Child maltreatment: variation in trends and policies in six developed countries.

We explored trends in six developed countries in three types of indicators of child maltreatment for children younger than 11 years, since the inception of modern child protection systems in the 1970s. Despite several policy initiatives for child protection, we recorded no consistent evidence for a decrease in all types of indicators of child maltreatment. We noted falling rates of violent death in a few age and country groups, but these decreases coincided with reductions in admissions to hospital for maltreatment-related injury only in Sweden and Manitoba (Canada). One or more child protection agency indicators increased in five of six countries, particularly in infants, possibly as a result of early intervention policies. Comparisons of mean rates between countries showed five-fold to ten-fold differences in rates of agency indicators, but less than two-fold variation in violent deaths or maltreatment-related injury, apart from high rates of violent child death in the USA. These analyses draw attention to the need for robust research to establish whether the high and rising rates of agency contacts and out-of-home care in some settings are effectively reducing child maltreatment.

Preventing severe and fatal child maltreatment: making the case for the expanded use and integration of data.

In this article we examine risk factors for severe and fatal child maltreatment. These factors emerge from studies based on different data sources, including official child maltreatment data, emergency department and hospitalization data, death certificates, and data from child death review teams. The empirical literature reflects a growing effort to overcome the measurement uncertainties of any one individual data system. After review and reflection upon what is known, we consider how integrating this information can advance efforts to protect children, providing examples where the use and linkage of multiple sources of data may enhance surveillance, improve front-end decisionmaking, and support cost-effective research and evaluation.

Understanding the Effects of COVID-19 on Child Maltreatment Reporting Among Rural Versus Urban Communities in the United States.

The onset of the coronavirus disease 2019 (COVID-19) pandemic impacted child protective services (CPS) reporting systems in the United States. It may have also led to widened gaps between rural and urban communities in child maltreatment (CM) report rates due to decreased interaction between children and mandated reporters especially in urban jurisdictions. Using data from the National Child Abuse and Neglect Data System, this study tests the hypothesis that during the onset of the COVID-19 pandemic, the decrease in CM reports made to CPS in urban counties was more pronounced than in rural counties. Reports of CM received by CPS offices between January 6, 2020 and June 28, 2020 were aggregated to per-county-per-week-per-10,000 children maltreatment report rates. We used changepoint analyses to analyze the inter- and intra-region incidence rate ratios among rural and urban counties. Moreover, we used multilevel random effects models to generate regression coefficients for the associations between rates of children with a maltreatment report, COVID-19 occurrence, rural-urban designation, and maltreatment risk factors. During the study period, rates of children with a maltreatment report among urban counties decreased more dramatically when compared with rural counties. Our findings persisted even with the inclusion of control variables associated with maltreatment risk factors. Social distancing restrictions may have had the unintended consequence of decreasing the visibility of at-risk children in urban counties more so than in rural counties. Considering geography is critical to continue to protect children during the COVID-19 pandemic and as we prepare for future disasters.

Differential Response and the Reduction of Child Maltreatment and Foster Care Services Utilization in the U.S. From 2004 to 2017.

By 2014, the majority of U.S. states had implemented differential response (DR), a system policy that seeks to serve families of low-to moderate-risk for child maltreatment through family engagement, diversion from formal child protective services investigations, and service provision. However, the effects of DR programs on child welfare dynamics have yet to be evaluated nationally using causal methods. Using a quasi-experimental study design with data drawn from the National Child Abuse and Neglect Data System from 2004 to 2017, we found states with DR programs had approximately 19% fewer substantiated reports, 25% fewer children substantiated for neglect, and a 17% reduction in foster care services utilization when compared to states without DR programs. We find these estimates to be robust to the opioid epidemic and incarceration rates. Additional research is needed to better characterize DR programs and isolate the effects of DR programs geographically.

Racial/ethnic and gender disparities in child protection decision-making: What role do stereotypes play?

BACKGROUND: A wide range of studies have revealed racial/ethnic and gender disparities in child protection decision-making. OBJECTIVE: This study investigated whether disparities are mediated by stereotypes that professionals may hold, by applying the Stereotype Content Model (SCM) which suggests that stereotypes are formed by perceptions of sociability, morality, and competence. PARTICIPANTS AND SETTING: 258 professionals (133 current staff and 125 trainees) from Colorado participated in the study. METHODS: The study applied a 2 × 3 randomized experimental vignette design. Participants read a case in which the gender of the parent responsible for maltreatment (mother or father) and race/ethnicity of the family (white, Black, or Latinx) varied. RESULTS: A SEM model (CFI = .94, RMSEA = .05) with free parameters for trainees and current staff was estimated. No significant association between stereotypes and race/ethnicity and gender appeared. However, evidence for disparities emerged. In the trainee group, scores to decide for a supervision order were higher for white fathers, Black mothers, Latinx mothers, and Latinx fathers (ß = 0.18 to 0.25) compared to white mothers. Current staff provided larger risk scores for Black mothers and both Latinx parents (ß = 0.20 to 0.22) compared to the white mother, resulting in increased inclinations to decide for a supervision order (ß = 0.26). Lastly, negative perceptions of morality increased supervision order scores (ß = -0.55 to -0.36). CONCLUSIONS: Evidence for disparities in decision-making appeared, but the study could not confirm that these disparities were mediated by stereotypes. Furthermore, perceptions of morality seemed to impact decision-making processes.

Addressing the overrepresentation of Black children in Ontario's child welfare system: insights from child welfare workers and community service providers.

BACKGROUND: The overrepresentation Black children experience in the child welfare system is well documented in the United States, but such studies are now emerging in Canada. In Ontario, there are few studies that address this issue concerning Black families. OBJECTIVE: This study is to explore the insights of child welfare workers and community service providers on how to potentially address Black children's overrepresentation in Ontario's child welfare system. PARTICIPANTS AND SETTING: Twenty-one child welfare workers from two child welfare organizations in Ontario that serves many Black families and thirteen community service providers in Toronto participated in the study. METHODS: Six focus groups were conducted with thirty-four participants. Audio recording from each of the focus groups was manually transcribed verbatim. We utilized constant comparison analysis to analyse the transcribed data. RESULTS: Potential solutions to overrepresentation that emerged from the focus group discussions included viewing Black families as experts of their own lives; increasing workforce diversity; educating referral sources and Black families on child welfare practices; subjecting referral sources to detailed questioning; stopping harmful record keeping on families; providing cultural sensitivity training and education; partnering with community organizations; and providing mentorship opportunities. CONCLUSIONS: The findings from this study emphasize the need for changes related to child welfare assessment tools, workforce development, and shifts in system orientation to address systemic racism and Black children's overrepresentation in the child welfare system.

Understanding the overrepresentation of Black children in Ontario's child welfare system: Perspectives from child welfare workers and community service providers.

BACKGROUND: The overrepresentation of Black children in the child welfare system is a social problem that has received longstanding attention in the United States, but has recently received increasing attention in Canada. OBJECTIVE: This qualitative study explores the findings of two quantitative studies (Antwi-Boasiako et al., 2020, 2021) in order to interpret them through the perspectives of child welfare workers and community service providers. The aim is to gain a deeper understanding on the potential factors that contribute to the overrepresentation of Black children in Ontario's child welfare system. PARTICIPANTS AND SETTING: The study involved twenty-one child welfare workers from two child welfare organizations in Ontario serving lots of Black families and thirteen community service providers in Toronto. METHODS: Six focus groups were completed with thirty-four participants. Each of the focus groups was audio recorded and manually transcribed verbatim. Constant comparison analysis was used to analyze the transcribed data. RESULTS: Themes that emerged from the study include the following concerns: racism and bias from referral sources; racism and bias from child welfare workers; lack of cultural sensitivity; lack of workforce diversity/training; lack of culturally appropriate resources; assessment tools; duty to report; fear of liability; lack of collaboration; and poverty. CONCLUSIONS: The results from this study reinforce the need to shift practice that acknowledges Black families as valuable stakeholders and experts of their own lives and involves them in the development and implementation of policies and practices that affect them.

The Impact of the COVID-19 Pandemic on Child Protection System Referrals and Responses in Colorado, USA.

Although the coronavirus disease 2019 (COVID-19) has amplified risk factors known to increase children's vulnerability to abuse and neglect, emerging evidence suggests declines in maltreatment reporting and responding following COVID-19 social distancing protocols in the United States. Using statewide administrative data, this study builds on the current state of knowledge to better understand the volume of child protection system (CPS) referrals and responses in Colorado, USA before and during the early phase of the COVID-19 pandemic and to determine whether there were differences in referral and response rates by case characteristics. Results indicated an overall decline in referrals and responses during COVID-19 when compared to the previous year. Declines were specific to case characteristics, such as reporter and maltreatment type. Implications regarding the impact of the COVID-19 pandemic on child maltreatment reporting and CPS response are discussed.

Child maltreatment reporting during the initial weeks of COVID-19 in the US: Findings from NCANDS.

BACKGROUND: After the national COVID-19 emergency declaration in the U.S. in March 2020, child welfare agencies observed large reductions in maltreatment reporting. OBJECTIVE: To quantify the impact of the COVID-19 pandemic on child maltreatment reporting nationally to inform policy for future emergencies. PARTICIPANTS AND SETTING: Administrative data from the National Child Abuse and Neglect Data System (NCANDS) for 48 states for federal fiscal years (FFYs) 2017 through 2020. METHODS: Analyses focused on reports to child protective services (CPS) between weeks 12 and 24 of calendar years 2017 through 2020 (mid-March through mid-June). Report sources of screened in and substantiated reports were compared with those during the prior year. Likelihood of a report being substantiated in 2020 compared with 2019 based on report source was calculated using odds ratios. RESULTS: In 2020, CPS screened in 39 % fewer reports than during the same period in 2019 and the proportion of reports substantiated increased from 18 to 22 %. Reports from all report sources decreased, especially from education personnel (90 % decrease) and child daycare providers (65 % decrease). The odds for substantiation were significantly higher during 2020 than in 2019 for reports from all but three sources. CONCLUSION: During the initial weeks following the national COVID-19 emergency declaration, the number of reports to CPS declined sharply at the national level and across all states, primarily in association with a large reduction in referrals from education sentinels. Explanations for the increase in percent of substantiation in the context of reduction of reports are considered.

What Proportion of Foster Care Children Do Not Have Child Protective Services Reports? A Preliminary Look.

It is perhaps surprising that we lack complete national information about why children enter foster care. While the annual Adoption and Foster Care Analysis Reporting System (AFCARS) report is informative, it leaves many questions unanswered, particularly "how many children enter foster care by means other than Child Protective Services (CPS) reports?" Drawing from a unique new integrated dataset, we examined foster care data (AFCARS) and CPS report data (National Child Abuse and Neglect Data System Child File). The linked dataset included 210,062 children with foster care placements in 2017 and no placements in the prior 5 years. We categorized each placed child along two dimensions of four levels each: Time since prior CPS report (if any) and stated AFCARS placement reason, ranging from clearly maltreated to clearly not maltreated. We also tracked the siblings of placed children, to see if non-maltreated children entered care because of maltreated siblings. We find that between 8-35% of children enter foster care for reasons other than maltreatment, depending how thresholds are set. These numbers decline somewhat when siblings are considered. A meaningfully large number of children are placed in foster care for reasons other than maltreatment investigated by CPS. Further research into these children is warranted to better inform foster care policy.

Understanding factors associated with barefoot social workers' decision making in assessing and reporting child physical abuse in China.

BACKGROUND: Mandatory reporting is new in China, and barefoot social workers are responsible for detecting and reporting child maltreatment. OBJECTIVE: Guided by the decision-making ecology, this study examined factors associated with barefoot social workers' decision making in assessing and reporting child physical abuse in China. PARTICIPANTS AND SETTINGS: Cross-sectional data were collected from barefoot social workers (N = 1489) in a metropolitan city in Southern China. METHODS: Descriptive, bivariate, and binary logistic regression analyses were conducted. Dependent variables were barefoot social workers' assessments of and intention to report child physical abuse in two cases. RESULTS: For a less severe physical abuse case, case severity (OR = 2.78, p < .001), receiving a social worker license (OR = 1.64, p = .03), and having a reporting history (OR = 23.55, p = .03) were associated with higher odds of assessments, whereas being younger (OR = 0.97, p = .04) was associated with lower odds. For a more severe physical abuse case, case severity (OR = 3.64, p < .001) and child welfare training (OR = 2.27, p = .03) were associated with higher odds of assessments. Across two cases, case severity (Case 1: OR = 1.44, p < .001; Case 2: OR = 1.34, p < .001), assessment of whether it is abuse (Case 1: OR = 11.48, p < .001; Case 2: OR = 15.98, p < .001), impacts of reporting on the family (Case 1: OR = 1.21, p < .001; Case 2: OR = 1.25, p < .001), and perceived behavior control (Case 1: OR = 1.06, p = .01; Case 2: OR = 1.10, p = .01) were associated with higher odds of reporting. Impacts of reporting on the child (OR = 1.27, p < .001) were associated with higher odds of reporting the less severe case. Attitudes regarding punishment of offenders or victims of child abuse (OR = 1.09, p = .01) and subjective norms of reporting (OR = 1.09, p = .01) were associated with higher odds of reporting the more severe case. CONCLUSIONS: This study identified factors associated with barefoot social workers' decision making in assessing and reporting child physical abuse in China. Results of this study indicate the importance of providing training to barefoot social workers on recognizing, detecting, and reporting child physical abuse. It is also important to encourage them to receive continued social work training and obtain a social work license, which may increase their confidence in decision making. Furthermore, increasing the effectiveness of mandatory reporting is needed.

Major findings from the Ontario Incidence Study of Reported Child Abuse and Neglect 2018.

BACKGROUND: The Ontario Incidence Study of Reported Child Abuse and Neglect (OIS) is the only source of province-wide statistics on families investigated by child welfare. OBJECTIVE: This paper presents key findings from the 2018 cycle of the OIS (OIS-2018) and highlights select policy and practice implications of these findings. PARTICIPANTS AND SETTINGS: The OIS-2018 captured information directly from investigating child protection workers about children and families who were the subject of a child protection investigation sampled for inclusion in the study. METHODS: The OIS-2018 sample was drawn in three stages: first, a representative sample of child welfare agencies in Ontario was selected, then cases were sampled over a three-month period within selected agencies, and, finally, investigations that met the study criteria were identified from the sampled cases. The data collected for the OIS-2018 were weighted in order to derive provincial, annual incidence estimates. RESULTS: An estimated 158,476 child maltreatment-related investigations were conducted in Ontario in 2018. In the majority of investigations, there was no documented physical or emotional harm to the child. The overall incidence of investigations remains unchanged between 2008 and 2018. The only statistically significant difference during this time period is an increase in risk investigations between 2013 and 2018. CONCLUSIONS: Data from the OIS gives Ontario child welfare policymakers and practitioners an empirical basis for making evidence-informed decisions. Findings are compared to the United States and Australia.

Child maltreatment data: A summary of progress, prospects and challenges.

BACKGROUND: In 1996, the ISPCAN Working Group on Child Maltreatment Data (ISPCAN-WGCMD) was established to provide an international forum in which individuals, who deal with child maltreatment data in their respective professional roles, can share concerns and solutions. OBJECTIVE: This commentary describes some of the key features and the status of child maltreatment related data collection addressed by the ISPCAN-WGCMD. METHODS: Different types of data collection methods including self-report, sentinel, and administrative data designs are described as well as how they address different needs for information to help understand child maltreatment and systems of prevention and intervention. RESULTS: While still lacking in many parts of the world, access to child maltreatment data has become much more widespread, and in many places a very sophisticated undertaking. CONCLUSION: The ISPCAN-WGCMD has been an important forum for supporting the continued development and improvement in the global effort to understand and combat child maltreatment thus contributing to the long term goals of the UN Convention on the Rights of the Child. Nevertheless, based on what has been learned, even greater efforts are required to improve data in order to effectively combat child maltreatment.

Recurrent involvement with the Quebec child protection system for reasons of neglect: A longitudinal clinical population study.

Studies in several jurisdictions have found that families become recurrently involved with child protection systems most frequently for reasons of neglect. Child protection involvement for reasons of neglect is shown to correlate with various socioeconomic vulnerabilities. OBJECTIVE: This study, the largest of its kind in Canada, examines when and for whom recurring conditions of neglect were most likely to occur for all children involved with child protection in the province of Quebec over a span of fifteen years. PARTICIPANTS AND SETTING: Specifically, the study population includes all children whose ongoing child protection intervention in Quebec closed between 2002 and 2017 (N = 76,176). METHODS: This clinical population study uses a longitudinal research design drawing anonymized clinical administrative data from all of Quebec's child protection jurisdictions spanning 15 years, and Quebec data extracted from the 2011 Canadian National Household Survey to estimate socioeconomic vulnerability. RESULTS: Of the total population studied, 32.5 % (N = 24,816) experienced a recurrence of maltreatment during the study period, of which more than one third (N = 8707) experienced a recurrence for reasons of neglect. CONCLUSIONS: Because the association between socioeconomic vulnerability and recurrence of neglect indicates a gap in material and social supports-which child protection systems have neither the mandate nor the resources to fill-we propose additional avenues that we urge policymakers and practitioners to consider in supporting the demonstrated needs of these families.

The effects of migrant background and parent gender on child protection decision-making: An intersectional analysis.

BACKGROUND: Disparities in decision-making are a recognized concern within child protection systems and imply that marginalized groups are being treated unequally compared to majoritized groups. Previous studies reported that both ethnicity and the gender of the parent that maltreated the child seem associated with an increased likelihood that child protection agencies provide services after an investigation or that children are placed out of their homes. OBJECTIVE: We investigated whether migration background and the gender of the parent who maltreated the child seem associated with the decision whether a case was opened for continuing services. In addition, we inspected whether the intersections between migration background and parent gender were correlated with disparities in decision-making. PARTICIPANTS AND SETTING: Our multinational sample consisted of 1189 cases that were involved with child protection agencies in England, the Netherlands, and Germany. METHODS: We systematically coded and analyzed child protection case files. We conducted logistic regression analysis to investigate for disparities in decision-making. RESULTS: The intersectional analysis showed that maltreatment committed by mothers (OR = 2.25, p =  .001) and migrant fathers (OR = 2.21, p =  .030) was associated with an increased likelihood to provide ongoing services. However, country specific analyses showed that these effects were most pertinent in the English sample. CONCLUSIONS: These findings suggest a need to address migration background and gender disparities in child protection practice. Future research could investigate whether other contextual factors (e.g. characteristics of the professional and agency) seem associated with disparities in decision-making.

Risk factors for child abuse, neglect and exposure to intimate partner violence in early childhood: Findings in a representative cross-sectional sample in Germany.

BACKGROUND: The KiD 0-3 national main study is a cross-sectional study on adversity in early childhood and parental access to support services, conducted as part of a long-term policy program for early intervention services in Germany. OBJECTIVE: To identify risk factors for child abuse, neglect and exposure to intimate partner violence (IPV) and investigate if parental use of early intervention programs or contact to child welfare services was associated with reported child maltreatment. PARTICIPANTS AND SETTING: 8063 families with infants and toddlers participated in the survey. Parents answered a written questionnaire during mandatory health checks for the child. The sampling was based on a regionally clustered model of pediatricians' practices. METHODS: An automatic variable selection process was used to test risk factors and logistic regression models were employed for each outcome. RESULTS: Significant risk factors (p < 0.05) for child abuse (1.91 %) were child age, IPV and parental stress. Neglect (0.83 %) was associated with couple distress, adverse childhood experiences, young maternal age, cramped housing, and migration history. IPV (2.98 %) was associated with child age, couple distress, depression/anxiety, harsh punishment, adverse childhood experiences, young maternal age, and poverty. Parents were more likely to use selective prevention programs in cases of child abuse and exposure to IPV. CONCLUSION: Child abuse is mainly associated with proximal risk factors and neglect with distal factors. Exposure to IPV violence is associated with child abuse as well as with an accumulation of adversities. The association between service use and child maltreatment is discussed.

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.

Differential Response and Children Re-Reported to Child Protective Services: County Data From the National Child Abuse and Neglect Data System (NCANDS).

Child protection systems that implement differential response (DR) systems screen to route referrals to an investigation response (IR) or alternative response (AR). AR responses emphasize family engagement, assessment of family needs, and service linkage. Usually, AR state-level policy does not require child welfare staff to make a maltreatment determination. Jurisdictions implement DR systems differently, leading to variations in the proportion of AR cases, risk levels of cases served, and the ways families access and use services. County data from the National Child Abuse and Neglect Data System were analyzed for six states from 2004 to 2013 that implemented DR. Variation in county-level AR rates were associated with county-level re-report rates using regression models with risk adjustments for socioeconomic and other county characteristics. Counties had 3% fewer re-reports overall for each percentage increase in AR use; higher levels of AR use are related to lower levels of re-reporting. When county AR and IR cases were analyzed separately, increasing rates of AR were associated with lower re-report rates for IR cases, but higher re-report rates for AR cases. Findings for the AR and IR subgroup must be interpreted with caution as a number of technical factors may be driving these results.

Longitudinal analysis of repeated child abuse reporting and victimization: multistate analysis of associated factors.

Most child subjects of maltreatment reports to child protective services (CPS) are involved just once, whereas other children experience repeated investigations and victimizations. This study examines individual, maltreatment, and service-related factors associated with maltreatment rereporting and substantiated rereporting in a multistate context. Case-level National Child Abuse and Neglect Data System data (505,621 children) were analyzed. Within 24 months, 22% of children were rereported, and 7% were rereported with substantiation. Younger and White and mixed race children, those with disabilities, and those whose caregivers abused alcohol were more likely to be rereported and rereported and substantiated. Service provision, including foster care placement, was associated with increased likelihood of subsequent events. When CPS agency performance is assessed using measures of reentry, separate measures may be necessary for children who receive services, so that improvements in safety can be appropriately recognized. Reentry into CPS is a complex interaction of risks to children and systemic factors tied to the intervention they receive.

The potential use of social media and other internet-related data and communications for child maltreatment surveillance and epidemiological research: Scoping review and recommendations.

Collecting child maltreatment data is a complicated undertaking for many reasons. As a result, there is an interest by child maltreatment researchers to develop methodologies that allow for the triangulation of data sources. To better understand how social media and internet-based technologies could contribute to these approaches, we conducted a scoping review to provide an overview of social media and internet-based methodologies for health research, to report results of evaluation and validation research on these methods, and to highlight studies with potential relevance to child maltreatment research and surveillance. Many approaches were identified in the broad health literature; however, there has been limited application of these approaches to child maltreatment. The most common use was recruiting participants or engaging existing participants using online methods. From the broad health literature, social media and internet-based approaches to surveillance and epidemiologic research appear promising. Many of the approaches are relatively low cost and easy to implement without extensive infrastructure, but there are also a range of limitations for each method. Several methods have a mixed record of validation and sources of error in estimation are not yet understood or predictable. In addition to the problems relevant to other health outcomes, child maltreatment researchers face additional challenges, including the complex ethical issues associated with both internet-based and child maltreatment research. If these issues are adequately addressed, social media and internet-based technologies may be a promising approach to reducing some of the limitations in existing child maltreatment data.