Left behind? Educational disadvantage, child protection, and foster care.

BACKGROUND: Current educational policies for children involved with the Child Protective Services (CPS) system focus largely on the minority of children currently in or aging out of foster care, and target school stability and college access. OBJECTIVE: The present study investigates the nature of secondary (high school) education performance and attainment and post-secondary (college) enrollment among youth with prior or current CPS contact and their low-income, but not CPS-contacted, peers. METHOD: Following a cohort of over 63,000 high school students in Wisconsin, we use CPS investigation and placement records, and public school records to evaluate associations between CPS involvement and educational attainment. RESULTS: CPS-contacted youth have lower educational performance and greater academic challenges than their low-income peers. Youth aging out of care are uniquely disadvantaged with regard to on-time high school completion but complete high school and enroll in college at equal or higher rates than reunified youth. Across all groups, 55-75 % of those who graduated on time with "basic" or above English and math skills enrolled in college. Foster care experiences, such as time in care and placement instability, were not consistently associated with educational outcomes. CONCLUSION: Efforts to improve secondary education experiences are needed to bolster college and career pathways for disadvantaged youth.

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.

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.

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.

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.

A Longitudinal Analysis of Concerning Psychotropic Medication Regimens Among Adolescents in Foster Care.

PURPOSE: To provide a population-based examination of psychotropic medication use before and after entry into foster care (FC), with special attention on the use of concerning medication regimens: polypharmacy, stimulants, and antipsychotics. METHODS: Using linked administrative Medicaid and child protective service data from Wisconsin, we follow a cohort of early adolescents ages 10-13 years who entered FC between June 2009 and December 2016 (N = 2,998). Descriptive statistics and Kaplan Meyer survival curves illustrate the timing of medication. Cox proportional hazard models identify hazard of outcomes (new medication, polypharmacy, antipsychotic, and stimulant medication) during FC. Separate models were run for adolescents with and without a psychotropic medication claim in the six months before FC. RESULTS: Overall 34% of the cohort entered with a pre-existing psychotropic medication, accounting for 69% of adolescents with any psychotropic medication claim during FC. Similarly, the majority of adolescents with polypharmacy, antipsychotics or stimulants during FC entered with those prescriptions. Among youth with pre-entry medication, rates of polypharmacy (56%), antipsychotic (50%) and stimulants (64%) were high. Among adolescents who entered FC with no prior medication, placement disruptions (30 days before or after) predicted new medication. DISCUSSION: Although a great deal of attention - and policies - have focused on youth in care, there is high reliance on psychotropic medications within the broader population of maltreated adolescents, indicating a need for timely and accurate re-assessment of current and past medications upon entry. Adolescents should also be actively involved in their own health care.

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.

Prevalence of Mental Health Diagnoses Among Early Adolescents Before and During Foster Care.

OBJECTIVE: This study aimed to characterize the rates and types of diagnosed mental health (MH) disorders among children and adolescents before and during foster care (FC) overall and by race and ethnicity. METHODS: We used population-based linked administrative data of medical assistance (public insurance) claims records and child protective services data from a cohort of early adolescents who entered FC at 10 to 14 years old. MH diagnoses were coded according to the International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification (ICD-9 and ICD-10) and included adjustment disorders, disruptive disorders, attention-deficit/hyperactivity disorder (ADHD), anxiety disorders, mood disorders, attachment disorders, autism, and other disorders. RESULTS: Before FC entry, 41% of children and adolescents had at least 1 MH diagnosis. Attention-deficit/hyperactivity disorder (25%), mood disorders (18%), and disruptive disorders (15%) were the most common pre-entry diagnoses. Among early adolescents entering FC with no previous diagnosis, 52% were later diagnosed with adjustment disorder (accounting for 73% of all youth with a new diagnosis during FC). White early adolescents had higher rates of diagnosed MH disorders before FC, whereas racial/ethnic minority early adolescents were more likely to receive a MH diagnosis during FC. Black early adolescents were more likely than White and Hispanic early adolescents to be diagnosed with disruptive disorders and less likely to be diagnosed with anxiety or adjustment disorders during FC. CONCLUSION: Results highlight the high rates of MH needs among early adolescents before entry into FC, whether detected before or during FC. Results also illustrate disparities in pre-entry MH care between racial/ethnic minority and White early adolescents, with minority youth less likely to be receiving services before entry.

Lifetime rates and types of subsequent child protection system contact following a first report of neglect: An age-stratified analysis.

An estimated 1 in 3 U.S. children will be the subject of a child protective services (CPS) investigation during their lifetime, typically for allegations of neglect. Whether and how an initial report of neglect is addressed may place children on divergent trajectories for safety and stability throughout childhood. The purpose of this study is to track subsequent CPS contact among children born in California in 2000 who were first investigated by CPS for neglect allegations alone (no co-occurring abuse) and not permanently separated from their families of origin (i.e., not removed or reunified if removed). We estimated the rates of subsequent CPS referrals, substantiated maltreatment, placement in foster care, and allegations of physical and sexual abuse by age 18. We assessed how rates of subsequent contact varied by initial CPS response and age at first investigation. Supplemental analyses disaggregated data by race and ethnicity. Results indicate that 64% of children initially investigated for neglect alone were re-referred to CPS by age 18 and 16% experienced a subsequent removal; however, these estimates varied greatly by age. Four out of five (79% to 83%) of children initially investigated as infants had one or more subsequent CPS referrals during childhood. Children were not only re-referred for allegations of neglect; more than half of children re-referred were reported for allegations of physical or sexual abuse, indicating that abuse risk was either missed during the initial CPS investigation or escalated afterward. The failure to address maltreatment risks when children first present to the system is a complex problem with no easy solution. Our findings document that a majority of children initially referred for neglect experience future CPS involvement, often for allegations of physical or sexual abuse.

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.

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.

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.

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.

State support policies and children's living arrangements.

BACKGROUND: Many children in the United States live apart from their parents, in either formal or informal foster care, due to concerns about child abuse and neglect. Prior research has established a connection between poverty and child maltreatment, but many aspects of state support to families remain unexamined in relation to child living arrangements. OBJECTIVE: We test welfare access, welfare generosity, work supports, and family supports indicators as predictors of foster care removal rates and nonparental care rates. PARTICIPANTS AND SETTING: We use a population of 51 states, including the District of Columbia, for years 2008 to 2018, totaling 561 state-years. METHODS: We utilize negative binomial regression models with state and year fixed effects. RESULTS: We find that one-dollar higher minimum wages are negatively associated with both foster care removal rates (IRR = 0.947, p < 0.001) and nonparental care rates (IRR = 0.975, p < 0.01), but that other state policies are not consistently beneficial. CONCLUSIONS: Our results have implications for policies to assist families and reduce child maltreatment.

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.

Child Protection Intervention and the Sexual and Reproductive Health of Female Adolescents Ages 13 to 17 Years.

Importance: Child maltreatment adversely affects health and development, but evidence is needed regarding whether and how Child Protective Services (CPS) interventions may mitigate risks. Objective: To assess whether different forms of CPS intervention are associated with sexual and reproductive health outcomes among female adolescents investigated by CPS for suspected exposure to maltreatment during childhood. Design, Setting, and Participants: This cohort study used linked, longitudinal, statewide administrative data from Wisconsin, including medical assistance and CPS records, to examine the rates and correlates of sexual and reproductive health outcomes (sexual transmitted infections, pregnancies, births, and high-risk sexual behavior) among 9392 female adolescents tracked from age 13 through 17 years who were investigated by CPS for suspected exposure to maltreatment prior to their 13th birthday. The study assesses how these outcomes were associated with types and frequency of CPS involvement and intervention and with adolescent and family demographic characteristics. Participants were female adolescents born from 2000 through 2002 who were investigated by Wisconsin CPS for suspected exposure to maltreatment before 13 years of age and who were covered by medical assistance at least 85% of the time from 13 to 17 years of age. Exposures: Varying levels and intensities of CPS interventions, ranging from a single investigation to adoption from foster care. Main Outcomes and Measures: Dependent variables were pregnancy, birth, sexually transmitted infection, and an aggregate measure of sexual health concerns from 13 to 17 years of age. Primary explanatory variables were the intensity of CPS intervention (investigation only, in-home services, and foster care) and frequency of maltreatment concerns (number of investigations, continued involvement during adolescence). Logistic regression was used to assess the association of CPS measures with differences in sexual health outcomes. Data were analyzed from March 1 to October 12, 2021. Results: This cohort study included 9392 female adolescents, among whom 3156 (33.6%) were born in 2000, 3064 (32.6%) in 2001, and 3173 (33.8%) in 2002; 2501 adolescents [26.6%] were Black, 1568 [16.7%] were Hispanic, 1024 [10.9%] were multiracial, 4024 [42.8%] were White, and 275 [2.9%] were listed as other [which included American Indian, Asian or Pacific Islander, or unknown race or ethnicity]). By 18 years of age, sizable proportions of maltreated female adolescents had at least 1 concerning sexual health outcome (23.5%), including diagnoses of gonorrhea, chlamydia, or trichomoniasis (8.4%), pregnancy (11.2%), and parenthood (6.1%). Compared with CPS investigation without formal intervention, foster care was associated with lower odds of pregnancy (adjusted odds ratio, 0.82; 95% C, 0.69-0.98) and live birth (adjusted odds ratio, 0.78; 95% CI, 0.61-0.99). Recurrent and ongoing CPS involvement was associated with adverse sexual health outcomes. Conclusions and Relevance: This cohort study found that maltreated girls face increased risks of adverse sexual health outcomes in adolescence, but CPS interventions were associated with limited influence. More effective interventions are needed to help maltreated girls avoid teen pregnancy, sexually transmitted infections, and risky sexual behaviors in adolescence.

Parent-Focused Sexual Abuse Prevention: Results From a Cluster Randomized Trial.

This study tested whether a child sexual abuse (CSA) prevention program, Smart Parents-Safe and Healthy Kids (SPSHK), could be implemented as an additional module in evidence-based parent training and whether the added module might detract from the efficacy of the original program. In a cluster randomized trial, six community-based organizations were randomized to deliver Parents as Teachers (PAT) with SPSHK (PAT+SPSHK) or PAT as usual (PAT-AU). CSA-related awareness and protective behaviors, as well as general parenting behaviors taught by PAT were assessed at baseline, post-PAT, post-SPSHK, and 1-month follow-up. Multilevel analyses revealed significant group by time interactions for both awareness and behaviors (ps < .0001), indicating the PAT+SPSHK group had significantly greater awareness of CSA and used protective behaviors more often (which were maintained at follow-up) compared to the PAT-AU group. No differences were observed in general parenting behaviors taught by PAT suggesting adding SPHSK did not interfere with PAT efficacy as originally designed. Results indicate adding SPHSK to existing parent training can significantly enhance parents' awareness of and readiness to engage in protective behavioral strategies. Implementing SPHSK as a selective prevention strategy with at-risk parents receiving parent training through child welfare infrastructures is discussed.

Childhood Sexual Abuse and Exposure to Peer Bullying Victimization.

Females exposed to child sexual abuse (CSA) are at an increased risk of experiencing further victimization in adolescence. Associations between CSA and several forms of cyber and in-person peer bullying victimization were assessed in a prospective, longitudinal study. Females exposed to substantiated CSA and a matched comparison group (N = 422) were followed over a two-year period. Bullying experiences were assessed in both survey and qualitative interviews. Qualitative data were coded and used to describe the types (e.g., cyber, physical, verbal), and foci (e.g., threats, physical appearance) of bullying victimization. Logistic regression was used to assess the odds that CSA was associated with subsequent bullying victimization, adjusted for demographics, social networking use, and prior bullying. CSA-exposed females were at an increased risk of multiple forms of bullying victimization with a persistent risk of bullying victimization over time. Specifically, they had 2.6 times higher odds of experiencing any bullying at follow-up, 2.9 times higher odds of experiencing cyberbullying at follow-up, and 2 times higher odds of experiencing combined cyber/in-person bullying at follow-up. CSA-exposed females were more likely than comparison females to experience bullying regarding their appearance/weight and dating relationships. Findings provide further insight into the unique circumstances of the cyberbullying and in-person bullying experienced by CSA-exposed females. Females exposed to child sexual abuse (CSA) are at an increased risk of experiencing bullying victimization, specifically cyberbullying and combined cyber/in-person bullying, as well as bullying about their appearance and dating relationships. These findings indicate that bullying prevention needs to include trauma-focused components to target these uniquely vulnerable females.

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.

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.