neglect. Method The data are from a prospective, longitudinal study of 332 low-income families recruited from urban pediatric primary care clinics, followed for over 10 years, until the children were approximately 12 years old. Children with prior child protective services involvement (CPS) were excluded. The initial assessment included sociodemographic, child, parent and family level variables. Child maltreatment was assessed via CPS reports. Risk ratios (RRs) and their 95% confidence intervals (CIs) were estimated using Cox regression models. Results Of the 224 children without a prior CPS report and with complete data who were followed for an average of 10 years, 97 (43%) later had a CPS report. In a multivariate survival analysis, 5 risk factors predicted CPS reports: child's low performance on a standardized developmental assessment (RR = 1.23, 95% CI = 1.01–1.49, p = .04), maternal education ≤ high school (RR = 1.55, CI = 1.01–2.38, p = .04), maternal drug use (RR = 1.71, CI = 1.01–2.90, p < .05), maternal depressive symptoms (RR per one standard deviation higher score = 1.28, CI = 1.09–1.51, p < .01), and more children in the family (RR per additional child = 1.26, CI = 1.07–1.47, p < .01). Conclusions Five risk factors were associated with an increased risk for later maltreatment. Child health care and other professionals can identify these risk factors and facilitate necessary services to strengthen families, support parents and potentially help prevent child maltreatment.

Analysis of paediatric drowning deaths in Washington State using the child death review (CDR) for surveillance: what CDR does and does not tell us about lethal drowning injury

BackgroundDrowning is second cause of paediatric injury death in Washington State. Child death review (CDR) data provide the unique opportunity to identify regional risk factors and opportunities for drowning prevention.MethodsCDR...

The use of risk assessment instruments in child protective services case planning and closures

This exploratory study examined variables expected to predict which caretakers are most likely to reabuse children under child protective services (CPS) supervision. Caretaker variables related to poverty, mental health problems, history as a victim of abuse, substance abuse, and prior CPS reports were evaluated to determine their effectiveness in predicting which children remain at risk of maltreatment. Method: Using a pretested instrument, data were collected from case records of 447 randomly selected children supervised by CPS while residing with parents or relatives for a minimum of six months. These children, in contrast to those in foster family care, were selected because of their more likely exposure to initial abusers. Results: This study offered little support for using variables employed by risk assessment instruments to predict which caretakers were most likely to reabuse because reabusers and non-reabusers shared many features. Importantly, findings in this study indicate that children residing in kinship care are not at significant risk for future maltreatment.