Longitudinal experiences of children remaining at home after a first-time investigation for suspected maltreatment

Abstract

Objective: To describe longitudinal change in risk for children remaining at home following a first-time investigation for suspected maltreatment.

Study design: A retrospective cohort study of children remaining at home following first-time investigation for maltreatment using a nationally representative sample of households involved with Child Protective Services. Outcomes include poverty, social support, caregiver depression, intimate partner violence (IPV), drug/alcohol dependence, corporal punishment, and child behavior problems at baseline, 18, and 36 months following first-time Child Protective Services investigation. We present longitudinal models to (1) estimate prevalence of risk factors at each timepoint; and (2) examine associations between risk-specific service referrals and longitudinal change in risk factor prevalence.

Results: Our sample represented 1057056 US children remaining at home following first-time investigation for maltreatment. Almost 100000 (9.2%) children experienced out-of-home placement within 36 months. The prevalence of poverty (44.3%), poor social support (36.3%), caregiver depression (24.4%), IPV (22.1%), and internalizing (30.0%) and externalizing (35.8%) child behavior problems was above general population prevalence at baseline and remained high over the next 36 months. Referral to risk-specific services occurred in a minority of cases, but was associated with significant longitudinal reductions in IPV, drug/alcohol dependence, and externalizing child behavior problems.

Conclusions: Children remaining at home following a first-time investigation for maltreatment live with persistent risk factors for repeat maltreatment. Appropriate service referrals are uncommon, but may be associated with meaningful reduction in risk over time. Pediatricians and policy makers may be able to improve outcomes in these families with appropriate service provision and referrals.

Figure

Prevalence of household, child, and caregiver risk factor at baseline, 18 months, and 36 months following first-time investigation for suspect child abuse or neglect Each panel reflects national estimates of risk factor prevalence adjusted for demographic covariates, primary maltreatment type, and investigation outcome. Error bars reflect 95% confidence intervals. Table I has specific services and comparison populations used for this analysis. NSCAW subjects remaining in home after a first-time investigation for suspected child abuse or neglect NSCAW subjects referred for risk-specific services after first-time investigation for suspected abuse or neglect (see Table 1 for services selected) General population comparison, not available for social support (see Table 1 for comparison populations used)