Black–White Differences in Child Maltreatment Reports and Foster Care Placements: A Statistical Decomposition Using Linked Administrative Data

Introduction Official statistics have confirmed that relative to their presence in the population and relative to white children, black children have consistently higher rates of contact with child protective services (CPS). We used linked administrative data and statistical decomposition techniques to generate new insights into black and white differences in child maltreatment reports and foster care placements. Methods Birth records for all children born in Allegheny County, Pennsylvania, between 2008 and 2010 were linked to administrative service records originating in multiple county data systems. Differences in rates of involvement with child protective services between black and white children by age 4 were decomposed using nonlinear regression techniques. Results Black children had rates of CPS involvement that were 3 times higher than white children. Racial differences were explained solely by parental marital status (i.e., being unmarried) and age at birth (i.e., predominantly teenage mothers). Adding other covariates did not capture any further racial differences in maltreatment reporting or foster care placement rates, they simply shifted differences already explained by marital status and age to these other variables. Discussion Racial differences in rates of maltreatment reports and foster care placements can be explained by a basic model that adjusts only for parental marital status and age at the time of birth. Increasing access to early prevention services for vulnerable families may reduce disparities in child protective service involvement. Using birth records linked to other administrative data sources provides an important means to developing population-based research.     

Supporting family engagement with child and adolescent mental health services: A scoping review

A key challenge facing the mental health field is connecting children and families to services when symptoms first appear. Multiple barriers inhibit timely access to treatment, and interventions to resolve barriers to care are not common among health and social care organisations. To address this research‐to‐practice gap this study undertook a scoping review of the empirical literature aimed at identifying key factors in the social ecology of families which influence family engagement with child and adolescent mental health services, then identifying and describing models of intervention designed to help facilitate access to care. Forty studies published between 1 January 2000 and 28 February 2019 were reviewed. Key factors associated with child and adolescent mental health service engagement included family attitudes towards mental illness and help seeking, the flexibility and availability of needed services, community attitudes and stigma surrounding mental illness and mental health treatment, and the degree of coordination and integration across systems of health and social care. Models of intervention to facilitate engagement with mental health services included family outreach, telephone and digital health strategies, and integrated care approaches. Empirical support is strongest for family outreach and integrated care, although telephone and digital health strategies are underexplored with children and families and a potentially promising avenue for future research. To support family engagement with child and adolescent mental health services health and social care organisations should be prepared to identify barriers in their local practice settings and integrate efficacious engagement approaches into their continuum of available services.     

The Use of Risk Assessment to Predict Recurrent Maltreatment: A Classification and Regression Tree Analysis (CART)

Research has suggested that recurrent maltreatment may be best predicted by a combination of factors that vary across families. The present study set out to determine whether a pattern-centered analytic approach would better predict families at high risk for recurrence when compared to logistic regression methods. Archival data from substantiated investigations during 2003 were collected from a Connecticut Department of Children and Families county branch. Families (n = 244) with a substantiated index case were followed for 18 months to identify the presence of additional substantiated cases within the CPS system. Classification and Regression Tree (CART) analyses revealed that prior CPS involvement was the best predictor of recurrent maltreatment. Further, risk items that were associated with recurrence were different for families with and without previous CPS investigations. Families with only prior unsubstantiated CPS investigations and poor child visibility within the community were at high risk for recurrence. Families without prior CPS involvement that were not actively involved in case planning and had a history of domestic violence were at high risk for recurrence. These findings suggest that pattern-centered analyses may be a useful approach to informing site-specific predictors of maltreatment recurrence by creating clear decision points that delineate high risk subgroups.     

Child maltreatment in Missouri: combining data for public health surveillance

BACKGROUND: Public health surveillance was established for nonfatal child maltreatment in Missouri using two data sources. This paper describes the epidemiology of nonfatal child maltreatment using this surveillance system, and assesses the usefulness of combining medical data with child protective services (CPS) reports for child maltreatment surveillance. METHODS: Child abuse and neglect reports for children aged <10 years for 2000 were obtained from the Missouri Division of Family Services (DFS) and linked to hospital discharge and emergency department (ED) data for 2000. Children were classified as maltreated if they had an International Classification of Disease (ICD) maltreatment code for a hospital or ED visit, or a substantiated report to DFS. Validity of the ICD maltreatment codes was assessed in a 10% random sample of the hospital/ED visits. Medical records were reviewed to determine the accuracy of the maltreatment code assigned. The data analyses reported here were conducted in 2002 and 2003. RESULTS: In the linked data, 5657 children met the case definition of maltreatment, providing a nonfatal maltreatment rate of 7.4/1000 children. Rates were higher among children aged <1 year (8.4/1000), females (7.7/1000), African Americans (11.8/1000), and children residing in rural counties (8.7/1000). The hospital/ED data identified proportionately more children who were African American, urban, physically abused, or infants, and uniquely identified only 10% of the total cases. In the validation sample, maltreatment was documented in 110 (87%) of the 127 records reviewed. CONCLUSIONS: CPS and medical data can be linked for surveillance. However, the medical data add few unique cases and identify only a subset of maltreated children.     

Risk assessment practices among home visiting nurses and child protection caseworkers in Colorado,United States: A qualitative investigation

Nurses and caseworkers engage in assessments with the families they serve. Nurse home visitors from Nurse–Family Partnership (NFP) improve maternal–child health outcomes with first‐time low‐income mothers through care, education and support. In the United States, Child Protective Services (CPS) are state‐level governmental agencies that protect children, including responding to reports of child maltreatment. This paper aimed to characterise similarities and differences in risk assessment practices between NFP nurses and CPS caseworkers in Colorado, United States. Using a grounded theory approach, we conducted in‐depth qualitative interviews with 112 NFP and CPS workers from seven Colorado NFP sites from 2013 to 2015. Study sites were purposefully selected based on size, structure, geography and degree of collaboration with CPS. We conducted interviews first with NFP sites and used snowball sampling to recruit CPS workers. Interviews were recorded, transcribed, validated and then coded in NVivo 10. Memo writing was conducted to organise and link concepts within the theme of risk assessment. NFP and CPS workers emphasised the importance of risk assessment in their respective practices. Although there were similarities in the types of risks assessed, we found variations in work processes, operational definitions and methods of risk assessment between the two organisations that impacted inter‐organisational collaboration to serve high‐risk mothers and their children. NFP and CPS workers may have different roles and responsibilities but their underlying goals are the same – to keep children and their families safe and healthy. By understanding these similarities and differences in practice, there lies potential to improve collaboration between home visiting programmes and child welfare to provide integrated service delivery of high‐risk families and prevention of future child maltreatment.     

Caregiver Reports of Serious Injuries in Children Who Remain at Home After a Child Protective Services Investigation

The study objectives were to examine serious injuries requiring medical attention among children who remain at home after a child welfare/child protective services (CPS) maltreatment investigation in the US and to determine whether child/caregiver characteristics and ongoing CPS involvement are related to injuries requiring medical attention. Using the National Survey of Child and Adolescent Well-being, we analyzed data on the subsample of children who remained at home (N = 3,440). A multivariate logistic regression model included child characteristics, chronic illness and disability in the child, level of CPS involvement, subsequent foster care placement, caregiver characteristics, and caregiver/family psychological variables. Injuries requiring medical attention were identified in 10.6% of the in-home population over a15-month period, with no differences in rates by age. Children with a chronic medical condition (OR = 2.07; 95% CI, 1.20–3.58) and children with depressed caregivers (OR = 2.28; 95% CI, 1.45–3.58) were more likely to have an injury that required medical care. Older caregivers (>54 years) were less likely (OR = 0.15; 95% CI, 0.03–0.69) to have a child with an injury requiring care. Injuries were not related to further involvement with CPS after the initial maltreatment investigation. Children with chronic medical conditions who remained in their biological homes or whose caregivers were depressed were likely to experience an injury requiring medical attention. Older caregivers were less likely to report a child injury. Extending existing health policies for foster children to children who remain at home following referral to CPS may encourage more comprehensive injury prevention for this population.     

Predictive Risk Modeling for Recurrence of Child Maltreatment Using Cases from the National Child Maltreatment Data System in Korea: Exploratory Data Analysis Using Data Mining Algorithm

The purpose of this study was to explore and identify patterns of risk predictors of maltreatment recurrence using predictive risk modeling (PRM). This study used the administrative dataset from the National Child Maltreatment Information System recorded by Korean CPS (Child Protective Service) workers. The information, including recurrent maltreatment, was collected in 2012; then, those reported cases were followed for 2 years through 2014. The data included information about child, family, caregiver, maltreatment, and service characteristics and consisted of male (50.22%) and female (49.78%) children with an average age of 9 years (n?=?4319). We examined the association of risk factors with recurrence using conditional inference trees (CTREE): a tree-based data mining algorithm for classification that allows the exploration of the interconnection between hypothesized risk factors. Study findings showed that a history of prior CPS involvement was the first decision point in the decision tree structure of recurrence. The effect of other risk factors depended on the presence of prior CPS involvement. In the absence of prior CPS involvement, cases with (a) a single-parent status and (b) a caregiver’s alcohol abuse living in other types of households (two-parent households, kinship care, and children without parents) were associated with recurrence. In the presence of prior CPS involvement, cases with out-of-home care or others (long- or short-term foster care and emergency placement) in the final decision of child placement (a) where in-home care in the initial decision of child placement within the presence of physical abuse and (b) where social isolation without physical abuse was related to recurrence. Cases with (a) a male caregiver and (b) a female caregiver with social isolation and without social isolation yet employed were at high risk for recurrence under the circumstance of in-home care in the final decision of child placement. This exploratory study found multiple connections among the factors in the prediction of recurrence. The CTREE helps unravel the complexity embedded in maltreatment recurrence by capturing its patterns. This information can deepen our knowledge of associations between risk factors in the prediction of recurrence and be used as a reference to inform child maltreatment policy and prevention.

     

Child and Parental Outcomes Following Involvement in a Preventive Intervention: Efficacy of the PACE Program

This study evaluated whether engagement (i.e., attendance and quality of participation) in the Parenting our Children to Excellence (PACE) program predicted positive child and parent outcomes. PACE in an 8-week preventive intervention aimed at parents of preschool children. The study investigated the relation of engagement to outcomes in an ethnically diverse sample of 610 parents and among a subset of those parents at high risk for child maltreatment. Overall results demonstrated that engagement in PACE significantly improved child and parent outcomes at post-assessment and/or one-year follow-up assessment. Results for the high-risk subsample were even stronger as engagement significantly improved almost all of the child and parent outcomes at post-assessment, which continued to significantly improve in the year following program completion. Findings provide support for the efficacy of PACE in improving child and parent outcomes in an ethnically diverse community population and among parents considered at risk for child maltreatment.     

The effect of outreach workers' services on the medical care utilization of a disadvantaged population

An original goal of the Kaiser-Permanente Neighborhood Health Center Project was to organize the project so that a medically indigent population would be able to utilize fully and appropriately the services of a complex medical care program. A special program of outreach services was designed as the principal means to achieve this goal. This study was made to determine the effects of these outreach services on (1) the use or nonuse of ambulatory care services; (2) the volume and type of services used; (3) the patterns of use; and (4) the appointment-keeping behavior of the project population for a 12-month period. Outreach and medical care services were provided to an average of 7,000 persons in 1,500 low-income families who were enrolled as health plan members in the Kaiser-Permanente Medical Care Program. Project participants were randomly divided into two groups, one with and one without outreach services, and utilization data were collected from their medical and administrative records. The findings suggest that outreach intervention had a positive effect on access to care. Persons who received outreach services were more likely to contact the medical care system; these persons also showed a substantial difference in the volume of services they used, when compared to those without outreach services. Outreach workers were less successful in changing utilization patterns, although slight differences were found in the direction of more appropriate use. Persons with outreach services were more likely to have made contacts with their regular physician, to have made a smaller proportion of walk-in contacts, to have had a higher proportion of regularly scheduled contacts, and to have made a higher proportion of continuing visits. Outreach workers also had little or no effect on appointment-keeping behavior.     

Community Outreach and Engagement to Prepare for Household Recruitment of National Children's Study Participants in a Rural Setting

Context: The National Children's Study (NCS) is a longitudinal study of environmental influences on children's health. Recruitment of a representative birth cohort that will be followed until 21 years of age requires unique approaches across the nationwide study communities. Purpose: To describe community outreach and engagement in preparation for household recruitment of women of childbearing age at a rural‐classified NCS location that includes 4 adjacent Northern Plains counties spanning 2,500 square miles. Methods: Outreach and engagement methods focused on rural community characteristics. The team established an advisory council, conducted outreach meetings with agencies and groups, participated in local events, and collaborated with stakeholders. Study awareness was raised using radio announcements, local television stories, and widespread distribution of print materials through churches, businesses, and child care centers. Impact evaluation examined the number of stakeholder events by type. Outcome evaluation examined the number of households contacted for recruitment, numbers of age‐eligible women who completed the screening, and exploration of whether women had heard about the study. Findings: Over 300 outreach events occurred, ranging from tribal council meetings to parade entries. Recruitment outcomes were as follows: (1) 80% of 14,700 non‐vacant households were reached for potential recruitment; (2) screening interviews were conducted with 89% of the 5,800 age‐eligible women identified; and (3) 53% of women who completed the screening had heard about the study. Conclusions: Outreach targeted to rural communities facilitated strong recruitment outcomes. Collaboration with the cooperative extension service was a unique rural asset that facilitated relevant activities. Participant retention is an ongoing priority.     

Reproductive,Maternal, Newborn,and Child Health in the Community: Task-sharing Between Male and Female Health Workers in an Indian Rural Context

Background:

Male community health workers (CHWs) have rarely been studied as an addition to the female community health workforce to improve access and care for reproductive, maternal, newborn, and child health (RMNCH).

Objective:

To examine how male health activists (MHAs) coordinated RMNCH responsibilities with existing female health workers in an Indian context.

Materials and Methods:

Interviews from male and female CHWs were coded around community-based engagement, outreach services, and links to facility-based care.

Results:

Community-based engagement: MHAs completed tasks both dependent and independent of their gender, such as informing couples on safe RMNCH care in the antenatal and postnatal periods. MHAs motivated males on appropriate family planning methods, demonstrating clear gendered responsibility. Outreach services: MHAs were most valuable traveling to remote areas to inform about and bring mothers and children to community health events, with this division of labor appreciated by female health workers. Link to facility-based services: MHAs were recognized as a welcome addition accompanying women to health facilities for delivery, particularly in nighttime.

Conclusion:

This study demonstrates the importance of gendered CHW roles and male-female task-sharing to improve access to community health events, outreach services, and facility-based RMNCH care.     

Preventing Early Child Maltreatment: Implications from a Longitudinal Study of Maternal Abuse History,Substance Use Problems,and Offspring Victimization

In the interest of improving child maltreatment prevention science, this longitudinal, community based study of 499 mothers and their infants tested the hypothesis that mothers’ childhood history of maltreatment would predict maternal substance use problems, which in turn would predict offspring victimization. Mothers (35% White/non-Latina, 34% Black/non-Latina, 23% Latina, 7% other) were recruited and interviewed during pregnancy, and child protective services records were reviewed for the presence of the participants’ target infants between birth and age 26 months. Mediating pathways were examined through structural equation modeling and tested using the products of the coefficients approach. The mediated pathway from maternal history of sexual abuse to substance use problems to offspring victimization was significant (standardized mediated path [ab] = .07, 95% CI [.02, .14]; effect size = .26), as was the mediated pathway from maternal history of physical abuse to substance use problems to offspring victimization (standardized mediated path [ab] = .05, 95% CI [.01, .11]; effect size = .19). There was no significant mediated pathway from maternal history of neglect. Findings are discussed in terms of specific implications for child maltreatment prevention, including the importance of assessment and early intervention for maternal history of maltreatment and substance use problems, targeting women with maltreatment histories for substance use services, and integrating child welfare and parenting programs with substance use treatment.     

Using Observational Assessment to Help Identify Factors Associated with Parent Participation Engagement in Community-Based Child Mental Health Services

Background

Parent engagement in child mental health (MH) services has received growing attention due to its significance in intervention outcomes and evidence-based care. In particular, parent participation engagement (PPE) reflects active and responsive contributions in and between sessions. Yet, limited research has examined factors associated with PPE, particularly within community-based MH services where PPE is low and highly diverse families are often served.

Objective

This study examined child, parent, and therapist factors associated with PPE in a sample of racially/ethnically diverse parent–child dyads receiving publicly-funded, community-based MH services.

Methods

This prospective study included 18 parent–child dyads receiving community-based MH services from 17 therapists in five outpatient clinics for child disruptive behaviors. PPE was measured using in-session observational assessment of therapy recordings. Child factors that were examined included age, first time child MH service use, and intensity of child behavior problems. Parent factors included ethnicity, education, depression symptoms, and parent motivation to participate in therapy. Therapist factors included therapist training in parent-mediation interventions, attitudes towards organizational functioning, and attitudes towards parent participation strategies.

Results

Results from linear regression analyses indicated that first time child MH service use, intensity of child behavior problems, parent ethnicity and motivation to participate in therapy, as well as therapists’ training and attitudes about their practice were each significantly associated with PPE.

Conclusions

Results highlight specific child, parent, and therapist characteristics that may impact observed PPE in child MH therapy. These findings underscore the importance of considering the influence of family and provider factors on PPE in community-based child MH services.

     

Health services utilization, satisfaction, and attachment to a regular source of care among participants in an urban health provider alliance

This study examines the effect of a provider alliance on service utilization, satisfaction , self efficacy, and attachment to a regular source of care for participating low income urban children and their families. The use of Physician Assistants and community health workers to expand community outreach, primary care services, pediatric sub-specialty care, and service coordination within and between care settings improved health services utilization, satisfaction with health services, parental self efficacy in navigating the health care system for their children, and service convenience for an at-risk population. Also, the use of Physician Assistants to provide pediatric sub-specialty services did not have a negative effect on parental satisfaction with a child's care. Parents were slightly more satisfied with services received from a Physician Assistant in comparison with the physician sub- specialists in cardiology and nephrology clinics.     

Child maltreatment and the use of social services.

A secondary analysis of 100 cases histories selected from social service records in a county department of social services (DSS) was conducted to examine the amount and kind of social services that persons identified as having maltreated a child received. Other objectives of the analysis were to observe the pattern of social service utilization over time and to discover what, if any, factors were associated with receiving social services. To accomplish these study objectives, two groups were selected for analysis: a target group of 50 families that had been reported to the county DSS for child maltreatment and a group of 50 families that had never been so reported. Both groups were composed mainly of young and socioeconomically deprived families that were characterized by poor incomes, little education, and low occupational levels. Analyses revealed significant differences in the amount and type of social services used by families in the target group and the comparison group. Although family structure was found to be related to the total amount of social service utilization, the degree of social disorganization within the family did not correlate with utilization. The study results indicate that the level of social services that protective service clients need and the level that they are actually getting should be re-examined.     

Integrating community outreach into a quality improvement project to promote maternal and child health in Ghana

Quality improvement (QI) is used to promote and strengthen maternal and child health services in middle- and low-income countries. Very little research has examined community-level factors beyond the confines of health facilities that create demand for health services and influence health outcomes. We examined the role of community outreach in the context of Project Fives Alive!, a QI project aimed at improving maternal and under-5 outcomes in Ghana. Qualitative case studies of QI teams across six regions of Ghana were conducted. We analysed the data using narrative and thematic techniques. QI team members used two distinct outreach approaches: community-level outreach, including health promotion and education efforts through group activities and mass media communication; and direct outreach, including one-on-one interpersonal activities between health workers, pregnant women and mothers of children under-5. Specific barriers to community outreach included structural, cultural, and QI team-level factors. QI efforts in both rural and urban settings should consider including context-specific community outreach activities to develop ties with communities and address barriers to health services. Sustaining community outreach as part of QI efforts will require improving infrastructure, strengthening QI teams, and ongoing collaboration with community members.     

Insights in Public Health: The Hawai‘i Home Visiting Network: Evidence-Based Home Visiting Services in Hawai‘i

Home visiting services are cost-effective and improve the health of children and families among those at increased risk. From 1985–2008, home visiting services in Hawai‘i were provided primarily through state funding of the Hawai‘i Healthy Start Program, but the program was severely reduced due to the economy and state budget changes over the past decade. The Maternal and Child Health Branch (MCHB) in the Family Health Services Division responded to these changes by seeking out competitive grant opportunities and collaborations in order to continue to promote home visiting services to those children and families in need. In 2010, the MCHB was awarded a federally funded Maternal, Infant and Early Childhood Home Visiting (MIECHV) grant for home visiting services to promote maternal, infant, and early childhood health, safety and development, strong parent-child relationships, and responsible parenting. In 2011, the MCHB was also awarded a competitive MIECHV development grant that funded the re-establishment of the hospital Early Identification program. Families in need of additional support identified through this program are referred for family strengthening services to a network of existing home visiting programs called the Hawai‘i Home Visiting Network (HHVN). The HHVN is supported by MIECHV and a small amount of state funds to assist programs with capacity building, training, professional development, quality assurance, and accreditation/certification support. The MIECHV grant requires that programs are evidence-based and address specific outcome measures and benchmarks. The HHVN provides home visiting services to families prenatally through 5 years of age that reside in specific at-risk communities, and is aimed at fostering positive parenting and reducing child maltreatment using a strength-based approach by targeting six protective factors: (1) social connections, (2) nurturing and attachment, (3) knowledge of parenting and child development, (4) parental resilience, (5) social and emotional competence of children, and (6) concrete supports for parents. This article provides an introduction to the HHVN as a diverse network of evidence-based home visiting programs with services currently available on all islands, and highlights aspects of home visiting programs that support the Family-Centered Medical Home (FCMH) model. The HHVN provides important services to families at risk and uses evidence-based practices to yield positive results. Health care professionals can support this network to promote the health of children and families by being aware that these home visiting services exist and encouraging families at-risk to participate. Continued collaboration and expanded partnerships with health providers can help strengthen the home visiting network and improve outcomes for children and families in Hawai‘i.     

Risk of Fatal Injury in Young Children Following Abuse Allegations: Evidence From a Prospective,Population-Based Study

Objectives. We examined variations in children’s risk of an unintentional or intentional fatal injury following an allegation of physical abuse, neglect, or other maltreatment.Methods. We linked records of 514 232 children born in California from 1999 to 2006 and referred to child protective services for maltreatment to vital birth and death data. We used multivariable Cox regression models to estimate variations in risk of fatal injury before age 5 years and modeled maltreatment allegations as time-varying covariates.Results. Children with a previous allegation of physical abuse sustained fatal injuries at 1.7 times the rate of children referred for neglect. Stratification by manner of injury showed that children with an allegation of physical abuse died from intentional injuries at a rate 5 times as high as that for children with an allegation of neglect, yet faced a significantly lower risk of unintentional fatal injury.Conclusions. These data suggest conceptual differences between physical abuse and neglect. Findings indicate that interventions consistent with the form of alleged maltreatment may be appropriate, and heightened monitoring of young children referred for physical abuse may advance child protection.In the United States in 2011, 6.2 million children were referred to child protective services (CPS) for abuse or neglect.1 When the demographic profile of referred children is compared with that of the general population, it becomes clear these children face multiple individual,2–4 family,5–7 and community8,9 risk factors. Among children referred to CPS, however, the accurate identification of those for whom the threat is most immediate and consequential has proven difficult.10 High rates of maltreatment rereferrals among children with initially unfounded allegations,11–13 and child maltreatment deaths despite CPS involvement,1 point to the challenge of accurately assessing children’s current and future risk of abuse and neglect.One possible indicator of the nature and severity of the physical threat faced by a child is the type of alleged maltreatment. Nationally, more than three quarters of children are referred to CPS for neglect (78.5%); far fewer are referred as possible victims of physical abuse (17.6%).1 Despite high rates of concurrence between maltreatment types,14–17 it is notable that physical abuse is alleged for only a minority of children. Because of the ambiguity surrounding what constitutes child neglect (broadly defined as acts of parental omission that endanger children),17 an allegation of physical abuse for a child younger than 5 years may be a more reliable marker of safety concerns that necessitate CPS intervention. In other words, although many children referred for neglect may also experience varying degrees of physical abuse, if the physical abuse is so severe or chronic that it is explicitly alleged, this may be an important signal of risk.Public health researchers use variations in rates of death as population-based indicators reflective of broader group disparities in health, safety, and well-being.18,19 Similarly, variable rates of fatalities among children previously referred for maltreatment may provide a means of differentiating among high-risk subsets of children. Although death is a relatively rare event, group differences in fatality rates suggest variable exposures to antecedent risk factors. Previous research indicates that children with a history of CPS referrals have an increased risk of death by injury and other causes.20–24 We examined whether children previously referred for physical abuse had an increased risk of both unintentional and intentional fatal injury compared with children referred for neglect and children referred for other forms of maltreatment.     

Identifying perinatal risk factors for infant maltreatment: an ecological approach

Background  

Child maltreatment and its consequences are a persistent problem throughout the world. Public health workers, human services officials, and others are interested in new and efficient ways to determine which geographic areas to target for intervention programs and resources. To improve assessment efforts, selected perinatal factors were examined, both individually and in various combinations, to determine if they are associated with increased risk of infant maltreatment. State of Georgia birth records and abuse and neglect data were analyzed using an area-based, ecological approach with the census tract as a surrogate for the community. Cartographic visualization suggested some correlation exists between risk factors and child maltreatment, so bivariate and multivariate regression were performed. The presence of spatial autocorrelation precluded the use of traditional ordinary least squares regression, therefore a spatial regression model coupled with maximum likelihood estimation was employed.