Child Physical Abuse Risk Research Articles

Does parental use of harsh discipline and punishment in response to ambiguous child situations vary by child physical abuse risk?

Background/objectivesThe present study investigated the extent to which fathers and mothers at high-risk and low-risk for child physical abuse (CPA) differed in their use of harsh discipline and punishment when presented ambiguous child situations (situations where differences in positive and negative valences are close to zero). Participants/methodsHigh-risk for CPA parents (N = 74: fathers, n = 41; mothers, n = 33) and low-risk parents (N = 178: fathers, n = 91; mothers, n = 87) were asked to indicate their likelihood of using harsh verbal discipline (HVD), harsh physical discipline (HPD), and punishment (i.e., retributive harm separate from HVD and HPD) after viewing each of eighteen ambiguous child situations. ResultsAs expected, high-risk, compared to low-risk, for CPA parents were significantly (ps < 0.001) more likely to use HVD (d = 0.546), HPD (d = 0.595), and punishment (d = 0.564). Overall, fathers, relative to mothers, were significantly more likely to use HVD (d = 0.261) and HPD (d = 0.238). For punishment, however, there was no significant parental role (father, mother) difference (d = 0.136). ConclusionsSince in everyday living situations many child behaviors are ambiguous, the findings that parents, especially high-risk for CPA parents, use harsh discipline and punishment when encountering ambiguous child situations suggest that non-contingent harsh child-related parental behaviors may be frequent in the lives of some children. The findings that parents may use non-contingent discipline and punishment suggest the need to explore whether, when these parenting behaviors occur, they increase the likelihood of negative child outcomes.

Identifying injuries suggestive of child physical abuse: An innovative application of the Trauma Quality Improvement Program.

Child physical abuse (CPA) carries high risk of morbidity and mortality. Screening for CPA may be limited by subjective risk criteria and racial and socioeconomic biases. This study derived, validated, and compared age-stratified International Classification of Diseases, 10th revision (ICD-10) diagnosis codes indicating high risk of CPA. Injured children younger than 6 years from the Trauma Quality Improvement Program (TQIP) database were included; years 2017 to 2018 were used for derivation and 2019 for validation. Confirmed CPA was defined as a report of abuse plus discharge with alternate caregiver. Patients were classified as high vs. low CPA risk by three methods: (1) abuse-specific ICD-10 codes, (2) previously validated high-risk ICD-9 codes crosswalked to equivalent ICD-10 codes, and (3) empirically-derived ICD-10 codes from TQIP. These methods were compared with respect to sensitivity, specificity, area under the receiver-operator curve (AUROC), and uniformity across race and insurance strata. A total of 122,867 children were included (81,347 derivation cohort, 41,520 validation cohort). Age-stratified high-risk diagnoses derived from TQIP consisted of 40 unique codes for ages 0 year to 2 years, 30 codes for ages 3 years to 4 years, and 20 codes for ages 5 years to 6 years. In the validation cohort, 890 children (2.1%) had confirmed CPA. On comparison with abuse-specific and crosswalked ICD-9 codes, TQIP-derived codes had the highest sensitivity (70% vs. 19% vs. 54%) and the highest AUROC (0.74 vs. 0.59 vs. 0.68, p < 0.0001) for confirmed abuse across all age groups. Age-based risk stratification using TQIP-derived codes demonstrated low variability by race (25% White vs. 25% Hispanic vs. 28% Black patients considered high-risk) and insurance status (23% privately insured vs. 26% uninsured). High-risk CPA injury codes empirically derived from TQIP produced the best diagnostic characteristics and minimized some disparities. This approach, while requiring further validation, has the potential to improve CPA injury surveillance and decrease bias in screening protocols. Diagnostic Test/Criteria; Level III.

Association between missed appointments and hospitalization for child physical abuse

Missed cases of child physical abuse (CPA) persist despite known risk factors. Prior studies have not evaluated missed medical appointments as a risk factor for CPA. The objective of this study was to determine if an association exists between missed appointments and hospitalization for CPA.We conducted a 20-year, single health system, retrospective chart review of hospitalized patients ≤36 months of age meeting International Classification of Diseases (ICD) 9/10 criteria for CPA with ≥1 scheduled appointment in our system prior to their admission. Cases were categorized as definite CPA, high likelihood, or no concern for CPA/unable to be determined. Cases identified as definite or high likelihood of CPA were matched (5:1) with controls based on age, distance to primary care provider's (PCP's) office, sex, prior hospitalization, and race. Missed appointments were compared between cases (n = 146) and controls (n = 730).A significant difference was identified between cases and controls (26 % vs 9 %, p < 0.001) for the median proportion of missed appointments. After adjusting for matched and significant covariates, there was a 3 % increase in a patient's odds of admission for CPA for every 1 % increase in missed appointments.We found an association between missed appointments and future admission for CPA. This finding has potential to assist clinicians with CPA risk stratification and future child abuse research. Limitations include single healthcare system, ICD criteria determined by research team, and narrow definition of definite CPA.

Engaging fathers to strengthen the impact of early home visitation on physical child abuse risk: Findings from the dads matter-HV randomized controlled trial

BackgroundDespite growing recognition of the importance of fathers in child abuse risk, the field of perinatal home visitation has only begun to consider fathers' roles in the implementation of such services. ObjectivesThis study examines the effectiveness of Dads Matter-HV (“DM-HV”), a father-inclusion enhancement to home visitation, and hypothesized mediators of impact. MethodsA multisite cluster randomized controlled trial was conducted with 17 home visiting program teams serving 204 families across study conditions. Program supervisors and their teams were randomized to deliver home visiting services plus DM-HV enhanced services (intervention) or home visiting services alone (control). Data were collected at three time points: baseline, 4 months post-baseline immediately following the intervention, and 12 months post-baseline. We employed structural equation modeling to estimate the effect of the intervention on physical child abuse risk and to trace hypothesized mediators, including the quality of the father-worker relationship, parents' partner support and abuse, and the timing of service initiation. ResultsResults indicated that the DM-HV enhancement improved home visitor relationships with fathers, but only for families receiving services initiated postnatally. For these families, the improved quality of the father-worker relationship predicted improved parents' support of one another and reduced bidirectional mother-father partner abuse at 4-month follow-up, which in turn lowered maternal physical child abuse risk and paternal physical child abuse risk at 12-month follow-up. ConclusionsDM-HV can strengthen the impact of home visitation services on physical child abuse risk for families when services are initiated postnatally.

Risk of Injury-Related Readmission Varies by Initial Presenting-Hospital Type Among Children at High Risk for Physical Abuse.

Children experiencing physical abuse may initially present to hospitals with underappreciated minor injuries, only to experience more severe injuries in the future. The objectives of this study were to 1) describe young children presenting with high-risk diagnoses for physical abuse, 2) characterize the hospitals to which they initially presented, and 3) evaluate associations of initial presenting-hospital type with subsequent admission for injury. Patients aged younger than 6 years from the 2009-2014 Florida Agency for Healthcare Administration database with high-risk diagnoses (codes previously associated with >70% risk of child physical abuse) were included. Patients were categorized by the hospital type to which they initially presented: community hospital, adult/combined trauma center, or pediatric trauma center. Primary outcome was subsequent injury-related hospital admission within 1 year. Association of initial presenting-hospital type with outcome was evaluated with multivariable logistic regression, adjusting for demographics, socioeconomic status, preexisting comorbidities, and injury severity. A total of 8626 high-risk children met inclusion criteria. Sixty-eight percent of high-risk children initially presented to community hospitals. At 1 year, 3% of high-risk children had experienced subsequent injury-related admission. On multivariable analysis, initial presentation to a community hospital was associated with higher risk of subsequent injury-related admission (odds ratio, 4.03 vs level 1/pediatric trauma center; 95% confidence interval, 1.83-8.86). Initial presentation to a level 2 adult or combined adult/pediatric trauma center was also associated with higher risk for subsequent injury-related admission (odds ratio, 3.19; 95% confidence interval, 1.40-7.27). Most children at high risk for physical abuse initially present to community hospitals, not dedicated trauma centers. Children initially evaluated in high-level pediatric trauma centers had lower risk of subsequent injury-related admission. This unexplained variability suggests stronger collaboration is needed between community hospitals and regional pediatric trauma centers at the time of initial presentation to recognize and protect vulnerable children.

Evaluation of Children after Caregiver Intimate Partner Violence: A Qualitative Study of Barriers, Facilitators, and Trauma- and Violence-Informed Care

To identify barriers and facilitators of evaluating children exposed to caregiver intimate partner violence (IPV) and develop a strategy to optimize the evaluation. Using the EPIS (Exploration, Preparation, Implementation, and Sustainment) framework, we conducted qualitative interviews of 49 stakeholders, including emergency department clinicians (n=18), child abuse pediatricians (n=15), child protective services staff (n=12), and caregivers who experienced IPV (n=4), and reviewed meeting minutes of a family violence community advisory board (CAB). Researchers coded and analyzed interviews and CAB minutes using the constant comparative method of grounded theory. Codes were expanded and revised until a final structure emerged. Four themes emerged: (1) benefits of evaluation, including the opportunity to assess children for physical abuse and to engage caregivers; (2) barriers, including limited evidence about the risk of abuse in these children, burdening a resource-limited system, and the complexity of IPV; (3) facilitators, including collaboration between medical and IPV providers; and (4) recommendations for trauma- and violence-informed care (TVIC) in which a child's evaluation is leveraged to link caregivers with an IPV advocate to address the caregiver's needs. Routine evaluation of IPV-exposed children may lead to the detection of physical abuse and linkage to services for the child and the caregiver. Collaboration, improved data on the risk of child physical abuse in the context of IPV and implementation of TVIC may improve outcomes for families experiencing IPV.

Child physical abuse risk factors: A systematic review and a meta-analysis

Child physical abuse (CPA) is a pervasive societal problem with serious outcomes. Understanding CPA risk factors is necessary to identify those at risk for CPA perpetration and to inform efforts to prevent the occurrence of CPA. The present study provides an updated review of conceptual models of CPA, a review of model-related CPA risk factors, and a meta-analytic review of CPA risk factors found in cross-sectional, case-controlled studies. The review of conceptual models yielded >70 explanatory models of CPA from which >140 putative CPA risk factors were extracted. A three-level random-effects meta-analysis of CPA risk factors was conducted. Database and literature searches yielded 58 studies that met the inclusion criteria from which 300 effect size (ES) estimates were identified. In the meta-analysis, 292 ESs were placed into 38 CPA risk factor domains. Twenty significant individual CPA risk factor domain ES estimates and five significant relationship CPA risk factor domain ESs were found. Future studies that simultaneously consider CPA risk and protective factors from within and between ecological levels and that establish causal CPA factors are needed to better inform CPA prevention and treatment efforts. • A literature review yielded >70 explanatory CPA models. • More than 140 CPA risk factors were extracted from >70 CPA models. • A three-level meta-analysis yielded 25 significant CPA risk factor domains. • Twenty individual and five relationship CPA risk factor domains were found.

Prolonged Infant Crying: Caregiving Quality and Child Physical Abuse Risk.

Research suggests that prolonged infant crying may increase risk for child physical abuse (CPA). However, few studies have examined behavioral responses to infant crying among parents at risk for CPA. The present study sought to fill this gap by using a simulated infant to examine how mothers and fathers with varying degrees of CPA risk respond to prolonged infant crying. Specifically, a sample of 184 general population caregivers (107 mothers and 77 fathers) participated in a task that involved attempting to soothe a simulated infant that cried continuously for 30min. The simulated infant sessions were video-recorded, and quality of caregiving behavior was coded in 5-min segments. Participants rated their negative affect (feelings of upset, distress, irritability) at the outset of the data collection session, before beginning the simulated infant task, and after the simulated infant task concluded. It was predicted that high-risk caregivers, compared to low-risk caregivers, would display lower quality caregiving, higher levels of negative affect, and that CPA risk group differences would increase over time. Gender differences were explored in relation to the aforementioned hypotheses. Over the course of the 30-min simulated infant task, the quality of caregiving behavior diminished among both high- and low-risk caregivers. As expected, high-risk caregivers, compared to low-risk caregivers, exhibited lower quality caregiving behaviors and were more likely to discontinue the simulated infant task early. In addition, high-risk, compared to low-risk, caregivers reported higher levels of negative affect throughout the data collection session, with the highest level of negative affect reported by high-risk caregivers after completing the simulated infant task. Overall, the quality of caregiving exhibited by men and women did not significantly differ. The present findings highlight the importance of early intervention designed to support caregivers' abilities to respond effectively to prolonged infant crying.

Psychometric Evidence for Indirect Assessment of Child Abuse Risk in Child Welfare-Involved Mothers.

Most research on factors related to physical child abuse risk rely heavily on direct self-report measures, which is a methodological strategy susceptible to participant response distortions. Such methodological reliance obfuscates the interpretations rendered about the risk factors predictive of child abuse. Efforts to develop alternative indirect assessment approaches, such as analog tasks, show promise, although most of those studies have applied these methods to community samples rather than with child welfare-involved samples. The present study evaluated the psychometric evidence for four separate analog tasks that have not yet been considered with mothers identified for child maltreatment by child welfare services, also contrasted to a sociodemographically matched sample of mothers. The results indicate acceptable reliability for the analog tasks, with additional evidence of validity. However, the two groups of mothers did not substantively differ across measures, suggesting that identification for abuse through child protective services does not differentiate from those closely matched on critical sociodemographic characteristics. The promising preliminary results of these analog tasks in the current study suggest that indirect analog assessment approaches to estimate child abuse risk could be useful in efforts to minimize dependence on self-report methods.

Examining Gender-Specific Modeling in the Intergenerational Transmission of Parenting Style and Physical Child Abuse Risk

Examining Gender-Specific Modeling in the Intergenerational Transmission of Parenting Style and Physical Child Abuse Risk

Physical punishment, physical abuse, and child behavior problems in South Korea

BackgroundPrior literature has demonstrated the associations of parental physical punishment with child behavior problems and increased risk of physical abuse. In South Korea, physical punishment is a common parenting practice. In 2021, legislative reforms eliminated legal grounds for parental physical punishment in South Korea. However, research on physical punishment, physical abuse, and child behavior problems in the Korean context is scarce. ObjectiveThis study examined whether physical punishment and physical abuse have unique associations with child behavior problems and whether physical punishment is associated with increased exposure to physical abuse. Participants and settingData came from the 2010 Korean Child and Youth Panel Survey (KCYPS), a nationally representative sample of South Korean children who attended 1st grade in 2010. Our analyses were based on three waves of the KCYPS (N = 2,180). MethodsWe employed fixed-effects regression to examine the associations of physical punishment and physical abuse with child behavior problems and the association of physical punishment with physical abuse after controlling for time-invariant characteristics. ResultsExposure to physical punishment and physical abuse was associated with higher levels of aggression, depression, and lower levels of academic behavior regulation. Physical punishment was associated with increased risk of physical abuse. ConclusionsOur findings suggest that physical punishment is a risk for child behavior problems and physical abuse in South Korea. Child maltreatment prevention efforts should focus on shifting favorable social norms around physical punishment and promoting non-physical disciplinary practices.

Child physical abuse and COVID-19: Trends from nine pediatric trauma centers

BackgroundEconomic, social, and psychologic stressors are associated with an increased risk for abusive injuries in children. Prolonged physical proximity between adults and children under conditions of severe external stress, such as witnessed during the COVID-19 pandemic with “shelter-in-place orders”, may be associated with additional increased risk for child physical abuse. We hypothesized that child physical abuse rates and associated severity of injury would increase during the early months of the pandemic as compared to the prior benchmark period. MethodsWe conducted a nine-center retrospective review of suspected child physical abuse admissions across the Western Pediatric Surgery Research Consortium. Cases were identified for the period of April 1-June 30, 2020 (COVID-19) and compared to the identical period in 2019. We collected patient demographics, injury characteristics, and outcome data. ResultsThere were no significant differences in child physical abuse cases between the time periods in the consortium as a whole or at individual hospitals. There were no differences between the study periods with regard to patient characteristics, injury types or severity, resource utilization, disposition, or mortality. ConclusionsApparent rates of new injuries related to child physical abuse did not increase early in the COVID-19 pandemic. While this may suggest that pediatric physical abuse was not impacted by pandemic restrictions and stresses, it is possible that under-reporting, under-detection, or delays in presentation of abusive injuries increased during the pandemic. Long-term follow-up of subsequent rates and severity of child abuse is needed to assess for unrecognized injuries that may have occurred.

Partner Physical Aggression and Risk for Physical Child Abuse

Two randomly drawn samples of mothers and fathers of young children in New York and Texas were assessed for both partner physical aggression and physical child abuse. Overall, both minor and severe physical aggression against a partner were associated with an increased likelihood of physical child abuse. However, even for severe aggression in these randomly drawn community samples, the likelihood of child abuse given partner abuse was less than 25%. These rates were significantly lower than those in battered women samples. Our findings have clinical and policy implications for professionals charged with determining child safety in custody and parenting time matters.

Do High-Risk Parents Use More Aggression During Competitive Play With Children?

The present study examined the extent to which the aggressive tendencies of parents at risk for perpetrating child physical abuse (CPA) generalize to situations other than discipline-related encounters (e.g., a competitive gaming interaction). Participants included parents who were either low (n = 90) or high (n = 75) risk for CPA. Parents were led to believe that they were playing a game against a child opponent with whom they exchanged sound blasts of varying intensities. Parental sound blast selections served as a proxy for aggressive behavior. Parents were randomly assigned to high or low loss conditions. The fictitious child opponent's responses were pre-programed so that sound blasts received by parents became louder (i.e., more provocative) over time. As predicted, high CPA risk parents exhibited higher levels of aggression than low CPA risk parents. Moreover, high-risk parents reported having higher levels of aggressive motives during the game than low-risk parents; and aggressive motives explained the link between parental CPA risk and parents' aggressive behavior. With one exception, higher levels of child provocation during the game prompted parents to send higher levels of sound blasts. The exception to this pattern occurred among low-risk parents who experienced high rates of loss during the game. Specifically, low-risk parents in the high loss condition continued to send low levels of sound blasts even as their child opponent became more provocative. Aggressive motives (and the ability to change motives as situations change) may help explain differences in aggressive tendencies evinced by parents with varying levels of CPA risk.

Testosterone Associations With Parents' Child Abuse Risk and At-Risk Parenting: A Multimethod Longitudinal Examination.

The current investigation considered salivary testosterone as a potential biomarker of physical child abuse risk. Parents enrolled in a prospective, longitudinal, multimethod study beginning prenatally provided saliva when their toddlers were 18 months old. Mothers and fathers self-reported on their empathy, frustration tolerance, and child abuse risk, as well as completing analog tasks of frustration intolerance and child abuse risk and participating in structured parent-child interactions. In contrast to mothers, fathers' higher testosterone levels were associated with increased child abuse risk, less observed positive parenting, more observed negative parenting, and an analog task of frustration intolerance; such findings were reflected across time. Further, fathers' socioeconomic status moderated the association between testosterone levels and abuse risk. No evidence of partner effects was observed in dyadic analyses. The current findings suggest that higher testosterone levels reflect an increased likelihood that paternal physically abusive behavior may be expressed.

Less efficient detection of positive facial expressions in parents at risk of engaging in child physical abuse

BackgroundParental physical punishment (e.g., spanking) of children can gradually escalate into child physical abuse (CPA). According to social-information processing (SIP) models of aggressive behaviors, distorted social cognitive mechanisms can increase the risk of maladaptive parenting behaviors by changing how parents detect, recognize, and act on information from their social environments. In this study, we aimed to identify differences between mothers with a low and high risk of CPA regarding how quickly they detect positive facial expressions.MethodsBased on their use of spanking to discipline children, 52 mothers were assigned to a low- (n = 39) or high-CPA-risk group (n = 13). A single-target facial emotional search (face-in-the-crowd) task was used, which required participants to search through an array of faces to determine whether a target emotional face was present in a crowd of non-target neutral faces. Search efficiency index was computed by subtracting the search time for target-present trials from that for target-absent trials.ResultsThe high-CPA-risk group searched significantly less efficiently for the happy, but not sad, faces, than did the low-CPA-risk group; meanwhile, self-reported emotional ratings (i.e., valence and arousal) of the faces did not differ between the groups.ConclusionsConsistent with the SIP models, our findings suggest that low- and high-CPA-risk mothers differ in how they rapidly detect positive facial expressions, but not in how they explicitly evaluate them. On a CPA-risk continuum, less efficient detection of positive facial expressions in the initial processes of the SIP system may begin to occur in the physical-discipline stage, and decrease the likelihood of positive interpersonal experiences, consequently leading to an increased risk of CPA.

Perceived Executive Functioning in Parents at Risk for Child Physical Abuse.

Research suggests that deficits in executive functioning are associated with negative parenting behaviors. However, limited research has examined the link between executive functioning and risk for child physical abuse (CPA) perpetration. Early studies examining executive functioning in parents at risk for perpetrating CPA relied on performance-based measures, which are designed to occur under carefully controlled conditions and may not capture difficulties experienced under less optimal conditions (e.g., during chaotic caregiving situations). Moreover, prior studies examining executive functioning in parents at risk for perpetrating CPA have relied on small samples comprised of only mothers. To advance our understanding of the linkage between executive functioning and CPA risk, the present study examined perceived deficits in executive functioning in a sample of general population mothers and fathers (N = 98) using a standardized self-report measure of executive functioning, namely, the adult version of the Behavior Rating Inventory of Executive Function (BRIEF-A). Parents were classified as low CPA risk or high CPA risk using the Child Abuse Potential Inventory. Compared with low-risk parents, high-risk parents had higher rates of clinical elevations on several BRIEF-A subscales, namely, Working Memory Problems, Emotional Control Difficulties, and Difficulties Shifting Thoughts, Feelings, and Behaviors. These findings highlight the potential importance of assessing and strengthening executive functioning in interventions designed to reduce risk of parent-to-child aggression.

Parents' PTSD symptoms and child abuse potential during the perinatal period: Direct associations and mediation via relationship conflict.

Posttraumatic stress disorder (PTSD) symptoms are associated with parental aggression towards children, but little is known about the relation between parents' PTSD symptoms and their risk for perpetrating child physical abuse during the early parenting years, when the potential for prevention of abuse may be highest. To examine direct associations between mothers' and fathers' PTSD symptoms and child abuse potential, as well as indirect effects through couple relationship adjustment (i.e., conflict and love) in a high-risk sample of parents during the perinatal period, most of whom were first-time parents. From March 2013 to August 2016, data were collected from 150 expecting or new parental dyads in which the mother was participating in a home visiting program. Data were analyzed using the Actor-Partner Interdependence Mediation Model. For mothers and fathers, there were direct associations between PTSD symptom severity and child abuse potential (βs = .51, ps <.001), and this association for fathers was stronger at higher levels of mothers' PTSD symptoms (β = .15, p = .03). In addition, parents' own and their partners' PTSD symptoms were each indirectly associated with parents' own child abuse potential through parents' report of interparental conflict (standardized indirect effects = .052-.069, ps = .004) but not love. Addressing parents' PTSD symptoms and relationship conflict during the perinatal period using both systemic and developmental perspectives may uniquely serve to decrease the risk of child physical abuse and its myriad adverse consequences.

The association between perceived injunctive norms toward corporal punishment, parenting support, and risk for child physical abuse.

The use of corporal punishment (CP) is a strong risk factor for many poor outcomes for children including child maltreatment. The use of CP occurs within social contexts which are important to understand. Although it is known that perceived social norms regarding CP are related to its use, the specific role that a mother's primary support person plays in influencing attitudes toward and use of CP remains unknown. The current study assessed linkages between maternal perceived social support in parenting and perceived injunctive norms of CP from her primary source of support, with maternal attitudes toward and use of CP. Survey data were collected from female primary caregivers (N = 436) of children age 2 to 7 years (mean age = 3.7) enrolled in Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clinics in Southeastern Louisiana. Most frequently, the biological father of the child (37.9%) and the maternal grandmother of the child (24.2%) were identified as the participant's primary source of social support in parenting. Perceived injunctive norms of this support person toward CP use were significantly and positively associated with attitudes toward, AOR = 5.97, 95% CI = [4.04, 8.82], and use of CP, AOR = 3.77, 95% CI = [2.55, 5.59]. However, perceived social support was not associated with these outcomes and also did not moderate these associations. Findings suggest that efforts to reduce maternal risk for child physical abuse and use of CP must include the mother's primary source of social support if they are to be successful.

Connecting Child Maltreatment Risk With Crime and Neighborhood Disadvantage Across Time and Place: A Bayesian Spatiotemporal Analysis.

Child maltreatment is a major public health problem. Although maltreatment rates vary over time and are influenced by neighborhood characteristics, the unique effects of crime and disadvantage on risk are not well understood. This study utilized a Bayesian spatiotemporal approach to examine risk factors for substantiated child abuse and neglect over a 9-year period across zip codes in Davidson County, TN. Risk of child sexual and physical abuse decreased from 2008 to 2016. In contrast, risk of child neglect increased from 2011 to 2014, followed by a rapid decrease in risk. Whereas higher percentages of families living in poverty were associated with higher risk of all maltreatment subtypes, higher unemployment rates were uniquely associated with risk of child neglect. Crime rates were positively associated with risk of child physical and sexual abuse but not neglect. Results have implications for tailoring prevention strategies according to geographic area and maltreatment subtype.