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.

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.

Infant birth weight and maltreatment of adolescent mothers.

BACKGROUND: Emerging literature suggests that maternal exposure to stress and adversity throughout the life course may have health consequences for offspring. PURPOSE: To examine the maltreatment history of adolescent mothers as an independent predictor of infant birth weight. METHODS: Birth records for all infants born between 2007 and 2009 to mothers aged 12-19 years were extracted from California's vital statistics files. Maternal information from the birth record was linked to child protection data (1999-2009) to identify young mothers with substantiated maltreatment. Generalized linear models run in 2012 were used to estimate the relationship between maternal maltreatment and infant birth weight, after adjusting for maternal sociodemographic risk factors and health behaviors. RESULTS: Among the 153,762 singleton infants born to adolescent mothers, 7.1% (n=10,886) weighed <2500 g at birth. Of all adolescent mothers, 13.6% had been substantiated as victims of maltreatment after age 10 years and before giving birth. After adjusting for known factors predictive of negative birth outcomes, maltreatment history was associated with a slight yet significantly increased risk of low birth weight among infants (risk ratio=1.06, 95% CI=1.01, 1.12). CONCLUSIONS: Findings from this study suggest that maltreatment history of adolescent mothers is associated with infant low birth weight (<2500 g). Although the increased risk was small and the mechanism unclear, these data indicate that maternal maltreatment not only may have consequences for the victim but also may contribute to intergenerational health disparities.

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.

A field experiment in capitated payment systems and recovery management: the women's recovery association pilot study.

Against the backdrop of shifting perspectives regarding substance abuse policy, upcoming changes to the health care system, and progress toward parity for mental health and substance abuse treatment, an exploratory pilot study is being conducted in San Mateo County, California, to assess the potential of a capitated case rate combined with a recovery management approach in a community-based substance abuse treatment program for women. The rationale for developing the approach, planning, and implementation of the pilot project, the struggle of the agency to transform from episodic treatment to a chronic care model, and a case study that highlights organizational changes are discussed. Lessons learned and implications for the second year of the pilot project are also discussed.