Patterns of Social Determinants of Health and Publicly-Funded Service Access among Children Involved in Educational, Child Welfare, and Social Service Systems.

Social determinants of health (SDOH)-conditions in which children live, learn, and play-affect child health and well-being. Publicly funded services in education and child welfare systems are important resources to support child well-being, but cross-system coordination is rare. Leveraging integrated administrative data from 60,287 6th graders enrolled in public schools in Minnesota, we used latent class analysis (LCA) to examine patterns of cross-system SDOH, including educational services and involvement in child welfare. Five classes emerged. The largest class was characterized by a few multi-system SDOH and had low service needs. Two classes had differing patterns of school service use, one with a greater likelihood of special education service use alone and the other characterized by the use of multiple school services. Two classes were characterized by cross-system SDOH/service use (e.g., homelessness, child protection, placement in care, mental health, and special education services). We then assessed whether race/ethnicity predicted class membership and tested educational distal outcomes. American Indian, Black, and Latinx children had higher odds of exposure to both cross-system SDOH classes. Students facing any SDOH, particularly those with greater multi-system SDOH exposure, had worse attendance and academic achievement. Our study indicates that children are navigating complex experiences of SDOH and service needs, with a disproportional likelihood that Black children, Indigenous children, and other children of color (BIPOC) experience SDOH. Identifying patterns of SDOH provides an opportunity for policymakers and practitioners to intervene to promote health equity. By understanding facilitators and barriers to child well-being, the results inform how child-serving systems can strive toward health equity.

Reprint of: Homelessness and child protection involvement: Temporal links and risks to student attendance and school mobility.

BACKGROUND: The experience of homelessness and child protection involvement pose risks to children's school success. Elucidating processes by which these interrelated systems affect child well-being is important for guiding policy and practice. OBJECTIVE: This study examines the temporal relation between emergency shelter or transitional housing use and child protection involvement among school-aged children. We evaluated effects of both risk indicators on school attendance and school mobility. PARTICIPANT AND SETTING: Using integrated administrative data, we identified 3278 children (ages 4 to 15) whose families used emergency or transitional housing in Hennepin and Ramsey County of Minnesota during the 2014 and 2015 academic years. A propensity-score-matched comparison group of 2613 children who did not use emergency or transitional housing. METHOD: Through a series of logistic regressions and generalized estimating equations, we tested the temporal associations of emergency/transitional housing and child protection involvement as well as how both experiences affected school attendance and mobility. RESULTS: Experiences of emergency or transitional housing often proceeded or occurred concurrently with child protection involvement and increased the likelihood of child protection services. Emergency or transitional housing and child protection involvement posed risks for lower school attendance and greater school mobility. CONCLUSIONS: A multisystem approach to assist families across social services may be important for stabilizing children's housing and bolstering their success at school. A two-generation approach focused on residential and school stability and enhancing family resources could boost adaptive success of family members across contexts.

Homelessness and child protection involvement: Temporal links and risks to student attendance and school mobility.

BACKGROUND: The experience of homelessness and child protection involvement pose risks to children's school success. Elucidating processes by which these interrelated systems affect child well-being is important for guiding policy and practice. OBJECTIVE: This study examines the temporal relation between emergency shelter or transitional housing use and child protection involvement among school-aged children. We evaluated effects of both risk indicators on school attendance and school mobility. PARTICIPANT AND SETTING: Using integrated administrative data, we identified 3278 children (ages 4 to 15) whose families used emergency or transitional housing in Hennepin and Ramsey County of Minnesota during the 2014 and 2015 academic years. A propensity-score-matched comparison group of 2613 children who did not use emergency or transitional housing. METHOD: Through a series of logistic regressions and generalized estimating equations, we tested the temporal associations of emergency/transitional housing and child protection involvement as well as how both experiences affected school attendance and mobility. RESULTS: Experiences of emergency or transitional housing often proceeded or occurred concurrently with child protection involvement and increased the likelihood of child protection services. Emergency or transitional housing and child protection involvement posed risks for lower school attendance and greater school mobility. CONCLUSIONS: A multisystem approach to assist families across social services may be important for stabilizing children's housing and bolstering their success at school. A two-generation approach focused on residential and school stability and enhancing family resources could boost adaptive success of family members across contexts.

Academic Outcomes Among Children Who Experienced or Were Exposed to Physical Abuse.

All forms of family violence may negatively affect a child's development. However, research on child maltreatment is primarily focused on the child who is directly maltreated and does not often account for how other children in the family experience the abuse. The central aim of our study was to better understand how children's direct experience of physical abuse and exposure to physical abuse influence their academic outcomes. Data were taken from the Minnesota Departments of Education and Human Services. The sample was developed from a population-level cohort of 8-10 years old children (N = 1740) from two groups: Child Protective Service (CPS)-involved (a child who allegedly experienced physical abuse or a child who was exposed to the alleged physical abuse of another child in their household) and the matched comparison. Exposure to intimate partner violence (IPV) was also measured for CPS-involved children. School attendance and academic achievement were examined over 4 years. Descriptive statistics and Generalized Estimating Equations (GEE) were used to answer the three research questions. Over time, declines in attendance for children exposed to physical abuse were significantly greater than those of their matched peers. Exposure to IPV for CPS-involved children resulted in further declines in attendance. Math proficiency of children who experienced physical abuse declined at a significantly faster rate than their matched peers. The decline in reading proficiency of both children who experienced physical abuse and children exposed to physical abuse was more significantly pronounced than that of their matched peers. Differences in math and reading proficiency were eliminated when IPV exposure was taken into account. Child protection workers and school professionals should be aware of negative effects of experiences of and exposures to child maltreatment and work collaboratively to provide academic support, counseling, and other interventions to support children's academic stability.

A latent class analysis of modifiable risk factors associated with child maltreatment re-reporting and recurrence.

BACKGROUND: Maltreatment re-reporting and recurrence represent missed opportunities for prevention and early intervention in child welfare settings. OBJECTIVES: This study identified latent classes of risk among families who experienced a child maltreatment re-report or maltreatment recurrence within 12-months of initial case closure. PARTICIPANTS AND SETTING: Administrative child welfare data from a large urban county were subject to secondary analysis. Samples included children who experienced a maltreatment re-report (n = 4390), and children who experienced a second maltreatment substantiation (n = 694). METHODS: Five modifiable risk factors (i.e., mental health, substance abuse, domestic violence, disability, parenting challenges) were extracted from the initial investigation and subject to latent class analysis. Case characteristics (i.e., age, gender, race, ethnicity, maltreatment type) were then compared across the latent classes in a post-hoc analysis. RESULTS: Re-report classes were characterized by (1) "Few Identified Challenges" (56%, n = 2458), (2) "Mental Health and Domestic Violence Challenges" (26%, n = 1133), and (3) "Substance Abuse, Domestic Violence, Mental Health, and Parenting Challenges" (18%, n = 790). Re-report classes differed according to child age, race, ethnicity, neglect and physical abuse allegations. Recurrence classes were characterized by (1) "Domestic Violence Challenges" (48%, n = 333), (2) "Mental Health Challenges" (15%, n = 104), and (3) "Domestic Violence, Mental Health, and Parenting Challenges" (37%, n = 257). Recurrence classes differed according to child race and age. CONCLUSIONS: Findings underscore the complex and co-occurring nature of maltreatment risk, and provide insights to strengthen assessment and intervention practices to reduce repeated contacts with child welfare systems.

Longitudinal association of child maltreatment and cognitive functioning: Implications for child development.

Although research investigating associations among child maltreatment, cognitive functioning, and academic achievement has grown in recent years, important questions remain. In particular, assessing the influence of maltreatment apart from that of other co-occurring and confounding factors remains difficult. This study was developed to further the field's understanding by investigating cognitive functioning in association with time-variant maltreatment patterns. Using multiple time-variant linear mixed models, we investigated the relationships between maltreatment timing and three domains of cognitive functioning (i.e., knowledge, comprehension, and analysis). In general, the cognitive functioning of students who experienced maltreatment was lower than that of their peers who had yet to experience maltreatment at the time of testing. Results of LMM indicated that the cognitive functioning of students who experienced maltreatment concurrent with the testing year fluctuated over time whereas the cognitive functioning of students who experienced maltreatment prior to or after the testing year remained stable. Students who experienced concurrent maltreatment showed the lowest functioning of any group. While maltreatment timing was a significant predictor of cognitive functioning over time, the addition of poverty into the model resulted in a non-significant effect of maltreatment timing. Additional research is needed to disentangle the longitudinal effect of maltreatment on cognitive functioning and address the interacting role of poverty and chronic maltreatment.

Child protection services and parents with intellectual and developmental disabilities.

BACKGROUND: Information about parents with intellectual and developmental disabilities (IDD) in the child protection system (CPS) continues to evolve. This study examined characteristics, experiences and representation of parents with IDD across three CPS decision points, as compared to parents with other disabilities and parents without disabilities in the United States. METHODS: The sample consisted of 303,039 individuals: 2,081 were individuals identified as parents in a CPS investigation; 1,101 had children in out-of-home care (OHC); and 308 experienced termination of parental rights (TPR). Descriptive statistics, chi-square analysis, disparity indices and logistic regression were employed. RESULTS: Parents with IDD were significantly more likely than parents without disabilities (but not significantly more likely than parents with other types of disabilities) to experience disproportionately representation. CONCLUSIONS: Parents with IDD are generally over-represented within CPS; however, this representation is dependent upon the comparison group utilized and other risk factors. CPS system-level changes are necessary.