Home, but Left Alone: Time at Home and Child Abuse and Neglect During COVID-19.

We use high-frequency mobile phone movement data and quick-release administrative data from Georgia to examine how time at home during the COVID-19 pandemic is related to child maltreatment referrals. Findings show that referrals plummeted by 58% relative to previous years, driven by fewer referrals from education personnel. After this initial decline, however, each 15 minutes at home was associated with an increase in referrals of material neglect by 3.5% and supervisory neglect by 1%. Our results describe how children have fared during the initial wave of the pandemic, and the results have long-term implications for child development and well-being.

Association of Expanded Child Tax Credit Payments With Child Abuse and Neglect Emergency Department Visits.

Importance: Poverty has long been associated with a higher risk for child maltreatment, and recent research suggests that income support policies are associated with reduced child abuse and neglect. However, income supports tied to employment cannot separate the associations of income from those of employment. Objective: To estimate the short-term association of universal and unconditional income payments to parents with child abuse and neglect. Design, Setting, and Participants: In this cross-sectional study, variation in the timing of the 2021 expanded child tax credit (CTC) advance payments was used to determine whether receiving unconditional income is associated with child abuse and neglect. A fixed-effects approach was used to compare child abuse and neglect before and after payments were made in 2021. The study compared 2021 trends with the same period in 2018 and 2019, during which no CTC payments were made. Participants were pediatric emergency department (ED) patients identified as experiencing child abuse or neglect at a level I pediatric hospital system in the Southeastern US from July through December 2021. Data were analyzed from July to August 2022. Exposures: Timing in the disbursement of the expanded CTC advance payments. Main Outcomes and Measures: Daily child abuse and neglect-related ED visits. Results: During the study period, there were 3169 ED visits related to child abuse or neglect. The 2021 advance payments of the expanded CTC were associated with fewer child abuse and neglect-related ED visits. There was a decrease in these ED visits in the 4 days following the advance CTC payments, although the reduction was not significant (point estimate, -0.22; 95% CI, -0.45 to 0.01; P = .06). There were significant reductions in such ED visits among male children (point estimate, -0.40; 95% CI, -0.75 to -0.06; P = .02) and non-Hispanic White children (point estimate, -0.69; 95% CI, -1.22 to -0.17; P = .01). These reductions did not persist, however. Conclusions and Relevance: These findings suggest that federal income supports to parents are associated with immediate reductions in child abuse and neglect-related ED visits. These results are important for discussions of making the temporary expansion of the CTC permanent and are applicable to income support policies more broadly.

Paid Family Leave: An Upstream Intervention to Prevent Family Violence.

Purpose: Family violence imposes tremendous costs on victims and society. Rarely are policies focused on the primary prevention of family violence. Given the prevalence of family violence-including child maltreatment and intimate partner violence (IPV)-during the perinatal period, policies targeting this vulnerable time period may be successful in primary prevention. Paid family leave (PFL) programs provide income-replacement during particularly stressful family events, such as the birth of a child. Method: In this commentary, we describe the conceptual links between PFL, child maltreatment, and IPV, suggesting that PFL may be a promising strategy for the primary prevention of child maltreatment and IPV. Results: There is emerging evidence that policies targeting the early years of life may reduce child maltreatment and IPV. Conclusion: Addressing the concrete and economic challenges faced by caregivers is one promising strategy for the prevention of family violence.

Impacts of Publicly Funded Health Insurance for Adults on Children's Academic Achievement.

Empirical evidence demonstrates that publicly funded adult health insurance through the Affordable Care Act (ACA) has had positive effects on low-income adults. We examine whether the ACA's Medicaid expansions influenced child development and family functioning in low-income households. We use a difference-in-differences framework exploiting cross-state policy variation and focusing on children in low-income families from a nationally representative, longitudinal sample followed from kindergarten to fifth grade. The ACA Medicaid expansions improved children's reading test scores by approximately 2 percent (0.04 SD). Potential mechanisms for these effects within families are more time spent reading at home, less parental help with homework, and eating dinner together. We find no effects on children's math test scores or socioemotional skills.

Better Late Than Never: Effects of Late ACA Medicaid Expansions for Parents on Family Health-Related Financial Well-Being.

Public health insurance eligibility for low-income adults has improved adult economic well-being. But whether parental public health insurance eligibility has spillover effects on children's health insurance coverage and family health-related financial well-being is less understood. We use the 2016 to 2020 National Survey of Children's Health (NSCH) to estimate the effects of Medicaid expansions through the Affordable Care Act (ACA) for parents on child health insurance coverage, parents' employment decisions due to child health, and family health-related financial well-being. We compare children in low-income families in states that expanded Medicaid for parents after 2015 to states that never expanded in a difference-in-differences framework. We find that these expansions were associated with increases in children's public health insurance coverage by 5.5 percentage points and reductions in private coverage by 5 percentage points. We additionally find that parents were less likely to avoid changing jobs for health insurance reasons and children's medical expenses were less likely to exceed $1000. We find no evidence that the expansions affected children's dual coverage and uninsurance. Our estimates are robust to falsification and sensitivity analyzes. Our findings also suggest that benefits on children's medical expenses are concentrated in the families with the greatest financial need.

Coverage Effects of the ACA's Medicaid Expansion on Adult Reproductive-Aged Women, Postpartum Mothers, and Mothers with Older Children.

OBJECTIVES: We estimate the effect of the Affordable Care Act's (ACA) Medicaid expansions on Medicaid coverage of reproductive-aged women at varying childbearing stages. METHODS: Using data from the American Community Survey (ACS) (n = 1,977,098) and a difference-in-differences approach, we compare Medicaid coverage among low-income adult women without children, postpartum mothers, and mothers of children older than one year in expansion states to non-expansion states, before and after the expansions. RESULTS: The ACA's Medicaid expansion increased Medicaid coverage among adult women with incomes between 101 and 200% of the federal poverty line (FPL) without children by 10.7 percentage points (54 percent, p < 0.01). Coverage of mothers with children older than one year increased by 9.5 percentage points (34 percent, p < 0.01). Coverage of mothers with infants rose by 7.9 percentage points (21 percent, p < 0.01). CONCLUSIONS FOR PRACTICE: Within the population of adult reproductive-aged women, we find a "fanning out" of effects from the ACA's Medicaid expansions. Childless women experience the largest gains in coverage while mothers of infants experience the smallest gains; mothers of children greater than one year old fall in the middle. These results are consistent with ACA gains being the smallest among the groups least targeted by the ACA, but also show substantial gains (one fifth) even among postpartum mothers.

Evaluating child maltreatment and family violence risk during the COVID-19 Pandemic: Using a telehealth home visiting program as a conduit to families.

The COVID-19 pandemic has affected many child maltreatment risk factors and may have affected maltreatment among vulnerable families. We surveyed 258 certified providers of an evidence-based home visiting program, SafeCare, about their perception of the impact of the pandemic on the families they serve. We examined if the providers perceived an overall change in child maltreatment and family violence risk among the families with young children they served and factors that may have contributed to changes. Regressions estimated the relationship between providers' assessment of families' ability to social distance, emotional struggles, and access to public resources/services with providers' perception of child maltreatment and family violence risk in the home. Findings indicate that 87% of providers believed maltreatment risk had increased during the pandemic. Providers serving families who were unable to social distance due to employment were more likely to report increased supervisory neglect and material neglect among the families they serve. Providers reporting that families were struggling with elevated frustration levels also reported more family conflict and material neglect among the families they serve. Results from this research can inform strategic decision-making for policies and programs that address the challenges low-income families with young children face in emergency situations.

La pandemia del COVID-19 ha afectado muchos factores de riesgo de maltrato del niño y pudiera haber afectado el maltrato en familias vulnerables. Les preguntamos en una encuesta a 258 proveedores certificados de un programa de visitas a casa con base en la evidencia, SafeCare®, acerca de sus percepciones del impacto de la pandemia en las familias a quienes les ofrecían el servicio. Examinamos si los proveedores percibían un cambio general en el maltrato del niño y el riesgo de violencia familiar en familias con niños pequeños a las que les servían y los factores que pudieran haber contribuido a los cambios. Las regresiones calcularon la relación entre la evaluación de los proveedores acerca de la habilidad de la familia para mantener la distancia social física, los problemas emocionales, así como el acceso a recursos y servicios públicos, con la percepción de los proveedores acerca del maltrato infantil y el riesgo de violencia familiar en la casa. Los resultados indican que el 87 por ciento de los proveedores creía que el riesgo de maltrato había aumentado durante la pandemia. Aquellos proveedores que les servían a familias que no podían mantener la distancia social física debido al empleo, estuvieron más propensas a reportar el aumento en la negligencia de supervisión y la negación de material en las familias a quienes les servían. Los proveedores que reportaron que las familias estaban luchando con elevados niveles de frustración también reportaron más conflicto familiar y negación de material en las familias a las que les servían. Los resultados de esta investigación pueden apoyar la toma de decisiones estratégica para políticas y programas que se enfoquen en los retos que enfrentan las familias de bajos recursos con niños pequeños en situaciones de emergencia.

La pandémie du COVID-19 a affecté bien des facteurs de risque de la maltraitance de l'enfant et peut avoir affecté la maltraitance chez les familles vulnérables. Nous avons questionné 258 prestataires certifiés d'un programme de visite à domicile fondé sur des données probantes, SafeCare®, sur leur perception de l'impact de la pandémie sur les familles qu'ils servent. Nous avons examiné si les prestataires ont perçu un changement général de la maltraitance de l'enfant et dans le risque de violence familiale au sein des familles avec les jeunes enfants qu'ils servaient et les facteurs qui ont pu contribuer à ces changements. Des régressions ont estimé la relation entre l'évaluation qu'ont fait les prestataires de la capacité des familles à assurer la distanciation sociale, des difficutés émotionnelles et de l'accès aux resources/services publiques avec la perception des prestataires de la maltraitance de l'enfant et du risque de violence familiale à la maison. Les résultats indiquent que 87 pourcent des prestataires pensaient que le risque de maltraitance avait augmenté durant la pandémie. Les prestataires servant les familles qui ne pouvaient pas assurer la distanciation sociale à cause de leur emploi étaient plus à même de faire état d'une négligence acrue de la supervision et de négligence matérielle chez les familles qu'ils servent. Les prestataires indiquant que les familles faisaient face à des difficultés avec des niveaux de frustration élevés ont aussi fait état de plus de conflit familial et de néglicence matérielle chez les familles qu'ils servent. Les résultats de ces recherches peuvent aider les prises de décision stratégiques pour les politiques et les programmes qui répondent aux défis des familles défavorisées avec de jeunes enfants dans des situations d'urgence.

The power of the future: Intergenerational income mobility and child maltreatment in the United States.

BACKGROUND: Recent research has shown that the likelihood of children experiencing intergenerational, upward income mobility depends on the community in which they are raised. Whether parents consider their children's economic chances in their parenting decisions, however, is not well understood. OBJECTIVE: To examine the relationship between county-level income mobility-distinct from income inequality and poverty-and child maltreatment. PARTICIPANTS AND SETTING: Administrative data from the National Child Abuse and Neglect Data System: Child File for 2406 counties were merged with measures of intergenerational income mobility from Chetty et al. (2014a), including the probability that a child born in the bottom quintile of the national income distribution reaches the top quintile by age thirty. METHODS: Weighted least squares analyses were used to empirically estimate the relationship between intergenerational income mobility and child maltreatment report rates. Maltreatment reports were also divided into subgroups by age and metropolitan status. RESULTS: Counties where children have a greater chance of moving up the income ladder have lower child maltreatment report rates, independent from income inequality and poverty rates. This relationship is consistent across all child ages (0-17). The relationship between upward income mobility and substantiated child maltreatment is also negatively correlated among non-metropolitan counties. CONCLUSIONS: Children experience a lower risk for maltreatment if they are more likely to move up the income ladder in adulthood. Macroeconomic factors and policies that reduce income inequality and enhance economic mobility are likely to prevent child maltreatment.

Effects of parental public health insurance eligibility on parent and child health outcomes.

Many states expanded their Medicaid programs to low-income adults under the Affordable Care Act (ACA). These expansions increased Medicaid coverage among low-income parents and their children. Whether these improvements in coverage and healthcare use lead to better health outcomes for parents and their children remains unanswered. We used longitudinal data on a large, nationally representative cohort of elementary-aged children from low-income households from 2010 to 2016. Using a difference-in-differences approach in state Medicaid policy decisions, we estimated the effect of the ACA Medicaid expansions on parent and child health. We found that parents' self-reported health status improved significantly post-expansion in states that expanded Medicaid through the ACA by 4 percentage points (p < 0.05), a 4.7% improvement. We found no significant changes in children's use of routine doctor visits or parents' assessment of their children's health status. We observed modest decreases in children's body mass index (BMI) of about 2% (p < 0.05), especially for girls.

The neglected ones: Time at home during COVID-19 and child maltreatment.

The early months of the COVID-19 pandemic led to extreme social isolation, precarious employment and job loss, working from home while tending to children, and limited access to public services. The confluence of these factors likely affects child health and well-being. We combine early release child maltreatment reports in Indiana with unique and newly available mobile phone movement data to better understand the relationship between staying at home intensively during the COVID-19 pandemic and child maltreatment. Our findings indicate that the prolonged stays at home promoted by the early public health response to COVID-19 resulted in reductions in child maltreatment reports overall and substantiated reports of maltreatment. However, relative to areas that stayed home less, children in areas that stayed home more were more likely to be both reported for and a confirmed victim of maltreatment, particularly neglect. These areas have historically been socioeconomically advantaged and experienced lower rates of maltreatment. We only observe increases in confirmed child maltreatment in metropolitan counties, suggesting that the effects of staying home on child maltreatment may reflect both the differential risk of leaving home and access to services in metropolitan-rather than non-metropolitan-counties. Staying at home has been challenging for many families. Families likely need assistance as the pandemic persists, evolves, and when it ends.

The Affordable Care Act Increased Medicaid Coverage Among Former Foster Youth.

Youth aging out of the foster care system in the US are a vulnerable population. When in foster care, youth are eligible for their state's Medicaid program, but they lose eligibility when they age out of foster care. The Affordable Care Act (ACA) has the potential to address some of the health care needs of former foster youth through the Medicaid eligibility expansion to low-income adults and by extending Medicaid eligibility up to age twenty-six for former foster youth. Using the 2011-18 National Youth in Transition Database, we found that Medicaid expansion increased Medicaid coverage among former foster youth by 10.1 percentage points, and the age extension increased coverage by 3.4 percentage points. There is suggestive evidence of positive spillovers for both policies. Our findings imply that the ACA improved Medicaid coverage among former foster youth, with the largest effects from Medicaid expansion. The modest effects of the Medicaid age extension may imply a need to revise enrollment, recertification, outreach, and eligibility determination processes to further increase Medicaid coverage among former foster youth.

Pediatric emergency department visits due to child abuse and neglect following COVID-19 public health emergency declaration in the Southeastern United States.

BACKGROUND: The ongoing worldwide COVID-19 pandemic has heightened several risk factors  for child abuse and neglect (CAN). We study whether COVID-19 and the public health response to it affected CAN-related pediatric emergency department (ED) visits in the southeastern United States (US). METHODS: We performed a retrospective chart review on medical records of ED visits from a level I pediatric hospital system serving one of the largest metropolitan areas in the southeastern US from January through June 2018-2020. We used multivariate Poisson regression and linear regression to compare professionally identified CAN-related ED visits before and after a COVID-19 public health emergency declaration in 2020, relative to trends over the same period in 2018 and 2019. RESULTS: Although the number of both overall pediatric ED visits and CAN-related ED visits declined, the number of CAN-related ED visits due to neglect from inadequate adult supervision increased by 62 % (p < 0.01). The number of CAN visits per 1,000 pediatric ED visits also increased by 97 % (p < 0.01). Finally, the proportion of CAN-related ED visits due to neglect from inadequate supervision increased by 100 % (p < 0.01). CONCLUSIONS: Physicians should be aware that patients who present with injuries during a pandemic may be victims of neglect due to changes in social structures in their households. In particular, maltreatment presenting to the ED shifted toward treating injuries and abuse resulting from inadequate supervision. Policymakers should consider the impacts of stay-at-home orders on child well-being when determining appropriate public health responses in the midst of a pandemic. TRIAL REGISTRATION: Not applicable.

Proximity to SNAP-authorized retailers and child maltreatment reports.

The Supplemental Nutrition Assistance Program (SNAP) has been shown to have positive benefits for children. Families may face fewer barriers to accessing food they can purchase with their benefits if more stores in their neighborhoods accept SNAP benefits. We examine whether proximity to stores accepting SNAP benefits is related to child maltreatment (abuse and neglect) reports, particularly those potentially related to food insecurity. We combine geographically identified child maltreatment report data from the state of Connecticut from 2011 through 2015 with state SNAP-authorized retailer data. Using within-Census block group changes in the presence of a SNAP-authorized store, we find that in large, rural areas, one additional SNAP store is associated with a 4.4 percent decrease in the child maltreatment report rate (p < 0.05), and an 11.3 percent decrease in substantiated cases of maltreatment (p < 0.10), even net of changing zip code level factors and time-invariant neighborhood characteristics. The relationship between a neighborhood SNAP store and child maltreatment reports in these rural areas is largely driven by neglect, concentrated among young and school-aged children (ages 0-9), and primarily due to fewer reports by medical personnel. We find no effects of a neighborhood SNAP store on child maltreatment reports in smaller, more densely populated neighborhoods. Sensitivity checks affirm these results. Results indicate the benefits of access to SNAP retailers on the child welfare system and child well-being more broadly, especially in rural areas.

The Effect of Paid Family Leave on Infant and Parental Health in the United States.

California's paid family leave (PFL) policy improved mothers' labor market outcomes, however, the health impacts of this program are less studied. I compare child and parental health of likely eligible households to a series of control groups before and after California's PFL program was implemented. I find improvements in parent-reported overall child health and suggestive improvements in maternal mental health status. Findings also suggest a reduction in asthma and a greater likelihood that parents feel they are coping well with the day-to-day demands of parenting. There are no significant effects on respiratory or food allergies, or father's mental health status. The results are robust to multiple control groups and placebo tests.

Prescription Contraceptive Sales Following the Affordable Care Act.

Objectives We examine trends in prescription contraceptive sales following the Affordable Care Act's (ACA) zero-copayment contraceptive coverage mandate in areas more likely to be affected by the provision relative to areas less likely to be affected. Methods Before the ACA, several states had their own contraceptive insurance coverage mandates. Using a national prescription claims database combined with wholesaler institutional sales activity from January 2008 through June 2014, we compare sales of the intrauterine device (IUD), implant, injectable, pill, ring, and patch in states that had a state-level insurance coverage mandate before the ACA to states that did not. Results Overall, our results imply the ACA increased sales of prescription contraceptives, with stronger effects for some methods than others. Specifically, we find the ACA increased sales of injectable contraceptives, but had no significant impact on sales of the IUD, implant, pill, or patch in states without a state-level mandate before the ACA relative to states that had a state-level mandate. We also find suggestive evidence of a reduction in sales of the ring. Conclusions for Practice Demand responses to changes in out-of-pocket expenses for contraception vary across methods. Eliminating copays could promote the use of contraceptives, but is not the only approach to increasing contraceptive utilization.

The Effect of Minimum Wages on Adolescent Fertility: A Nationwide Analysis.

OBJECTIVES: To investigate the effect of minimum wage laws on adolescent birth rates in the United States. METHODS: I used a difference-in-differences approach and vital statistics data measured quarterly at the state level from 2003 to 2014. All models included state covariates, state and quarter-year fixed effects, and state-specific quarter-year nonlinear time trends, which provided plausibly causal estimates of the effect of minimum wage on adolescent birth rates. RESULTS: A $1 increase in minimum wage reduces adolescent birth rates by about 2%. The effects are driven by non-Hispanic White and Hispanic adolescents. CONCLUSIONS: Nationwide, increasing minimum wages by $1 would likely result in roughly 5000 fewer adolescent births annually.