What Does Child Protective Services Investigate as Neglect? A Population-Based Study.

Most child protective services (CPS) investigations involve allegations of neglect. Broad and vague definitions have led to concerns that CPS-investigated neglect is driven by poverty-based material hardship. In a representative sample of 295 neglect investigations in California in 2017, structured data and narrative text fields were used to characterize the types of neglect and concurrent parental risk factors investigated by CPS and to assess the rate and nature of investigated physical neglect, defined as inadequate food, housing, or hygiene. The most common types of neglect were inadequate supervision (44%) and failure to protect (29%), followed by physical neglect (14%). Common risk factors identified in neglect investigations were parental substance use (41%), domestic violence (21%), mental illness (18%), and co-reported physical or sexual abuse (29%). Nearly all investigations of physical neglect (99%) included concerns related to substance use, domestic violence, mental illness, co-reported abuse or an additional neglect allegation (i.e., abandonment). Given concerns identified in neglect investigations, economic supports are likely insufficient without an array of behavioral-health supports.

Caseworker documentation of mothers in foster care: A case study in California.

BACKGROUND: Young people in foster care frequently experience early parenting, and U.S. law requires the documentation of parents in care. The extent to which the child protection system (CPS) has accurately collected information on parents in care remains largely unknown and has ramifications for the planning and delivery of services. OBJECTIVE: Using California as a case study, this study documented young mothers in care using birth records, determined the proportion of mothers correctly identified in CPS records, and compared characteristics and placements of mothers who were or were not identified. POPULATION: All mothers aged 15-21 years documented by vital birth records (2014 and 2019) were probabilistically linked to CPS records, yielding 3199 mothers in care. METHOD: We compared mothers who were or were not identified in CPS records using bivariate statistics. A chi-square test for trends examined differences in documentation over time. RESULTS: A third of mothers were not identified as such in CPS records (n = 1136). The proportion of mothers identified by caseworkers rose from 50 % in 2014 to 71.5 % in 2019 (p < .001). Nonminor dependent mothers and those placed in supervised independent living programs were more likely to be misclassified in CPS data. CONCLUSIONS: Motherhood may not be documented in CPS records; however, significant improvements were evident. Results suggest that all nonminor dependents should be informed of available services for expectant and parenting individuals, especially if they are living in less restrictive placements, given they are more likely to give birth and less likely to be identified in CPS records than minor dependents.

The Measurement of Intimate Partner Violence Using International Classification of Diseases Diagnostic Codes: A Systematic Review.

Intimate partner violence (IPV) is challenging to measure yet systematic surveillance of IPV is critical to informing public health prevention and response efforts. Administrative medical data provide opportunities for such surveillance, and often use the International Classification of Diseases (ICD). The primary purpose of this systematic review was to document which ICD codes have been used in empirical literature to identify IPV, understand the justification used to select specific codes to develop IPV case definitions, and identify the data sources and types of research questions addressed by the existing literature. We searched 11 databases and of the initial 2182 results, 21 empirical studies from 2000 to 2020 met the study inclusion criteria including using ICD codes to measure IPV. The majority of these studies (90.5%) used either national samples of data or population-based administrative data from emergency departments (52.4%) or inpatient hospitalizations (38.1%). We found wide variation of ICD diagnostic codes to measure IPV and categorized the sets of codes used based on the number of codes. The most commonly used ICD-9 codes were E967.3, 995.81, 995.80, 995.85 and the most common ICD-10 codes were T74.1 and Z63.0. Few studies validated the ICD codes used to measure IPV. Most included studies (81.0%) answered epidemiological research questions. The current study provides suggestions for future research, including justifying the selection of ICD codes and providing a range of estimates based on narrow and broad sets of codes. Implications for policy and practice, including enhanced training for healthcare professionals in documenting IPV, are discussed.

A Population-Level Examination of Incarcerated Women and Mothers Before and After the California Public Safety Realignment Act.

BACKGROUND: In 2011, California enacted its public safety realignment initiative (realignment) motivated by a U.S. Supreme Court ruling to reduce state prison overcrowding and in effort to reduce recidivism. Realignment transferred authority for lower-level felony offenders from the state to the counties, leading to a rapid reduction in state prison incarceration levels. OBJECTIVE: This study drew on a unique dataset to assess the effects of California's efforts to downsize the prison system on maternal incarceration levels and to better understand the characteristics of incarcerated mothers and their children. METHODS: Incarceration records concerning all women in California state prisons between 2010 and 2012 (N = 16,917) were linked to 7.5 million vital birth records dating to 1999 to identify incarcerated women who had given birth. Multinomial logistic regression models were specified to better understand offense type differences among incarcerated mothers versus nonmothers. RESULTS: Findings indicate that realignment disproportionately affected women. The number of men entering prison decreased 67.8% between 2010 and 2012. In comparison, the number of women entering prison decreased 78.5%. Further, more than half of incarcerated women had given birth. Mothers were more likely than nonmothers to be convicted of nonviolent crimes. DISCUSSION: This study underscores how prison downsizing can disproportionately reduce incarceration levels for women. Given that such large proportion of incarcerated women were mothers, this policy change may have potential spillover next-generation benefits. Finally, this work reinforces the potential to use linked administrative records to study incarcerated populations.

Dual system youth and their pathways in Los Angeles County: A replication of the OJJDP Dual System Youth Study.

BACKGROUND: The estimated number of youth who come into contact with both the child welfare and juvenile justice systems, or "dual system" youth, varies widely because studies use different methodologies. Recent work using linked administrative data shows promise for identifying a stable range of dual system rates, generalizable to other jurisdictions and useful for understanding the nature and timing of system involvement. OBJECTIVE: This study replicates the U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention (OJJDP) Dual System Youth Design Study methodology to explore dual system overlap and six distinct dual system pathways defined by the type (i.e., nonconcurrent or concurrent) and timing (i.e., first contact with child welfare or juvenile justice) of dual system contact in Los Angeles County. PARTICIPANTS AND SETTING: Using data from the Los Angeles Probation Department, a cohort of youth born in/after 1998 with a first juvenile justice petition between 2014 and 2016 was identified (N = 6877) and matched to statewide child welfare records between 1998 and 2017. METHOD: Descriptive statistics were produced for dual system youth and pathways, and differences across groups were tested using chi-square and t-tests. RESULTS: Two-thirds of youth with a first juvenile justice petition interacted with the child welfare system. The majority of dual system youth did not have contact with both systems at the same time and nearly all dual system youth were involved with the child welfare system before the juvenile justice system. Female and Black youth were more likely to be dual system youth and to have more extensive involvement with the child welfare system. Probation experiences and outcomes were associated with the nature and chronicity of child welfare involvement. CONCLUSION: Implementing a delinquency prevention continuum that starts with community-based supports and continues throughout all levels of child welfare and juvenile justice involvement is essential to disrupting dual system involvement.

Co-Reporting of Child Maltreatment and Intimate Partner Violence: The Likelihood of Substantiations and Foster Care Placements.

Intimate partner violence (IPV) negatively affects children. Although IPV-related reports frequently come to the attention of child protective services (CPS), there is neither a unified standard for how CPS systems should respond, nor sufficient research documenting that reaction. The current study used population-based administrative records from California to assess how CPS responds to reported allegations of IPV, with and without physical abuse and/or neglect allegations. We used multinomial regression to model the likelihood of investigation outcomes. Results indicate that 20.7% of CPS reports had IPV alleged during hotline screening, and of those, just 3.2% were screened out compared to 20.2% for reports where IPV was not alleged. Almost half (45.5%) of IPV-alleged reports came from law enforcement, in contrast to 15.2% of reports that did not allege IPV. IPV-alleged reports were more likely to have allegations substantiated without a case opened for services, but less likely to result in foster care placements. Several statistically significant differences were identified by the type of alleged maltreatment co-reported with IPV. This study contributes to an understanding of how CPS responds to IPV-alleged reports.

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.

Early Childbirth Among Foster Youth: A Latent Class Analysis to Determine Subgroups at Increased Risk.

CONTEXT: Research has documented elevated rates of early childbirth among adolescents who have spent time in foster care, and a better understanding is needed of the characteristics of vulnerable individuals and the circumstances of their time in care. METHODS: California birth records for 1999-2010 were probabilistically linked to state child welfare service records spanning the same date range to identify females aged 12-19 who had spent time in foster care and had had a first birth before age 20. Latent class analysis was used to identify subgroups based on age at most recent entry into care, length of this stay and three indicators of placement instability. The probability of a first birth being related to class membership was assessed as a distal outcome, and differences across classes were assessed using chi-square tests. RESULTS: Four distinct classes of foster youth were identified: Later Entry/High Instability (20% of individuals), Later Entry/Low Instability (43%), Earlier Entry/High Instability (12%) and Earlier Entry/Low Instability (25%). The probability of a first childbirth ranged from 31% (class 1) to 15% (class 4); classes 2 and 3 experienced moderate risk (23% and 24%, respectively). Two groups were further characterized by high rates of reentry into care, with 56% of class 1 and 41% of class 3 individuals experiencing more than one episode in care. CONCLUSIONS: Identifiable subgroups of female foster youth are at heightened risk of early childbirth and may benefit from early intervention, enhanced support and access to reliable, ongoing sexual and reproductive health care.

A Descriptive Analysis of the Child Protection Histories of Youth and Young Adults Arrested in California.

In this study, we use population-based linked administrative data to document the full child protective service (CPS) histories of arrested youth and young adults. We extracted records for all individuals aged 24 and under who were arrested in California in 2014 and 2015. These records were probabilistically linked to statewide CPS records dating back to 1998. Overall, 43.4% of those arrested had a history of CPS involvement. Among individuals with uncensored CPS records (born in 1998 or later), 60.2% had past CPS involvement. Findings indicate that youth and young adults booked for a felony offense were more likely to have a history of CPS involvement than those booked for misdemeanors. A multinomial model served to confirm bivariate findings. This study provides further evidence that community concerns of childhood maltreatment were common among criminal justice-involved young adults.

An examination of child protective service involvement among children born to mothers in foster care.

OBJECTIVE: This study identified children born to mothers in foster care and documented Child Protective Service (CPS) involvement among children. METHODS: Probabilistically linked birth and CPS records from California (2009-2012) were used to identify all mothers in foster care on or after conception. Children were followed prospectively using linked records to identify CPS involvement occurring during the first three years of life. Differences between reported and unreported children were examined using χ2 tests. The Latent Class Analysis (LCA) identified classes of children born to mothers in care who were at increased risk of CPS involvement. Model fit was assessed using the Bayesian Information Criterion, entropy, and likelihood ratio tests. For each of the classes, the relationship to the distal outcome (i.e., a maltreatment report by age three), was examined. RESULTS: Findings indicate that 53% of children born to mothers in care were reported. The proportion of children reported to CPS for maltreatment declined over time, from 63% of children born to mothers in foster care in 2009, to 46% in 2012. The LCA documented three distinct classes of mother-child dyads with varying risk of report. More than one third of children in Class 1 and nearly 70% of children in Class 3 were reported. CONCLUSIONS: This study was the first to develop multi-dimensional class profiles of two-generation CPS involvement among mother-child dyads. This study documents that mothers' experiences in care and mental health conditions vary widely, underscoring the importance of providing services that fit the needs of dyads.

Data on children reentering foster care from kinship guardianship.

This article describes a dataset containing information on children exiting to kinship guardianship in California between 2003 and 2010 (N = 18,831). Children and young people in the sample were followed for up to fourteen years. The data presented here show summary statistics of the sample included in the analysis. Furthermore, the data consist of life tables showing counts of children at risk of reentry, counts of children who reentered the foster care system as well as nonparametric estimates of the survival function and the cumulative hazard function for the period 2003-2017.

Age and other risk factors related to reentry to care from kin guardian homes.

Although kinship guardianship is an increasingly important foster care exit pathway for children in the United States, research on the factors leading to kinship guardianship breakdown is lacking. This study examines the factors associated with guardianship breakdown for children who exited foster care to kinship guardianship in California between 2003 and 2010 (N = 18,831). Specifying time-dependent Cox relative risk models, children's age trajectories are directly accounted for in the analysis. This allows differentiation between duration dependence (i.e., time spent in guardianship) and children's development (expressed as age). Overall, 17.3% of children reentered care by 2017. Early adolescents, age 13-15 years (HR = 1.63, p < .001), and late adolescents, age 16-17 years (HR = 1.93, p < .001), had an increased hazard of reentry compared with children under the age of six. Children with a history of mental health concerns had more than twice the hazard of reentering than children without such a history (HR = 2.18, p < .001). Our findings indicate that transition to adolescence was associated with increased risk of reentry into care, highlighting the need for guardianship support services leading up to, and during, this child developmental stage.

Exit Outcomes for Probation-Supervised Youth in Foster Care: An Examination of Past Child Protection Involvement.

Research on youth in foster care has focused on those placed for reasons of maltreatment rather than delinquency, yet most states provide foster care services to youth under probation supervision. This analysis generated knowledge about youth in probation-supervised foster care (PSFC) in California by examining the relationship between past child protective services (CPS) involvement and exit type. CPS records were extracted to identify 17-year-old youths in PSFC between 2008 and 2012 ( N = 11,188). The relationship between allegations of maltreatment and exit type was assessed using regression models. Of the PSFC youth, 64.6% had previous allegations of maltreatment and a quarter had been reported at least 6 times. Youth with a history of placement in CPS foster care were more likely to age out relative to achieving permanency in comparison to PSFC youth with no maltreatment history (relative risk ratio = 2.20; 95% confidence interval [1.90, 2.55]). As the number of reports increased, the likelihood of exiting care by aging out increased relative to achieving permanency ( p < .001). The findings suggest a majority of PSFC youth had maltreatment histories, the overlap between CPS and probation was constant, and maltreatment records may characterize youth in PSFC at risk of negative exits from care.

Maternal Mental Health Disorders and Reports to Child Protective Services: A Birth Cohort Study.

Background. Existing literature has documented a strong relationship between parental mental illness and child maltreatment, but little is known about the prevalence of mental illness among childbearing women. In the present study, linked administrative records were used to identify the prevalence of maternal mental health (MH) disorders documented at birth and determine the associated likelihood of maltreatment reports during infancy. Materials and Methods. Vital records for California's 2006 birth cohort were linked to hospital discharge and Child Protective Services (CPS) records. The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) billing codes from the mother's delivery hospitalization were used to determine diagnosed maternal MH disorders for 551,232 infants born in 2006, and reports of alleged maltreatment were documented from CPS records. Vital birth records were used to control for sociodemographic factors. Finally, the associated risk of reported maltreatment during the first year of life was examined using generalized linear models. Results. Among infants in this statewide birth cohort, 2.8% were born to a mother with a documented MH disorder, of which 41.3% had documented maternal substance abuse issues versus less than 0.5% of infants born to mothers without a diagnosed MH disorder. Further, 34.6% of infants born to mothers with a MH disorder were reported to CPS within one year, and a majority of those reports were made within the first month of life (77.2%). In contrast, among children born to mothers without a MH disorder, 4.4% were reported to CPS during infancy. After controlling for sociodemographic factors, the rate of CPS reports during infancy for infants born to mothers with a MH disorder but no substance use disorder was 2.6 times that of infants born to mothers without a MH disorder (95% CI = 2.47, 2.73). Among infants born to mothers with MH and substance use disorders, the rate of CPS reports during infancy was 5.69 times that of infants born to mothers without a MH disorder (95% CI = 5.51, 5.87). Conclusions. Administrative records provide a method for identifying infants born to mothers with MH disorders, enabling researchers to track rates over time and generate population-level data to inform policy development and improve service delivery.

Risk of re-report: A latent class analysis of infants reported for maltreatment.

A key challenge facing child protective services (CPS) is identifying children who are at greatest risk of future maltreatment. This analysis examined a cohort of children with a first report to CPS during infancy, a vulnerable population at high risk of future CPS reports. Birth records of all infants born in California in 2006 were linked to CPS records; 23,871 infants remaining in the home following an initial report were followed for 5 years to determine if another maltreatment report occurred. Latent class analysis (LCA) was used to identify subpopulations of infants based on varying risks of re-report. LCA model fit was examined using the Bayesian information criterion, a likelihood ratio test, and entropy. Statistical indicators and interpretability suggested the four-class model best fit the data. A second LCA included infant re-report as a distal outcome to examine the association between class membership and the likelihood of re-report. In Class 1 and Class 2 (lowest risk), the probability of a re-report was 44%; in contrast, the probability in Class 4 (highest risk) was 78%. Two birth characteristics clustered in the medium- and highest-risk classes: lack of established paternity and delayed or absent prenatal care. Two risk factors from the initial report of maltreatment emerged as predictors of re-report in the highest-risk class: an initial allegation of neglect and a family history of CPS involvement involving older siblings. Findings suggest that statistical techniques can be used to identify families with a heightened risk of experiencing later CPS contact.

Extended Foster Care for Transition-Age Youth: An Opportunity for Pregnancy Prevention and Parenting Support.

PURPOSE: This analysis examined California county birth rate variations among girls in foster care. The objective was to generate data to assess potential intervention points tied to federal legislation extending foster care beyond age 18 years. METHODS: Child protection records for all adolescent girls in foster care at age 17 years between 2003 and 2007 (N = 20,222) were linked to vital birth records through 2011. The cumulative percentage of girls who had given birth by age 21 years was calculated by county and race/ethnicity. RESULTS: One in three (35.2%) adolescent girls in foster care had given birth at least once before age 21 years. Although significant birth rate variations emerged, even at the low end of the county range, more than one in four girls had given birth by age 21 years. CONCLUSIONS: Child welfare systems are now charged with coordinating transitional services for foster youth beyond age 18 years. Extended foster care provides new opportunities for pregnancy prevention work and targeted parenting support.

Risk of re-reporting among infants who remain at home following alleged maltreatment.

Maltreatment that begins during infancy is likely to be chronic in duration and developmentally consequential if the appropriate intervention is not delivered. Repeated reports of maltreatment may signal unmet service needs. This study prospectively followed infants who remained at home following an initial report of maltreatment to determine the rate of re-reporting within 5 years. Birth records for all children born in California in 2006 were linked to statewide child protection records through 2012; 5.2% (n = 29,135) of children were reported for abuse or neglect prior to age 1. Following an initial report, 81.9% of infants remained in the home, the majority (60.7%) of whom were re-reported within 5 years. The highest rate of re-reporting was observed among infants whose initial allegation was substantiated and who had a case opened for family maintenance services (69.1%). Infants whose initial allegation was not investigated had re-reporting rates that were equal to or higher than other infants remaining in the home without services. Findings highlight that most families with infants reported for maltreatment are not formally served through the child protection system. High rates of re-reporting underscore the challenge of delivering services that remedy conditions necessitating child protection follow-up and call attention to the importance of accessing data from community service providers.