Disparities in child protective services involvement in pediatric traumatic brain injury.

PURPOSE: Traumatic brain injury (TBI) is a leading cause of pediatric death and disability. Abusive head trauma confers greater morbidity and mortality compared with accidental TBI. National trends reveal disproportionate involvement of minority children in the child welfare system. The study investigates socioeconomic disparities in child protective services (CPS) involvement in pediatric TBI. METHODS: Retrospective chart review was conducted for TBI patients (n = 596) admitted to an academic pediatric level I trauma center from 2015 to 2022, where institutional policy dictates automatic CPS referral for TBI patients ≤ 2 years. Analysis of variance, chi-squared, and logistic regressions compared racial and ethnic groups and calculated adjusted odds of CPS case acceptance. RESULTS: Rates of non-accidental trauma, CPS involvement, insurance, and marital status differed across racial and ethnic backgrounds (p < 0.05). Of patients ≤ 2 years, Hispanic patients (OR: 0.38, 95%CI [0.16,0.91]) had decreased odds of CPS involvement compared to non-Hispanic White patients when adjusting for confounders including injury severity, injury type, and socioeconomic status. CONCLUSIONS: We highlight racial and ethnic differences in incidence of pediatric TBI and CPS involvement, even in the setting of an automatic CPS referral policy for pediatric TBI patients ≤ 2 years.

The Hispanic paradox in child maltreatment: Does it fade over time?

BACKGROUND: The "Hispanic Paradox" refers to a commonly noted tendency for Hispanic immigrants to have good health outcomes relative to risks faced. This paper demonstrates the presence of the Hispanic Paradox relative to child maltreatment, with a focus on how it appears to "fade" generationally. OBJECTIVES: To use national child maltreatment and census data to determine if the protective effects of the Hispanic Paradox are weaker ("fade") for counties with fewer foreign-born Hispanics. DESIGN: Census data, including the percentage of Hispanics in a county who were foreign-born, was used to predict child maltreatment rates as observed in the National Child Abuse and Neglect Data System. The analysis was done at a county level and included a number of covariates (e.g. Hispanic Median Income, Rural/Urban status…). PARTICIPANTS AND SETTING: We included national child maltreatment data at the county level. RESULTS: A negative binomial mixed effects model showed that for each point of increase in the percentage of the Hispanic foreign-born population of a county, the county Hispanic child maltreatment rate was expected to drop by 1 %. Variation in Hispanic national origin (i.e. Puerto Rico) was found to significantly moderate this relationship. CONCLUSION: Counties with higher percentages of foreign-born Hispanics have lower child maltreatment rates after controlling for other factors. This is consistent with emerging findings in the child mortality data and suggests that for child maltreatment, the Hispanic Paradox may fade generationally.

Estimating the alcohol-related burden of child maltreatment among Maori in Aotearoa, New Zealand.

INTRODUCTION: To assesses the alcohol-related burden of child maltreatment among Maori in Aotearoa New Zealand. We compared the risk of child maltreatment among Maori (0-17 years) exposed to parents with alcohol-related hospitalisation or mental health/addiction service use. We also conducted a sensitivity analysis to estimate the number of cases of maltreatment that could be attributed to alcohol among Maori. METHODS: A cohort study of 16,617 Maori aged 0-17 and their parents from 2000 to 2017 was conducted using the Statistics New Zealand Integrated Data Infrastructure. A Bayesian piecewise exponential model estimated the risk of time to first child maltreatment event. This analysis used data from child protection, hospital, mortality and police records, and specifically focused on the risk associated with exposure to parents with an alcohol-attributable hospitalisation or mental health/addiction service use event. Potential confounders for both parents and Maori (0-17 years) were included. We calculated a population-attributable fraction to estimate the proportion of maltreatment cases that could be attributed to alcohol in 2017. RESULTS: Results showed a 65% increased risk for young Maori exposed to parents with heavy alcohol use. We estimated 17% of substantiated child maltreatment among Maori could be attributed to parental hazardous alcohol consumption. DISCUSSION AND CONCLUSIONS: Severe or hazardous alcohol consumption among parents is a risk factor for child maltreatment among Maori. Maori alcohol consumption and harm are symptomatic of wider inequities related, among other things, to the ongoing effects of colonisation, as well as gaps in the regulation of alcohol sales.

Maternal victimization and neglected offspring: Child marriage, IPV and depression symptoms among Salar Muslim women.

BACKGROUND: Child neglect is prevalent in western rural China, yet there is limited research among ethnic minority communities. The Salar, a Turkic-Muslim ethnic minority residing primarily in western China, also face this specific problem. The group is deeply influenced by ethnicity, Islam and Chinese Confucianism, which in turn makes women vulnerable to child marriage and IPV. These victimizations, coupled with various life stressors, further complicate the challenges of providing adequate care for their children. OBJECTIVE: This study hypothesizes a relationship between child neglect and maternal child marriage, IPV victimization, and depression symptoms. PARTICIPANTS AND SETTING: 201 married Salar women from five villages in Xunhua Salar Autonomous County, China, were randomly selected to participate in the study. METHOD: A probability proportional to size (PPS) sampling approach was used to collect a random representative multi-stage cluster sample in 2022. Random effects Poisson regression models were used to test the hypotheses. RESULTS: The participants reported a 65.6 % rate of child neglect and a 30.8 % rate of IPV in the past year. 37.6 % experienced child marriage. Results revealed significant associations between child neglect and child marriage, IPV, and depression symptoms. A two-way interaction between IPV and depression symptoms was strongly positively associated with child neglect. CONCLUSIONS: This research indicates that Salar Muslim mothers who have experienced child marriage, adulthood victimization, and depression are at a higher risk of neglecting their children. The findings represent a valuable initial step toward researching and addressing the protection needs of women and children from Muslim ethnic minorities in China.

Public Benefit Programs and Differential Associations With Child Maltreatment by Race and Ethnicity.

Importance: Public benefit programs, including state spending on local, state, and federal-state partnership programs, have consistently been associated with overall reductions in child protective services (CPS) involvement. Inequities in eligibility and access to benefit programs may contribute to varying associations by race and ethnicity. Objective: To determine whether associations between state spending on benefit programs and rates of CPS investigations differ by race and ethnicity. Design, Setting, and Participants: This cross-sectional ecological study used repeated state-level measures of child maltreatment from the National Child Abuse and Neglect Data System and population estimates from the US Census Bureau for all Black, Hispanic, and White children. All 50 US states from October 1, 2009, through September 30, 2019 (fiscal years 2010-2019), were included. Data were collected and analyzed from May 13, 2022, to March 2, 2023. Exposures: Annual state spending on benefit programs per person living below the federal poverty limit, total and by the following subcategories: (1) cash, housing, and in-kind; (2) housing infrastructure; (3) child care assistance; (4) refundable earned income tax credit; and (5) medical assistance programs. Main Outcomes and Measures: Race- and ethnicity-specific rates of CPS investigations. Generalized estimating equations, with repeated measures of states, an interaction between race and spending, and estimated incidence rate ratios (IRRs) and 95% CIs for incremental changes in spending of US $1000 per person living below the federal poverty limit were calculated after adjustment for federal spending, race- and ethnicity-specific child poverty rate, and year. Results: A total of 493 state-year observations were included in the analysis. The association between total spending and CPS investigations differed significantly by race and ethnicity: there was an inverse association between total state spending and CPS investigations for White children (IRR, 0.94 [95% CI, 0.91-0.98]) but not for Black children (IRR, 0.98 [95% CI, 0.94-1.02]) or Hispanic children (IRR, 0.99 [95% CI, 0.95-1.03]) (P = .02 for interaction). Likewise, inverse associations were present for only White children with respect to all subcategories of state spending and differed significantly from Black and Hispanic children for all subcategories except the refundable earned income tax credit (eg, IRR for medical assistance programs for White children, 0.89 [95% CI, 0.82-0.96]; P = .005 for race and spending interaction term). Conclusions and Relevance: These results raise concerns that benefit programs may add relative advantages for White children compared with Black and Hispanic children and contribute to racial and ethnic disparities in CPS investigations. States' eligibility criteria and distribution practices should be examined to promote equitable effects on adverse child outcomes.

Racial Identification as a Protective Factor for At-Risk Parenting in Black Parents: A Longitudinal, Multi-Method Investigation.

Although considerable literature focuses on risk factors predicting parents' likelihood to engage in maltreatment, relatively less work evaluates potentially protective parental resources, particularly culturally relevant qualities. The current investigation utilized a multi-method longitudinal study to examine parents' racial identification as a possible resource, hypothesizing that Black parents with stronger racial group identification would demonstrate lower at-risk parenting, operationalized as lower child abuse risk and less negative observed parenting. In a sample of 359 mothers and fathers (half self-identified Black, half non-Hispanic White), controlling for socioeconomic status, findings partially supported the hypothesis. Black parents' greater racial identification was associated with lower child abuse risk and less observed negative parenting, whereas the reverse was true for White parents. The potential limitations of current assessment approaches to gauge at-risk parenting in parents of color are discussed, as well as how racial identification could be considered in culturally informed prevention programming for at-risk parenting.

Childhood abuse, posttraumatic stress symptoms, and alcohol misuse among African-American women.

The study explored associations among childhood abuse, post-traumatic stress symptoms (PTSS), and alcohol misuse in a sample of low-income African-American women (N = 172). Using bootstrapping techniques, a mediation effect was found of childhood physical and emotional abuse on alcohol misuse via PTSS symptom severity, avoidance, and hyperarousal, as well as for childhood sexual abuse on alcohol misuse via PTSS symptom severity and hyperarousal. Our results suggest that PTSS indicators, particularly symptom severity and hyperarousal, may be important mechanisms underlying the association of experiences of abuse during childhood and alcohol misuse in adulthood.

Cumulative Rates of Child Protection Involvement and Terminations of Parental Rights in a California Birth Cohort, 1999-2017.

Objectives. To document the cumulative childhood risk of different levels of involvement with the child protection system (CPS), including terminations of parental rights (TPRs).Methods. We linked vital records for California's 1999 birth cohort (n = 519 248) to CPS records from 1999 to 2017. We used sociodemographic information captured at birth to estimate differences in the cumulative percentage of children investigated, substantiated, placed in foster care, and with a TPR.Results. Overall, 26.3% of children were investigated for maltreatment, 10.5% were substantiated, 4.3% were placed in foster care, and 1.1% experienced a TPR. Roughly 1 in 2 Black and Native American children were investigated during childhood. Children receiving public insurance experienced CPS involvement at more than twice the rate of children with private insurance.Conclusions. Findings provide a lower-bound estimate of CPS involvement and extend previous research by documenting demographic differences, including in TPRs.Public Health Implications. Conservatively, CPS investigates more than a quarter of children born in California for abuse or neglect. These data reinforce policy questions about the current scope and reach of our modern CPS.

Association of Child Abuse and Systemic Lupus Erythematosus in Black Women During Adulthood.

OBJECTIVE: Exposure to psychosocial stressors may contribute to the onset of systemic lupus erythematosus (SLE) through dysregulation of the adaptive stress response. The present study was undertaken to assess the relationship of childhood physical and sexual abuse to risk of SLE among Black women. METHODS: Using data from the Black Women's Health Study, we followed 36,152 women from 1995 through 2015 with biennial questionnaires. Women reported on exposure to abuse during childhood (up to age 11) in 2005. Self-reported cases of incident SLE were confirmed as meeting the American College of Rheumatology SLE classification criteria by medical record review. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for SLE among women exposed to physical or sexual abuse during childhood, controlling for potential confounders. RESULTS: We confirmed 101 cases of incident SLE and identified patients who had completed questions on child abuse during 670,822 person-years of follow-up. Both physical and sexual abuse during childhood were associated with statistically significant increases in SLE incidence. The HR for SLE associated with ≥2 episodes of severe sexual abuse compared to no abuse was 2.51 (95% CI 1.29-4.85) after adjustment for alcohol consumption, smoking, body mass index, oral contraceptive use, age at menarche, and parental education. The multivariable-adjusted HR for SLE with ≥5 episodes of severe physical abuse was 2.37 (95% CI 1.13-4.99). CONCLUSION: Our results suggest that sexual and physical abuse during childhood increase SLE risk during adulthood among Black women. Research is necessary both to confirm this finding and to understand potential mediating mechanisms.

Association between parental negligence in feeding and social activity of obese adults among jazan population.

BACKGROUND: Neglectful feeding and physical activity (PA) practices by parents are associated with development of adulthood obesity. The Arab world has reported an alarming increase of adulthood obesity and childhood neglect by parents, yet have not studied the association between the two variables. Aims: The objectives of this study were to evaluate two parental negligence parameters (feeding style and social activity) associated with adulthood obesity and to identify the level of parental negligence on a customized parent neglect scale. METHODS: In total 450 adult subjects 18-30 were screened for body mass index (BMI) values. 240 subjects fulfilling the criteria for the study were divided into two groups normal weight (N Gp) (n = 150) and overweight/obese (Ov/Ob Gp) (n = 90) groups. A questionnaire was formulated through a dual moderator focus group discussion, which was then tested in a prepilot and a pilot study (qualitative) to determine its validity (content and criterion) and reliability (repeated measurement) before distributing to the parents of both groups. Physical activity and screen time were also recorded for the subjects and their parents. Chi square test for association/difference between two categorical variables and Pearsons correlation coefficient for BMI correlation were employed. RESULTS: Parenting parameters like maternal age, consanguineous marriage, breastfeeding duration, formula food introduction, and maternal smoking were significantly different between studied groups. Higher physical inactivity was observed among parents (father/mother 53%) and subjects (80%). The higher amount of screen time (73% ≥ 60-100 h/week) was found in the Ov/Ob Gp that significantly differed with the other group. Maternal BMI was positively related to the subjects BMI. Parents of obese subjects were found negligent in feeding style and very negligent for social activity on a parent neglect scale as compared to the parents of the normal weight subjects. CONCLUSION: Parents are responsible for developing healthy eating habits and competitive social behavior among their children. Parents need to practice the same to influence changes in their children during their early childhood, as well as when their children grow into adults. Negligent parenting in the studied parameters were found to increase the risk of developing adulthood obesity and should be considered as a potential marker for adult obesity.

Stress and parenting during the global COVID-19 pandemic.

BACKGROUND: Stress and compromised parenting often place children at risk of abuse and neglect. Child maltreatment has generally been viewed as a highly individualistic problem by focusing on stressors and parenting behaviors that impact individual families. However, because of the global coronavirus disease 2019 (COVID-19), families across the world are experiencing a new range of stressors that threaten their health, safety, and economic well-being. OBJECTIVE: This study examined the impacts of the COVID-19 pandemic in relation to parental perceived stress and child abuse potential. PARTICIPANTS AND SETTING: Participants included parents (N = 183) with a child under the age of 18 years in the western United States. METHOD: Tests of group differences and hierarchical multiple regression analyses were employed to assess the relationships among demographic characteristics, COVID-19 risk factors, mental health risk factors, protective factors, parental perceived stress, and child abuse potential. RESULTS: Greater COVID-19 related stressors and high anxiety and depressive symptoms are associated with higher parental perceived stress. Receipt of financial assistance and high anxiety and depressive symptoms are associated with higher child abuse potential. Conversely, greater parental support and perceived control during the pandemic are associated with lower perceived stress and child abuse potential. Results also indicate racial and ethnic differences in COVID-19 related stressors, but not in mental health risk, protective factors, perceived stress, or child abuse potential. CONCLUSION: Findings suggest that although families experience elevated stressors from COVID-19, providing parental support and increasing perceived control may be promising intervention targets.

Differences and disparities over time: Black and White families investigated by Ontario's child welfare system.

BACKGROUND: Black-White disparities in child welfare involvement have been well-documented in the United States, but there is a significant knowledge gap in Ontario about how and when these disparities emerge. OBJECTIVE: This paper compares incidence data on Black and White families investigated by Ontario's child welfare system over a 20-year period. METHODS: Data from the first five cycles of the Ontario Incidence Study of Reported Child Abuse and Neglect (OIS) (1993-2013) were used to examine trends in child maltreatment investigations involving Black and White families. Incidence rates were calculated. T-tests were conducted to assess statistically significant differences between and within cycles. Population and decision-based enumeration approaches were also used to examine child welfare disparities. RESULTS: The incidence of investigations involving White families almost doubled between 1998 and 2003, but for Black families the incidence increased almost fourfold during the same period. These increases and the difference between Black and White families in 2003 were statistically significant. The results further indicate that Black families experience disparate representation in Ontario's child welfare system over time for most service dispositions. CONCLUSIONS: Several possible explanations are offered for the study's outcome, including changes in risk related to social safety net, the threshold for risk of harm, and bias and racist institutional policies and practices. This study invites policy-makers and child welfare authorities to rethink service delivery in addressing the disparate representation of Black families in the child welfare system.

The link between hearing impairment and child maltreatment among Aboriginal children in the Northern Territory of Australia: is there an opportunity for a public health approach in child protection?

BACKGROUND: International studies provide evidence of an association between child disabilities, including hearing impairment (HI), and child maltreatment. There are high prevalences of ear disease with associated HI, and child maltreatment among Australian Aboriginal children, but the link between HI and child maltreatment is unknown. This study investigates the association between HI and child maltreatment for Aboriginal children living in the Northern Territory (NT) of Australia. METHODS: This was a retrospective cohort study of 3895 Aboriginal school-aged children (born between 1999 and 2008) living in remote NT communities. The study used linked individual-level information from health, education and child protection services. The outcome variables were child maltreatment notifications and substantiations. The key explanatory variable, HI, was based on audiometric assessment. The Kaplan-Meier estimator method was used in univariate analysis; Cox proportional hazards regression was used in multivariable analysis. RESULTS: A majority of the study cohort lived in very remote (94.5%) and most disadvantaged (93.1%) regions. Among all children in the study cohort, 56.1% had a record of either HI or unilateral hearing loss (UHL), and for those with a history of contact with child protection services (n = 2757), 56.7% had a record of HI/UHL (n = 1564). In the 1999-2003 birth cohort, by age 12 years, 53.5% of children with a record of moderate or worse HI had at least one maltreatment notification, compared to 47.3% of children with normal hearing. In the 2004-2008 cohort, the corresponding results were 83.4 and 71.7% respectively. In multivariable analysis, using the full cohort, children with moderate or worse HI had higher risk of any child maltreatment notification (adjusted Hazard Ratios (adjHR): 1.16, 95% CI:1.04-1.30), notification for neglect (adjHR:1.17, 95% CI:1.04-1.31) and substantiation (adjHR:1.20, 95% CI:1.04-1.40), than children with normal hearing. In the 2004-2008 birth cohort, children with moderate or worse HI had higher risk of a substantiated episode of physical abuse (adjHR:1.47, 95% CI:1.07-2.03) than children with normal hearing. CONCLUSION: Our findings demonstrate the urgent need for HI and child maltreatment prevention strategies through raised community awareness and inter-agency collaboration. Effective information-sharing between service providers is a critical first step to a public health approach in child protection.

Cumulative Prevalence of Confirmed Maltreatment and Foster Care Placement for US Children by Race/Ethnicity, 2011-2016.

Objectives. To estimate the cumulative prevalence of confirmed child maltreatment and foster care placement for US children and changes in prevalence between 2011 and 2016.Methods. We used synthetic cohort life tables and data from the Adoption and Foster Care Analysis and Reporting System and the National Child Abuse and Neglect Data System and population counts from the Centers for Disease Control and Prevention.Results. US children's cumulative prevalence of confirmed maltreatment remained stable between 2011 and 2016 at about 11.7% (95% confidence interval [CI] = 11.6%, 11.7%) of the population and increased by roughly 11% for foster care placement from 4.8% (95% CI = 4.8%, 4.8%) to 5.3% (95% CI = 5.3%, 5.4%). American Indian/Alaska Native children experienced the largest change, an 18.0% increase in confirmed maltreatment risk from 13.4% (95% CI = 13.1%, 13.6%) to 15.8% (95% CI = 15.6%, 16.1%) and a 21% increase in foster care placement risk from 9.4% (95% CI = 9.2%, 9.6%) to 11.4% (95% CI = 11.2%, 11.6%).Conclusions. Confirmed child maltreatment and foster care placement continued to be experienced at high rates in the United States in 2012 through 2016, with especially high risks for American Indian/Alaska Native children. Rates of foster care have increased, whereas rates of confirmed maltreatment have remained stable.

They ask for protection: An exploratory study into experiences with violence among unaccompanied refugee children in Dutch reception facilities.

BACKGROUND: Children placed under governmental supervision and staying in residential or foster care are more vulnerable to violence than children who live with their own families. One specific group of children staying in reception facilities under governmental supervision comprises unaccompanied refugee children who have fled to a host country without their parents. OBJECTIVE: This qualitative study explores the experiences of unaccompanied children with regard to violence in reception facilities in the Netherlands from the perspective of the children. PARTICIPANTS AND SETTING: 183 unaccompanied children (N = 183) sheltered in a variety of reception facilities in the Netherlands. METHOD: Semi-structured interviews were conducted focusing on several topics related to their perceived quality of life. The transcripts of the interviews were analyzed for experiences with violence occurring inside the reception facilities. The codebook that was used was based on the categorization of maltreatment in the fourth United States National Incidence Study (NIS-4) and the interpretation of violence by the Committee on the Rights of the Child in General Comment No. 13 (GC 13). RESULTS: A large share (66 %) of the unaccompanied children had experienced violence in various reception facilities. Most of the experiences reported had to do with either physical and emotional abuse and neglect or institutional violence. CONCLUSION: The breadth of experiences of violence underlines the responsibility of the Dutch state to invest in the safe reception of unaccompanied children in order to protect their development, while also investing in further research on the prevalence of violence in the reception of unaccompanied children.