Associations Between State TANF Policies, Child Protective Services Involvement, And Foster Care Placement.

The Temporary Assistance for Needy Families (TANF) program, which was established in 1996 and renewed in 2005, constituted a major reform of the US welfare system. Since its renewal, few studies have examined its effects on children. We used instrumental variables, two-way fixed effects, and event studies to examine the associations between state-level TANF policies, Child Protective Services involvement, and foster care placement during the period 2004-16. We found that each additional TANF policy that restricted access to benefits was associated with a 13 percent reduction in TANF caseloads. Using TANF policies as an instrument, we found that increases in TANF caseloads were associated with significant reductions in numbers of neglect victims and foster care placements. In two-way fixed effects models, restrictions on TANF access were associated with more than forty-four additional neglect victims per 100,000 child population and between nineteen and twenty-two additional children per 100,000 placed in foster care. Our findings suggest that additional research using data that capture the nuances of maltreatment should be used to investigate the relationships among TANF policies, child maltreatment, and foster care placement.

Social Determinants of Health and Child Maltreatment Prevention: The Family Success Network Pilot.

Child maltreatment is a highly prevalent public health concern that contributes to morbidity and mortality in childhood and short- and long-term health consequences that persist into adulthood. Past research suggests that social determinants of health such as socioeconomic status and intergenerational trauma are highly correlated with child maltreatment. With support from the U.S. Children's Bureau, the Ohio Children's Trust Fund is currently piloting the Family Success Network, a primary child maltreatment prevention strategy in Northeast Ohio that seeks to address these social determinants through pillars of service that include family coaching, financial assistance, financial education, parenting education, and basic life skills training. This study highlights the initial development phase of a pilot study. Plans for in-depth process and outcome evaluations are discussed. The project seeks to improve family functioning and reduce child protective services involvement and foster care entry in an economically disadvantaged region.

Association Between State Supplemental Nutrition Assistance Program Policies, Child Protective Services Involvement, and Foster Care in the US, 2004-2016.

Importance: Public assistance policies may play a role in preventing child maltreatment by improving household resources among families of low incomes. The Supplemental Nutrition Assistance Program (SNAP) is one of the largest public assistance programs in the US. However, the association of state SNAP policy options to Child Protective Services (CPS) outcomes has not been rigorously examined. Objective: To model the association of state SNAP policies with changes in CPS and foster care outcomes in the US over time. Design, Setting, and Participants: This cohort study used panel data to examine the association between SNAP policy options and study outcomes from 2004 to 2016 for 50 US states and the District of Columbia in 2-way fixed-effects regression models. The count of SNAP policies was used as an instrument for SNAP caseloads in instrumental variables models. Data analysis was conducted in November 2021. Exposures: The adoption of 1 or more state SNAP income generosity policies that improves or stabilizes household resources for SNAP participants. Main Outcomes and Measures: Reports of child maltreatment accepted for CPS investigation, children in substantiated reports, and children receiving foster care services for all forms of maltreatment, and specifically for child neglect per 100 000 child population. Results: The mean (SD) number of SNAP income generosity policies increased from 1.47 (0.95) in 2004 to 2.37 (0.94) in 2010, to 2.49 (0.86) in 2016 across states; the median increased from 1 to 3 (range, 0-4) over the same period. A count of state income generosity policies was associated with large reductions in reports accepted for CPS investigation (-352.6 per 100 000 children; 95% CI, -557.1 to -148.2). Income generosity policy was associated with -94.8 (95% CI, -155.6 to -34.0) fewer substantiated reports and -77.0 (95% CI, -125.4 to -28.6) fewer reports substantiated for neglect per 100 000. Each additional income generosity policy adopted by a state was associated with -45.1 (95% CI, -71.6 to -18.5) to -42.3 (95% CI, -64.8 to -19.8) fewer total foster care placements per 100 000 children. Conclusions and Relevance: State SNAP policies that improve and stabilize household resources appear to be associated with reductions in CPS involvement and use of foster care. The number of policies implemented had cumulative outcomes beyond individual policy outcomes.

Dating Violence, Protection Orders, and Gender Inequality: A Cross-state Analysis of Policy Formulation and Implementation.

Teen dating violence (TDV) is a public health crisis that organizations and individuals in several fields are working to prevent and address. State lawmakers are a group with substantial power to address TDV and intimate partner violence (IPV) through policies including Civil Protection Order (CPO) statutes. Understanding the factors that influence how state legislators craft TDV and IPV policies and how those policies are implemented can lead to policy processes that better serve survivors. Past research suggests the level of gender inequality in a state may be an important influence on TDV policies. This study used a case study approach to compare the processes of adding individuals in dating relationships to CPO statutes in a subset of states (n = 3) with high, middle, and low levels of gender inequality. Results did not suggest that gender inequality was related to variation between states but rather that it was a larger factor that creates the need for TDV policies at all. Relationships between the state IPV coalitions and lawmakers and the historical moment that laws were considered emerged as important factors in interstate variation. Future research can build on these results by further exploring the role of gender inequality in policy processes with additional states or policies and by examining the factors identified here in greater depth. Implications for practice are also discussed.

Novel Service Delivery Approach to Address Reproductive Health Disparities within Immigrant Latino Communities in Geographic Hot Spots: An Implementation Study.

Latinx youths continue to have the highest rates of teenage births in the United States and are at increased risk of acquiring sexually transmitted infections, including HIV/AIDS. A community-based research partnership piloted Families Talking Together, a brief, parent-based sexual risk reduction program using a novel and culturally relevant approach. This mixed-methods study examined the feasibility and acceptability of Spanish-speaking promotoras de salud (that is, community health workers) as implementers of an evidence-based intervention (EBI) to reach underserved immigrant communities. Findings suggest that promotoras are capable of implementing the EBI with positive organizational, client, and implementation outcomes. Furthermore, promotoras hold particular promise for addressing reproductive health disparities as they are indigenous and trusted members of the community who can reach members of marginalized Latino populations.

Parent, Teacher, and School Stakeholder Perspectives on Adolescent Pregnancy Prevention Programming for Latino Youth.

Teen pregnancy remains a public health concern particularly among Latinos, whose pregnancy rate of 83.5 per 1000 girls constitutes one of the highest rates of teen pregnancy among all ethnic and racial groups in the United States. To enhance the effectiveness of interventions for diverse Latino populations in the US, it is crucial to assess the community's understanding of the etiology of the problem of adolescent pregnancy and to implement programs that reflect the local community's beliefs and preferences. We present findings from six focus groups held with parents (n = 18), teachers (n = 23) and school stakeholders (n = 8) regarding teen pregnancy prevention among Latino youth at a high school located in a large, Midwestern city. Two investigators analyzed data iteratively using a template organizing approach. A consensus emerged across the groups regarding content that emphasized respect for oneself and one's family, a focus on personal and shared responsibility in reproductive health behavior, information about the "realities" or consequences associated with engaging in sexual activity, and information about contraceptives. The strong request from participants to include a parental education component reflects the community's belief that parents play a crucial, protective role in the socialization and development of adolescent sexual behavior, a view that is supported by empirical research. Findings highlight the importance of involving local school communities in identifying adolescent pregnancy prevention strategies that are responsive to the community's cultural values, beliefs, and preferences, as well as the school's capacity and teacher preferences.

A study in contrasts: Supports and barriers to successful implementation of two evidence-based parenting interventions in child welfare.

Although evidence-based interventions (EBIs) are spreading to child welfare, research on real-world dynamics of implementation within this setting is scarce. Using a six-factor implementation framework to examine implementation of two evidence-based parenting interventions, we sought to build greater understanding of key facilitators and barriers by comparing successful versus failed EBI implementation in a child welfare setting. Semi-structured interviews were conducted with a purposive sample of 15 frontline practitioners and state-level managers. Interviews were transcribed verbatim and data analysis used a modified analytic approach. Our results showed the successful EBI was viewed more positively on all six factors; however, implementation was multidimensional, multilevel, and mixed with accomplishments and challenges. An accumulation of strengths across implementation factors proved beneficial. Implementation frameworks may be advantageous in organizing and explaining the numerous factors that may influence successful versus failed implementation. While encountering obstacles is largely inevitable, understanding which factors have shaped the success or failure of EBI implementations in child welfare settings may optimize future implementations in this context.

Geographic variation in racial disparities in child maltreatment: The influence of county poverty and population density.

There are documented disparities in the rates at which black children come into contact with the child welfare system in the United States compared to white children. A great deal of research has proliferated aimed at understanding whether systematic biases or differential rates of risk among different groups drive these disparities (Drake et al., 2011). In the current study, county rates of maltreatment disparity are compared across the United States and examined in relation to rates of poverty disparity as well as population density. Specifically, using hierarchical linear modeling with a spatially lagged dependent variable, the current study examined data from the National Child Abuse and Neglect Data System (NCANDS) and found that poverty disparities were associated with rates of maltreatment disparities, and densely populated metropolitan counties tended to have the greatest levels of maltreatment disparity for both black and Hispanic children. A significant curvilinear relationship was also observed between these variables, such that in addition to the most densely populated counties, the most sparsely populated counties also tended to have higher rates of maltreatment disparity for black and Hispanic children.

Disparities in reported and substantiated infant maltreatment by maternal Hispanic origin and nativity: a birth cohort study.

We followed Latino infants prospectively through age 1 to determine whether maternal foreign-born status conferred a protective advantage against reported and substantiated maltreatment across Hispanic-origin groups, and whether the likelihood an infant was reported or substantiated for maltreatment varied by Hispanic origin. We drew data for all Latino infants born in California between 2000 and 2006 (N = 1,909,155) from population-based birth records linked to child protective services data. We used χ(2) tests to assess distributional differences in covariates and utilized generalized linear models to estimate the adjusted relative risk of report and substantiation in models stratified by nativity. We observed significant health advantages in reported and substantiated maltreatment for infants of foreign-born mothers within every Hispanic-origin group. Risks of report and substantiation among infants of Mexican and Central/South American mothers were consistently lower than Puerto Rican and Cuban mothers despite socioeconomic disadvantage. The presence of disparities among Hispanic-origin groups in child maltreatment report and substantiation during infancy has implications for the health of Latinos across the life course. Further research is warranted to unravel the complex processes underlying observed relationships.

Bias in child maltreatment self-reports using interactive voice response (IVR).

Few methods estimate the prevalence of child maltreatment in the general population due to concerns about socially desirable responding and mandated reporting laws. Innovative methods, such as interactive voice response (IVR), may obtain better estimates that address these concerns. This study examined the utility of interactive voice response (IVR) for child maltreatment behaviors by assessing differences between respondents who completed and did not complete a survey using IVR technology. A mixed-mode telephone survey was conducted in English and Spanish in 50 cities in California during 2009. Caregivers (n=3,023) self-reported abusive and neglectful parenting behaviors for a focal child under the age of 13 using computer-assisted telephone interviewing and IVR. We used hierarchical generalized linear models to compare survey completion by caregivers nested within cities for the full sample and age-specific ranges. For demographic characteristics, caregivers born in the United States were more likely to complete the survey when controlling for covariates. Parenting stress, provision of physical needs, and provision of supervisory needs were not associated with survey completion in the full multivariate model. For caregivers of children 0-4 years (n=838), those reporting they could often or always hear their child from another room had a higher likelihood of survey completion. The findings suggest IVR could prove to be useful for future surveys that aim to estimate abusive and/or neglectful parenting behaviors given the limited bias observed for demographic characteristics and problematic parenting behaviors. Further research should expand upon its utility to advance estimation rates.

Does a paradox exist in child well-being risks among foreign-born Latinos, U.S.-born Latinos, and Whites? Findings from 50 California cities.

Past research has identified "paradoxes" in infant health and child welfare services involvement, whereby children of Latinos and immigrants often demonstrate better health and decreased risk for child protective services involvement when compared to whites of similar socioeconomic position. This population-based study examined whether a paradox exists among immigrant and U.S.-born Latino caregivers in the prevalence and magnitude of risks to child well-being when compared to whites of similar socioeconomic position. Data were drawn from a random, general population telephone survey of parenting practices in 50 California cities (n=2,259), which was administered in English and Spanish. The sample included 1,625 U.S.-born whites (72.0%), 351 U.S.-born Latinos (15.5%) and 283 foreign-born Latino respondents (12.5%). After adjusting for covariates in logistic regression models stratified by household income, immigrant caregivers in lower income households reported odds of insufficient food for the child that were 12 times as large as those for whites (OR 11.97, 95% CI 2.87, 49.86); odds of reported inability to take the child to the doctor and leaving a child in a place of questionable safety were nearly eight times as large (OR 7.92, 95% CI 2.38, 26.36 and OR 7.93, 95% CI 1.73, 36.46 respectively). These relationships were attenuated or insignificant for immigrant caregivers in households with greater resources. Therefore, a paradoxical relationship between socioeconomic position and risks to child well-being was not identified. Further research is needed to better understand the complex relationships between such risks, child health, and child protective services involvement.

Racial and ethnic disparities: a population-based examination of risk factors for involvement with child protective services.

OBJECTIVE: Data from the United States indicate pronounced and persistent racial/ethnic differences in the rates at which children are referred and substantiated as victims of child abuse and neglect. In this study, we examined the extent to which aggregate racial differences are attributable to variations in the distribution of individual and family-level risk factors. METHODS: This study was based on the full population of children born in California in 2002. Birth records were linked to child protective service (CPS) records to identify all children referred for maltreatment by age 5. Generalized linear models were used to compute crude and adjusted racial/ethnic differences in children's risk of referral, substantiation, and entry to foster care. RESULTS: As expected, stark differences between Black and White children emerged in the rates of contact with CPS. Black children were more than twice as likely as White children to be referred for maltreatment, substantiated as victims, and enter foster care before age 5. Yet, there were also significant differences across racial/ethnic groups in the distribution of socioeconomic and health factors strongly correlated with child maltreatment and CPS involvement. After adjusting for these differences, low socioeconomic Black children had a lower risk of referral, substantiation, and entry to foster care than their socioeconomically similar White counterparts. Among Latinos, before adjusting for other factors, children of U.S.-born mothers were significantly more likely than White children to experience system contact, while children of foreign-born mothers were less likely to be involved with CPS. After adjusting for socioeconomic and health indicators, the relative risk of referral, substantiation, and foster care entry was significantly lower for Latino children (regardless of maternal nativity) compared to White children. CONCLUSIONS: Race and ethnicity is a marker for a complex interaction of economic, social, political, and environmental factors that influence the health of individuals and communities. This analysis indicates that adjusting for child and family-level risk factors is necessary to distinguish race-specific effects (which may reflect system, worker, or resource biases) from socioeconomic and health indicators associated with maltreatment risk. Identifying the independent effects of these factors is critical to developing effective strategies for reducing racial disparities.