Rates of Emotional Disturbance Among Children in Foster Care: Comparing Federal Child Welfare Data and Medicaid Records in Two States.

The purpose of this study is to estimate the rate of emotional disturbance (ED) among children in foster care and assess the validity of the national foster care census data (AFCARS) measure of ED. This study used linked child protection and Medicaid records from 2014 and 2015, for the states of California and Wisconsin, as well as data from AFCARS, a federal population census of children in foster care which states are mandated to contribute to. ED is defined by AFCARS and includes an array of mental and behavioral health diagnoses. According to AFCARS, 13% of CA children in foster care and 15% of WI children in foster care had an ED, whereas Medicaid claims produce rates of 45% and 48%, respectively. Rates of ED among children in congregate care were underestimated by 43-46 percentage points, with substantial proportions having diagnoses of disruptive behavioral disorders. Despite the AFCARS ED measure being cited in congressional testimonies and its wide use in research, results from this study suggest that the AFCARS ED estimates are an unreliable metric for use in research, policy, or practice.

General cognitive ability assessment in the German National Cohort (NAKO) - The block-adaptive number series task.

Objectives. Evaluate the block-adaptive number series task of reasoning, as a time-efficient proxy of general cognitive ability in the Level-2 sample of the German National Cohort (NAKO), a population-based mega cohort.Methods. The number series task consisted of two blocks of three items each, administered as part of the touchscreen-based assessment. Based on performance on the first three items, a second block of appropriate difficulty was automatically administered. Scoring of performance was based on the Rasch model. Relations of performance scores to age, sex, education, study centre, language proficiency, and scores on other cognitive tasks were examined.Results. Except for one very difficult item, the data of the remaining 14 items showed sufficient fit to the Rasch model (Infit: 0.89-1.04; Outfit: 0.80-1.08). The resulting performance scores (N = 21,056) had a distribution that was truncated at very high levels of ability. The reliability of the performance estimates was satisfactory. Relations to age, sex, education, and the executive function factor of the other cognitive tasks in the NAKO supported the validity.Conclusions. The number series task provides a valid proxy of general cognitive ability for the Level-2 sample of the NAKO, based on a highly time-efficient assessment procedure.

A Population-Based Study of Mental Health Diagnoses and Child Protection System Involvement Among Medicaid-Insured Children.

OBJECTIVE: To determine the population prevalence of diagnosed mental health disorders among Medicaid-insured children <18 years old in California based on levels of current and past child protection system (CPS) involvement. STUDY DESIGN: In this retrospective, population-based study, we examined the full population of children enrolled in California's Medicaid program for at least 1 month between 2014 and 2015 and who had at least 1 claim during that period (n = 3 352 886). Records for Medicaid-insured children were probabilistically linked to statewide CPS records of maltreatment and foster care placements since 1998. A primary or secondary mental health diagnosis was classified using International Classification of Diseases codes. RESULTS: Overall, 14% (n = 470 513) of all children insured through Medicaid in 2014-2015 had a documented mental health diagnosis. Among children with a diagnosis, the percentage with CPS involvement (ie, any report for maltreatment) was nearly twice that of the Medicaid population overall (50.4% vs 26.9%). This finding held across all diagnostic groups but with notable variations in magnitude. A graded relationship emerged between the level of CPS involvement and the likelihood of a mental health diagnosis. Diagnoses among children reported for maltreatment were common, regardless of placement in foster care. CONCLUSIONS: Findings document high rates of both mental health diagnoses and past child protection involvement in a population of Medicaid-insured children. Most children reported for maltreatment will never be placed in foster care, underscoring the importance of ensuring that the children who remain at home receive the proper array and coordination of services.

Community disadvantage, family socioeconomic status, and racial/ethnic differences in maltreatment reporting risk during infancy.

BACKGROUND: Children are reported for maltreatment during infancy at elevated rates; research has established persistent racial/ethnic differences in the likelihood of reporting to the child protection system (CPS). OBJECTIVE: To model the influence of race/ethnicity and community disadvantage in CPS reporting during infancy. PARTICIPANTS/SETTING: A population-based dataset consisting of more than 1.2 million children born in California between 2012 and 2014. Vital birth records were probabilistically linked to administrative CPS records. American Community Survey data were used to measure community disadvantage. METHODS: For each child, we coded sociodemographic information from the birth record, assigned the child to a community using their residential address at birth, and captured maltreatment reports from child protection records. We employed a modified Poisson regression model to examine an infant's likelihood of being reported to CPS by race/ethnicity across levels of community disadvantage and after adjusting for individual-level covariates. RESULTS: Infants born in neighborhoods with the most concentrated disadvantage were reported to CPS at 7 times the rate of children born in the most advantaged neighborhoods (12.3% vs. 1.8%). After adjusting for individual-level covariates, we found that both Black and Hispanic infants born on public insurance were significantly less likely than White infants to be reported for maltreatment overall - and Black and Hispanic infants had a statistically equivalent or lower likelihood of reporting at the two extremes of neighborhood disadvantage. Among privately insured families, Hispanic infants continued to have a lower likelihood of reporting, but Black infants were reported at higher rates than White infants. This Black-White difference persisted in the most advantaged neighborhoods, but disappeared in the most disadvantaged neighborhoods. CONCLUSIONS: Capturing individual-level differences in socioeconomic status and associated risk factors is critical to understanding sources of racial/ethnic differences in CPS reporting, including when there is unwarranted variation or disparate treatment. Our findings suggest an elevated likelihood of maltreatment reporting among privately insured Black infants not explained by differences in observed risk or neighborhood, but no such differences were documented for Black or Hispanic infants on public insurance.

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.

The Children's Data Network: Harnessing the scientific potential of linked administrative data to inform children's programs and policies.

The Children's Data Network (CDN) is a data and research collaborative focused on the linkage and analysis of administrative records. In partnership with public agencies, philanthropic funders, affiliated researchers, and community stakeholders, we seek to generate knowledge and advance evidence-rich policies that improve the health, safety, and well-being of the children of California. Given our experience negotiating access to and working with existing administrative data (and importantly, data stewards), the CDN has demonstrated its ability to perform cost-effective and rigorous record linkage, answer time-sensitive policy- and program-related questions, and build the public sector's capacity to do the same. Owing to steadfast and generous infrastructure and project support, close collaboration with public partners, and strategic analyses and engagements, the CDN has promoted a person-level and longitudinal understanding of children and families in California and in so doing, informed policy and program development nationwide. We sincerely hope that our experience-and lessons learned-can advance and inform work in other fields and jurisdictions.

Blunted cortisol stress reactivity in low-income children relates to lower memory function.

Lower socioeconomic status (SES) environments are marked by higher stress that is hypothesized to alter cortisol secretion in children, thereby damaging hippocampal volume and memory performance. However, empirical evidence demonstrating these putative links is lacking. We assessed the diurnal cortisol awakening response (CAR) on two mornings and cortisol stress reactivity (CSR) with the Trier Social Stress Test for Children in 102 healthy, socio-demographically diverse 6-to-7-year-old children (46% female). Children performed a hippocampal-dependent item-location associative memory task and 60 of these children underwent structural MRI scanning for hippocampal volume. Cortisol values were modeled with latent-change structural equation models to represent overall levels and change. We found lower income is associated with a flatter CAR, blunted reactivity and recovery to acute stress, and smaller hippocampal volume. Furthermore, hyporeactivity in CSR was related to lower memory among lower-income children, whereas there was no reliable association of CSR and memory among higher-income children (an income x cortisol interaction). We found no evidence that smaller hippocampal volume in lower income was associated with poorer memory performance. Notably, hyporeactivity in both CAR and CSR was specific to using income as the SES predictor. The income x cortisol interaction and smaller hippocampal effects, however, were replicated with education and an SES composite score. This suggests that hyporeactivity to acute stress may function as a mediator in SES-cognition associations at the lower end of the SES spectrum, but it does not imply environmental- or genetically-mediated causation.

A birth cohort study of Asian and Pacific Islander children reported for abuse or neglect by maternal nativity and ethnic origin.

Research identifying racial and ethnic disparities in child protective services (CPS) involvement in the U.S. has focused on the overrepresentation of Black children and the growing Latino child population. Little attention has been paid to children of Asian origin, the most underrepresented group of children in the U.S. CPS system. The objective of this analysis was to examine subgroup patterns of CPS involvement in California for Asian and Pacific Islander (API) children prospectively based on maternal nativity and ethnic origin. We extracted data for API children born in California in 2006 and 2007 (N=138,858) from population-based birth records and linked those records to CPS records spanning the first 5 years of life (through 2012). We assessed distributional differences in risk indicators for the full birth cohort of API children and calculated a summary risk variable representing the cumulative number of risks present at birth. Generalized linear models were used to estimate API children's adjusted relative risk of CPS report by subgroup. Overall, 12.2% of children born in California in the 2006-2007 birth cohort were API. The majority of API children had foreign-born mothers (80.9%). Children of U.S.-born Hawaiian, Guamanian, or Samoan mothers had the highest rate, with 20.4% being reported to CPS by their 5th birthday. The lowest rates of child abuse and neglect reporting were observed among children of foreign-born Asian Indian (2.5%), Korean (2.7%), and Chinese (2.8%) mothers, compared to 5.4% of all Asian and Pacific Islander children, and 14.8% of children in general population. Findings underscore the presence of disparities in CPS involvement among API children, which has implications for health and well-being across the life course and for targeted maltreatment prevention strategies.

Paper-Based Assessment of the Effects of Aging on Response Time: A Diffusion Model Analysis.

The effects of aging on response time were examined in a paper-based lexical-decision experiment with younger (age 18-36) and older (age 64-75) adults, applying Ratcliff's diffusion model. Using digital pens allowed the paper-based assessment of response times for single items. Age differences previously reported by Ratcliff and colleagues in computer-based experiments were partly replicated: older adults responded more conservatively than younger adults and showed a slowing of their nondecision components of RT by 53 ms. The rates of evidence accumulation (drift rate) showed no age-related differences. Participants with a higher score in a vocabulary test also had higher drift rates. The experiment demonstrates the possibility to use formal processing models with paper-based tests.

How representative is the ACTIVE sample? A statistical comparison of the ACTIVE sample and the HRS sample.

OBJECTIVE: This research is designed to examine demographic differences between the ACTIVE sample and the larger, nationally representative Health and Retirement Study (HRS) sample. METHOD: After describing some relevant demographics (age, education, sex, and race/ethnicity), we use three statistical methods to determine sample differences--logistic regression modeling (LRM), decision tree analysis (DTA), and post-stratification and raking methods. When some differences are found, we create sample weights that other researchers can use to adjust these differences. RESULTS: The ACTIVE sample is younger, more likely to be female, Black, and more highly educated than the HRS sample. Sample weights were created. DISCUSSION: By using the resulting sample weights, all results of ACTIVE analyses can be said to be nationally representative based on HRS demographics.