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.     

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.     

Engaging Families in Voluntary Prevention Services to Reduce Future Child Abuse and Neglect: a Randomized Controlled Trial

Research on secondary prevention is mixed as to whether referrals to evidence-based practices and other community interventions reduce maltreatment recidivism. This evaluation sought to rigorously assess whether a community service–linkage model to evidence-based programs decreased subsequent reports of abuse and neglect among families reported to the child protection system (CPS). Between 2016 and 2018, administrative CPS records were used to identify families with at least one child under 5 years of age recently reported for maltreatment in Orange County, California, but where no follow-up services were mandated. Families were randomized to one of two community outreach and engagement conditions (i.e., targeted provider outreach vs. treatment-as-usual). Re-reporting outcomes were tracked in administrative records for a period of 12 months. A total of 4873 families met eligibility criteria, with 2231 (45.0%) randomized to the intervention arm and 2642 (54.0%) families to the control group. Among families in the intervention group, 811 (36.4%) were successfully contacted by a community provider. Of those families contacted, 145 (18.0%) agreed to participate in voluntary services. Overall, we did not detect any significant difference in re-reporting between our treatment and control groups (P?=?.433). Likewise, no significant differences in re-reporting were observed when we stratified the treatment group by levels of outreach and service engagement. Findings indicate low levels of successful engagement of families in voluntary services. Notwithstanding the absence of significant findings, this study demonstrates the potential for using community-based RCTs and administrative records to rigorously evaluate secondary prevention programs in the child protection system.

     

Preventable injury deaths: a population-based proxy of child maltreatment risk in California

Objective

This study used group variations in child injury fatality rates to assess racial bias in the population of children identified as victims of maltreatment.

Methods

Injury fatality and maltreatment data from California were compiled for the years 1998–2007. Death and maltreatment risk ratios (RRs) and 95% confidence intervals (CIs) were computed by race and age. Rates of excess child injury mortality by race were derived from three different baseline rates of death. Substantiations per excess injury death were calculated.

Results

Compared with white children, black children faced a risk of substantiated maltreatment that was more than twice as great (black RR: 2.39, 95% CI 2.37, 2.42) and were fatally injured at nearly twice the rate (black RR: 1.89, 95% CI 1.68, 2.12). Per excess death, however, black children had rates of substantiated maltreatment allegations that were equivalent to or lower than the rates for white children.

Conclusions

These data support claims that, at least in California, black-white racial disparities observed in maltreatment rates reflect real group differences in risk. These data provide no evidence of systematic racial bias in the child protective services'' substantiation process.In the United States, data collected by child protective services (CPS) consistently indicate that black children are abused and neglected at roughly twice the rate of white children.^1–3 Yet, these data reflect only maltreatment victims known to CPS, with other sources suggesting the count of abused and neglected children may be far higher.^4,5 Unknown is whether the group of maltreated children identified by CPS is racially representative of the broader population of maltreated children.In an effort to overcome the limitations of CPS data, the National Incidence Study of Child Abuse and Neglect (NIS) has been conducted on four separate occasions between 1980 and 2006.^4,6–8 The NIS attempts to estimate the actual number and characteristics of maltreated children based on cases reported to CPS, as well as knowledge of abused and neglected children ascertained from other professionals. Despite large black-white disparities observed in CPS-reported rates of maltreatment, the first three waves of the NIS failed to identify any statistically significant racial differences in the community incidence of abuse and neglect.^6–8 As such, it was widely concluded that there must be a racially biased identification of black children by CPS.^9–11 For the first time, however, the most recent wave of the NIS found that black children were maltreated at significantly higher rates than white children, reporting “strong and pervasive race differences in the incidence of maltreatment.”⁴The purpose of this study was to examine racial disparities in child maltreatment using a new, population-based and public health-oriented approach. Given the incomplete nature of CPS data,^5,12,13 the contradictory claims and sampling controversies that surround the NIS,^14–16 and research arising from other sources suggesting possible reporting and CPS substantiation bias of black children,^17–19 it seemed an opportune time to consider other data that might inform an understanding of racial disparities. In this ecological study, data from two public surveillance systems were used to assess possible bias in one source (data collected by CPS) by using the more complete and objective information available in the other (vital statistics death data). Rates of excess injury mortality were based on different assumptions as to the fraction of injury deaths that were preventable. The ratios of substantiations per excess death were compared across races. It was hypothesized that racial variability in rates of excess injury death would be observed—arising from disproportionate burdens of poverty, substance use, and other risk factors—but that absent widespread bias on the part of CPS, there would be a fairly consistent count of substantiations for each excess death.     

Report of maltreatment as a risk factor for injury death: a prospective birth cohort study

This article presents a population-based study of early childhood injury mortality following a nonfatal allegation of maltreatment. Findings are based on a unique data set constructed by establishing child-level linkages between vital birth records, administrative child protective services records, and vital death records. These linked data reflect over 4.3 million children born in California between 1999 and 2006 and provide a longitudinal record of maltreatment allegations and death. Of interest was whether children reported for nonfatal maltreatment subsequently faced a heightened risk of unintentional and intentional injury mortality during the first 5 years of life. Findings indicate that after adjusting for risk factors at birth, children with a prior allegation of maltreatment died from intentional injuries at a rate that was 5.9 times greater than unreported children (95% CI [4.39, 7.81]) and died from unintentional injuries at twice the rate of unreported children (95% CI [1.71, 2.36]). A prior allegation to CPS proved to be the strongest independent risk factor for injury mortality before the age of five.