Child protective services involvement and exclusionary school discipline.

The study examined the impact of child protective services (CPS) contact on out-of-school suspensions for 49,918 Wisconsin students (followed from ages 5-6 to 14-15; [school years 2010-2019; 74% White; 7% Black; 11% Hispanic; 8% other; 49% female]). A quasi-experimental design comparing recent CPS contact to upcoming (future) CPS contact shows that both recent CPS contact without foster care and future CPS contact predict higher odds of suspension compared with no contact. Higher odds of suspension emerged prior to CPS contact and did not substantially increase during or after CPS contact, suggesting that system-induced stress is not a primary driver of behavioral problems leading to suspension. Foster care reduced the odds of suspension among White children and children in special education.

Developmental pathways from child maltreatment to adolescent pregnancy: A multiple mediational model.

Adolescent pregnancy (AP) is a significant public health issue. Child maltreatment (CM) represents an established risk factor, yet little is known about the explanatory mechanisms linking the phenomena. Informed by developmental theory, this study prospectively tested seven multi-level, indirect pathways that could plausibly explain the relationship between CM and AP: (1) substance use (polysubstance use and frequency); (2) sexual risk behavior; (3) depressive symptoms; (4) posttraumatic stress disorder symptoms; (5) cognitive dysregulation; (6) pregnancy desire and difficulty expectancies; and (7) age at menarche. Data came from a prospective, longitudinal cohort study of 469 ethnically diverse, nulliparous adolescent females, designed to examine the impact of substantiated CM on reproductive outcomes such as pregnancy and childbirth (265 maltreated and 204 demographically matched comparison adolescents). A multiple-mediator structural equation model was conducted to simultaneously test multiple indirect effects while accounting for confounding variables. Maltreatment had an indirect effect on pregnancy via substance use and higher pregnancy desire/lower perceived difficulty. Findings represent a step towards elucidating pathways linking CM with AP. Recommendations are offered to prevent pregnancy by addressing the pregnancy-specific mechanisms that are part of the maltreatment sequelae.

Foster Care, Kinship Care, and the Transition to Adulthood: Do Child Welfare System Processes Explain Differences in Outcomes?

Despite longstanding policy preferences favoring kinship care placements over non-relative family foster care placements, research findings on the benefits of kinship care vary by measurement, assessed outcome, follow-up period, and other study design elements. We examined early adulthood outcomes-incarceration and teen parenthood-among WI youth who entered foster care in early-to-middle childhood (ages 5-10). Results suggest that initial placement in kin or nonrelative kinship care was not significantly related to imprisonment or teenage parenthood directly; however, first placement in kinship care is associated with fewer moves, longer duration in care, and a higher probability of a new maltreatment investigation, which in turn is related to long-term outcomes. Further, a new maltreatment investigation was an important mediator and was significantly associated with a higher probability of incarceration and teenage parenthood. This study provides mechanisms on the ways in which first placement setting influences incarceration and teenage parenthood. Findings provide important policy and practice implications on how children's experiences in foster care, based on their initial placement type, can lead to maladaptive outcomes.

State Contexts and Foster Care Adoption Rates.

Prior research has examined associations between state adoption policies and assisted reproductive technology insurance coverage and foster care adoption rates, but knowledge of the relationships between state policies and contexts and foster care adoption is still limited. In this study, we test adoption subsidy policy, alternative means of family formation, and the demographic characteristics of potential adoptive parents and children as predictors of foster care adoption rates at the state-year level using data from the Adoption and Foster Care Analysis and Reporting System and other sources for 2005 to 2016. We use between-within models to obtain random effects estimates between states and fixed effects estimates within states. We find that states with higher average adoption subsidies have lower foster care adoption rates. Foster parent rates, international adoption rates, and mandated in vitro fertilization insurance coverage are positively associated with foster care adoption. States with higher median household incomes and more same-sex couples have higher foster care adoption rates, but states with more women of childbearing age have lower rates of older child adoption. These findings suggest some ways states may seek to increase adoptions from foster care.

Prevalence and Risk Factors for Early Motherhood Among Low-Income, Maltreated, and Foster Youth.

Early childbearing is associated with a host of educational and economic disruptions for teenage girls and increased risk of adverse outcomes for their children. Low-income, maltreated, and foster youth have a higher risk of teen motherhood than the general population of youth. In this study, we assessed differences in the risk of early motherhood among these groups and investigated whether differences likely reflect selection factors versus effects of involvement with Child Protective Services (CPS) or foster care. Using a statewide linked administrative data system for Wisconsin, we employed survival analysis to estimate the hazard of early birth (child conceived prior to age 18) among females. We found that both the youth involved in CPS and youth in foster care were at significantly higher risk of early motherhood than low-income youth, and these differences were not explained by a range of sociodemographic and family composition characteristics. Moreover, our findings indicate that CPS and foster care are unlikely to be causal agents in the risk of early motherhood: among foster youth, risk was lower during foster care compared with before; among CPS-involved girls, risk was the same or lower after CPS investigation compared with before. Subsequent analysis showed that after girls exited foster care, those who were reunified with their birth families were at higher risk than those placed in adoption or guardianship. Overall, our findings suggest that whereas CPS and foster youth are high-risk populations for early motherhood, CPS involvement and foster care placement do not exacerbate, and may instead reduce, risk.

Is Sexual Abuse a Unique Predictor of Sexual Risk Behaviors, Pregnancy, and Motherhood in Adolescence?

This study tested sexual abuse as a unique predictor of subsequent adolescent sexual behaviors, pregnancy, and motherhood when in company with other types of maltreatment (physical abuse, neglect) and alternative behavioral, family, and contextual risk factors in a prospective, longitudinal study of maltreated (n = 275) and comparison (n = 239) nulliparous females aged 14-19 years old assessed annually through 19 years old. Hierarchical regression was used to disentangle risk factors that account for the associations of maltreatment type on risky sexual behaviors at 19 years old, adolescent pregnancy, and adolescent motherhood. Findings indicate that sexual and physical abuse remain significant predictors of risky sexual behaviors, and that sexual abuse remains a significant predictor of adolescent motherhood when alternative explanatory variables are controlled.

Parenting Influences on Adolescent Sexual Risk-taking: Differences by Child Welfare Placement Status.

Positive parenting behaviors and parent-child relationships reduce sexual risk-taking among youth, but these associations may differ for adolescents in the child welfare system. Using two cohorts of a national longitudinal dataset of youth, the authors employed linear probability modeling to investigate associations of caregiver-child closeness, monitoring, and dating communication with youth's sexual initiation, sexual partners, and unprotected intercourse over the subsequent 12 months. Moderation by placement status (non-relative foster care, kinship care, or birth parent care) was then tested. Closeness was negatively associated with risk-taking. Monitoring was positively associated with new sexual partners among youth in birth parent care, but negatively associated with new partners for youth in out-of-home care. Dating communication was positively associated with sexual initiation and additional sexual partners, and with unsafe sex among non-relative foster youth. In sum, caregiver relationships and parenting behaviors may matter differently for maltreated and foster youths' sexual risk-taking.

A Short-Term Evaluation of a Hospital No Hit Zone Policy to Increase Bystander Intervention in Cases of Parent-to-Child Violence.

This study used a pre/post design to evaluate the implementation of a hospital-wide No Hit Zone (NHZ) bystander intervention around parent-to-child hitting. A total of 2,326 staff completed the pre-NHZ survey and received training about the NHZ policy; 623 staff completed the post-test survey 10 months later. A group of 225 parents participated in the pre-NHZ survey and a second group of 180 participated in the post-NHZ survey, also 10 months later. Compared to staff in the pre-NHZ group, staff in the post-NHZ group had more negative attitudes about spanking and more positive attitudes about intervention when parents hit children in the hospital. Few differences were found among the parent pre- and post-groups. This study demonstrated that NHZs are a feasible way to inform and train hospital staff in ways to intervene during incidents of parent-to-child hitting to promote a safe and healthy medical environment.

Child maltreatment and children's developmental trajectories in early to middle childhood.

Associations between experiencing child maltreatment and adverse developmental outcomes are widely studied, yet conclusions regarding the extent to which effects are bidirectional, and whether they are likely causal, remain elusive. This study uses the Fragile Families and Child Wellbeing Study, a birth cohort of 4,898 children followed from birth through age 9. Hierarchical linear modeling and structural equation modeling are employed to estimate associations of maltreatment with cognitive and social-emotional well-being. Results suggest that effects of early childhood maltreatment emerge immediately, though developmental outcomes are also affected by newly occurring maltreatment over time. Additionally, findings indicate that children's early developmental scores predict their subsequent probability of experiencing maltreatment, though to a lesser extent than early maltreatment predicts subsequent developmental outcomes.

Kinship and nonrelative foster care: the effect of placement type on child well-being.

This study uses a national sample of 1,215 children, ages 6-17, who spent some time in formal kinship or nonrelative foster care to identify the effect of placement type on academic achievement, behavior, and health. Several identification strategies are used to reduce selection bias, including ordinary least squares, change score models, propensity score weighting, and instrumental variables regression. The results consistently estimate a negative effect of kin placements on reading scores, but kin placements appear to have no effect on child health, and findings on children's math and cognitive skills test scores and behavioral problems are mixed. Estimated declines in both academic achievement and behavioral problems are concentrated among children who are lower functioning at baseline.

Perceptions of juvenile sexual abuse victims: a meta-analysis on vignette-based studies on the effects of victims' age and respondents' gender.

This study synthesizes results of vignette-based studies on lay perceptions of juvenile sexual victimization. A systematic literature review was conducted to identify factors affecting perceptions of juvenile sexual abuse victims. Then meta-analytic techniques were utilized to calculate average effects of victim age and respondent gender on perceived victim credibility and culpability. The average effects of victim age and respondent gender were modest. Results from moderation tests suggest that some of the variation in effect size estimates across studies can be explained by vignette and sample characteristics. Findings suggest that prior research may be misstating the effects of victim age and respondent gender by failing to account for vignette content.

A Meta-Regression of Racial Disparities in Wellbeing Outcomes During and After Foster Care.

Children in foster care face heightened risk of adverse psychosocial and economic outcomes compared with children in the general population. Yet, the effects of foster care as an intervention are heterogeneous. Heterogeneity outcomes by race and ethnicity are of particular interest, given that Black and Indigenous youth experience foster care at higher rates than other racial/ethnic groups and experience group differences in setting, duration, and exits to permanency. This meta-regression explores racial disparities in education, employment, mental health, and behavioral outcomes during and following foster care. A systematic search of PsycINFO, ERIC, and Academic Search Complete using a series of search terms for studies published between January 2000 and June 2021 found 70 articles and 392 effect sizes that provided outcomes of US-based foster care by race/ethnicity. Findings reveal that Black foster care impacted persons (FCIPs) have 20% lower odds (95% CI: .68-.93) of achieving employment or substantial financial earnings and have 18% lower odds (95% CI: .68-1.00) of mental health concerns compared to White FCIPs. Hispanic FCIPs have 10% lower odds (95% CI: .84-.97) of achieving stable housing compared to non-Hispanic FCIPs. Moderator analyses revealed certain study features (i.e. publication type, timing of the study, location of the study, and placement status of the participants) have a significant impact on the gap between Black and non-Black and Hispanic and non-Hispanic FCIPs. The findings provide important implications for racial disparities in foster care outcomes, as well as highlight important gaps and missing information from published studies.

Iron status, development, and behavior in young children in the Pennsylvania foster care system.

BACKGROUND: Children in foster care are classified as a highly vulnerable population and struggle with both physical and mental health problems. Medical conditions, like poor nutritional status, remain understudied in children in foster care. To our knowledge, few studies in children in U.S. foster care have quantified the prevalence of anemia, and no studies have examined the association between anemia status and relevant developmental and behavioral outcomes. OBJECTIVE/AIMS: (1) To determine the prevalence of anemia among children in or adopted from Pennsylvania foster care, between the ages of six months to ten years and (2) To examine if a child's anemia status is associated with greater odds of relevant developmental and behavioral diagnoses. METHODS: We conducted a secondary data analysis utilizing the Medicaid Analytic eXtract database between 2010-2015. Children six months-ten years were included in the analysis if they were in or had been adopted from Pennsylvania foster care. Logistic regression was used to calculate adjusted odds ratios (AOR) with 95% confidence intervals for the association between iron status and health outcomes. RESULTS: A total of 50,311 children were included in our sample, of which 1,365 children (2.7%) were diagnosed with anemia. Children diagnosed with anemia had greater odds of delayed milestones (AOR: 2.38 [1.64-3.45]), specific delays in development (AOR: 1.59 [1.23-2.07]), adjustment disorder (AOR: 1.59 [1.06-2.39]), and irritability (AOR: 10.57 [3.36-33.25]), than children not diagnosed with anemia. CONCLUSION: The prevalence of anemia among children between six months-ten years in or adopted from the Pennsylvania foster care system is within the national rate of U.S. childhood anemia. Odds of several relevant developmental and behavioral diagnoses were greater among children diagnosed with anemia than children who were not.

Provider Attitudes and Self-Efficacy When Delivering a Child Sexual Abuse Prevention Module: An Exploratory Study.

BACKGROUND: As constant figures in children's lives, parents are key in protecting children from sexual abuse. One barrier to reaching parents is that the topic can be difficult to broach and is sensitive in nature. Such barriers can interfere with implementation and fidelity of evidence-based prevention strategies that are focused on reducing rates of childhood sexual abuse (CSA). AIMS: In this exploratory study, we examine provider attitudes about delivering CSA-specific content in an evidence-based prevention module and their self-efficacy. METHOD: Thirty-three providers participated in three surveys: prior to a skills-oriented training on how to deliver the CSA prevention module (pretraining), immediately posttraining, and 6 months posttraining. Changes in self-reported willingness to deliver content, beliefs about parents' role in CSA prevention, and confidence about their ability to deliver content were assessed over time. Open-ended questions were coded thematically to reinforce quantitative findings. RESULTS: Prior to training, providers were worried that parents would respond negatively to CSA content and were concerned about their comfort level discussing victimization and sexual development. Findings suggest that skill-oriented training and provision scripts effectively supported providers and improved confidence in delivering CSA prevention content. DISCUSSION: Provider self-efficacy is an important element of implementation fidelity. This exploratory study demonstrated that, though providers may approach CSA content with wariness and trepidation, adequate skills-oriented training can reduce negative attitudes and increase perceived efficacy in the actual delivery of CSA content that persists through implementation. CONCLUSION: Skills-based training can significantly enhance fidelity in the delivery of difficult content included in parent-focused preventative interventions.

Racial/Ethnic Differences in Child Protective Services Reporting, Substantiation and Placement, With Comparison to Non-CPS Risks and Outcomes: 2005-2019.

We used National Child Abuse and Neglect Data System and Census data to examine Black-White and Hispanic-White disparities in reporting, substantiation, and out-of-home placement both descriptively from 2005-2019 and in multivariate models from 2007-2017. We also tracked contemporaneous social risk (e.g., child poverty) and child harm (e.g., infant mortality) disparities using non-child protective services (CPS) sources and compared them to CPS reporting rate disparities. Black-White CPS reporting disparities were lower than found in non-CPS risk and harm benchmarks. Consistent with the Hispanic paradox, Hispanic-White CPS reporting disparities were lower than risk disparities but similar to harm disparities. Descriptive and multivariate analyses of data from the past several years indicated that Black children were less likely to be substantiated or placed into out-of-home care following a report than White children. Hispanic children were slightly more likely to be substantiated or placed in out-of-home care than White children overall, but this difference disappeared in multivariate models. Available data provide no evidence that Black children were overreported relative to observed risks and harms reflected in non-CPS data. Reducing reporting rates among Black children will require addressing broader conditions associated with maltreatment.

Examining Racial Disproportionality in Child Protective Services Case Decisions.

Using a national sample of 1,461 child protective services (CPS) investigations in the United States, we examine differences between black and white families with regard to caseworker ratings of risk and harm to the child, as well as the probability that a case is substantiated for maltreatment. We employ difference-in-difference methods to identify whether gaps in outcomes for black and white families are equivalent when black and white CPS workers conduct the investigation, and Blinder-Oaxaca decomposition methods to identify the portion of the black-white difference in outcomes that is attributable to differences in case characteristics (risk factors) versus differences in associations between these characteristics and the outcomes by race (differential treatment). We find no differences in outcomes by child race after adjusting for case characteristics. At the same time, we find that relative to white caseworkers, black caseworkers are more likely to rate black children at subjectively higher risk of harm than white children and are also more likely to substantiate black families for maltreatment. The decomposition results suggest that-even after accounting for caseworker race-differences in outcomes for black and white children are primarily explained by differences in family and case circumstances rather than differential treatment. Thus, our analyses suggest that interventions addressing maltreatment-related risk factors that disproportionately affect black families may have greater utility for reducing racial disparities in CPS involvement than current emphases on cultural competence training.

The Centrality of Child Maltreatment to Criminology.

Despite sufficient evidence to conclude that maltreatment exposure affects the risk of crime and delinquency, we conclude that the unique effects of child maltreatment on crime and delinquency, and the mechanisms through which those effects operate, remain poorly identified. Key challenges include insufficient attention to the overlap of child maltreatment with various forms of family dysfunction and adversity and a lack of comprehensive measurement of the multiple, often comorbid, forms of child maltreatment. We then consider potential impacts of the child welfare system on the maltreatment-crime link. Because the child welfare system typically provides voluntary, short-term services of unknown quality, it likely neither increases nor reduces risks of delinquency and crime for most children who encounter it. For the comparatively small subset of children experiencing foster care, impacts on delinquency and crime likely vary by the quality of environments within and after their time in care - issues that, to date, have received too little attention.

Rates and predictors of child maltreatment re-perpetration against new victims and prior victims.

BACKGROUND: Limited prior research has examined the rates or predictors of re-perpetration of child maltreatment. Yet, perpetrators may have multiple victims, and perpetrators, rather than their victims, are often the primary focus of child welfare services. OBJECTIVE: We examine rates of child maltreatment re-perpetration of repeat and new victims, and test perpetrator demographics and maltreatment index incident case characteristics as predictors of re-perpetration. PARTICIPANTS AND SETTING: We use a sample of 285,245 first-time perpetrators of a substantiated maltreatment incident in 2010 from the National Child Abuse and Neglect Data System. METHODS: We use linear probability models with full information maximum likelihood to test new victim and same victim perpetration by the end of FY 2018. RESULTS: Fifteen percent of perpetrators re-maltreated one or more of their original victims ("same victim re-perpetration"); 12% maltreated a new victim. Overall, re-perpetration was more common among younger, female, and White perpetrators. Perpetrators who were the biological or adoptive parent of their initial victim(s) had higher rates of same victim re-perpetration; new victim re-perpetration was more common among perpetrators who initially victimized an adoptive or stepchild. Same victim re-perpetration was less common among perpetrators of physical abuse than other types of maltreatment, and new victim re-perpetration was more common among perpetrators of sexual abuse and neglect than physical abuse. CONCLUSIONS: Child welfare agencies should track re-perpetration in addition to revictimization as part of agency evaluations and risk assessments.

Sibling Separation and Placement Instability for Children in Foster Care.

U.S. foster care policy prioritizes keeping siblings together while in foster care. However, prior research on the effects of sibling placement is limited in sample, measures, and research design. In this study, we use data on 2,297 children from an urban county in years 2015-2019 and assess how sibling separation is associated with placement instability. We use multilevel parametric hazard modeling with adjustments for child, sibling, and placement characteristics. Findings indicate that children placed with at least one sibling are less likely to experience a placement move and are specifically less likely to experience a non-progress move (e.g., moves due to problems or negative experiences in their foster home). For larger sibling groups, sibling separation was not consistently associated with placement instability and there was little difference in placement instability for children placed with some versus all siblings. Results were robust to differences in measurement and model specification. Black or Hispanic race/ethnicity was also associated with increased risk of instability, and associations between sibling separation and instability were stronger for Black children, implying enhanced efforts to maintain sibling groups may be especially beneficial for Black children. Overall, findings provide support for the continuation and expansion of policies promoting sibling placement.