Childhood Poverty, Adverse Childhood Experiences, and Adult Health Outcomes.

This study aimed to consider childhood poverty in relation to a count measure of adverse childhood experiences (ACEs) as a predictor of adult health outcomes and to determine whether associations are sensitive to how childhood poverty is operationalized. A sample of 10,784 adult residents was derived using data 2014-2015 Wisconsin annual Behavioral Risk Factor Survey data, derived from the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS). Adult health outcomes (health risk behaviors, general health problems, chronic health problems, and depression) were predicted using a more conservative and severe indicator of childhood poverty, and authors tested whether observed associations were attenuated by the inclusion of an ACE count variable. Findings showed that severe indicators of childhood poverty are associated with general and chronic health problems as well as adult depression. These associations are attenuated, but remain intact, when ACEs are included in regression models. Using the CDC BRFSS data for Wisconsin, the study showed that associations between childhood poverty and adult health are sensitive to the way in which childhood poverty is operationalized. The relationship between childhood poverty and other ACEs is complex and thus warrants treating the former as a distinct childhood adversity rather than an item in an ACE summary score.

Physically Hazardous Housing and Risk for Child Protective Services Involvement.

The quality and safety of the home environment is a common focus of Child Protective Services (CPS) investigations.Yet little is known about whether such conditions influence CPS outcomes. The present study uses a sample of low-income families to assess the relative importance of housing conditions and other common risk and protective factors associated with child maltreatment. Results show that hazardous conditions predict investigated child neglect, but not physical abuse or indicated reports.

Individual and Organizational Factors Associated With Intent to Leave the Job and Public Child Welfare Field Amid the COVID-19 Pandemic.

The public child welfare system is plagued with high turnover, which is consistently associated with job-related stress. However, the COVID-19 pandemic introduced challenges that impact both the work and caseworkers' decision to stay in their job. To better understand stressors and intention to stay amid the COVID-19 pandemic, one state-level agency implemented a survey, completed by forty-eight percent of public child welfare caseworkers in the state. The current analysis employs multinomial logistic regression to predict intention to stay in the job and in the field and narrative analysis to describe caseworker experiences. Expanding on prior research, findings suggest that caseworker perception of an organization's response to COVID-19 challenges is associated with a caseworker's intent to leave. Further, this study highlights the distinction in commitment to the field compared to commitment to one's job, introduces challenges associated with work during the COVID-19 pandemic, and describes worker-identified benefits of those work changes.

Wisconsin's Community Response Program for families that have been reported for child maltreatment.

In 2006, the Wisconsin Children's Trust Fund launched a pilot initiative called "Community Response," a program targeted to families reported for maltreatment but not served by child protective services due to insufficient child safety concerns. This article presents general information on the program, including the variation in models used by sites across the state, information on the families that were served by the program, and lessons learned from the experience that may guide practical decisions around the implementation of similar models elsewhere.

Examining Racial Disproportionality in Child Protective Services Case Decisions.

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

Exploring the relationship between childhood adversity and adult depression: A risk versus strengths-oriented approach.

BACKGROUND: Previous research suggests a dose-response relationship between adverse childhood experiences (ACEs) and adult depression. Both constructs are also known correlates of child maltreatment risk. OBJECTIVES: This study examines the relationship between a cumulative count of ACEs and adult depressive symptoms in a sample of families at risk for child maltreatment. The study also aims to determine if a new childhood caregiving environment (CCE) scale predicts adult depressive symptoms as well as or better than the traditional ACE score in this high-risk population, and whether it holds potential as a service needs assessment tool for the child maltreatment prevention field. PARTICIPANTS AND SETTING: Baseline survey data from a randomized control trial testing a child maltreatment prevention program in Milwaukee, Wisconsin were used. The sample (n = 618) included caregivers reported to and investigated by child protective services (CPS) for allegations of abuse or neglect. METHODS: Ordinary least squares regression was used to look at the relationship between the number of ACEs, scores on the CCE scale, and adult depressive symptoms. Exploratory factor analysis was used to examine the CCE scale items in comparison to ACEs. RESULTS: A high ACE score was associated with more depressive symptomatology (B = 0.82, p < 0.001). Conversely, adults with higher scores on the CCE scale had fewer depressive symptoms (B = -0.30, p < 0.001). There was also preliminary evidence that the CCE scale may tap into similar underlying constructs as ACEs. CONCLUSIONS: Given that the CCE measure favors strengths-oriented question items, it may be a promising alternative to the risk-oriented ACE score in assessing parental childhood adversities known to be associated with the maltreatment of one's own children, and as an approach for identifying service needs related to childhood trauma in a maltreatment prevention context.

Material hardship and the physical health of school-aged children in low-income households.

OBJECTIVES: We examined the relationship between material hardship reported by low-income caregivers and caregivers' assessments of their children's overall health. METHODS: We used logistic regression techniques to analyze data from 1073 children aged 5 through 11 years whose caregivers participated in multiple waves of the Illinois Families Study. RESULTS: Caregivers' reports of food hardship were strongly associated with their assessments of their children's health. Other sources of self-reported material hardship were also associated with caregivers' assessments of their children's health, but the effects disappeared when we controlled for caregiver physical health status and mental health status. Proximal measures of material hardship better explained low-income children's health than traditional socioeconomic measures. There were no statistically significant cumulative effects of material hardships above and beyond individual hardship effects. CONCLUSIONS: Our findings highlight the importance of developing and supporting programs and policies that ensure access to better-quality food, higher quantities of food, and better living conditions for low-income children, as well as health promotion and prevention efforts targeted toward their primary caregivers as ways to reduce health disparities for this population.

The Complex Interplay of Adverse Childhood Experiences, Race, and Income.

An extensive research base shows evidence of racial disparities in health outcomes, and a growing body of evidence points to associations between adverse childhood experiences (ACEs) and poor health. This study uses data from the 2011 and 2012 Wisconsin Behavioral Risk Factor Surveillance System surveys to identify the relative contributions of ACEs, race, and adult income to predicting three sets of adverse adult health outcomes. The authors found that controlling for demographic factors, ACEs strongly predict health risk behaviors, indicators of poor general health, and chronic health conditions. Adult low-income status is associated with poor general health and chronic health conditions, but not health risk behaviors. African American race is marginally associated only with indicators of poor general health, and this association is attenuated when ACEs and adult income are controlled. These findings suggest a complex interplay among ACEs, race, and income.

Adverse childhood experiences and behavioral problems in middle childhood.

Children who have been exposed to maltreatment and other adverse childhood experiences (ACEs) are at increased risk for various negative adult health outcomes, including cancer, liver disease, substance abuse, and depression. However, the proximal associations between ACEs and behavioral outcomes during the middle childhood years have been understudied. In addition, many of the ACE studies contain methodological limitations such as reliance on retrospective reports and limited generalizability to populations of lower socioeconomic advantage. The current study uses data from the Fragile Families and Child Wellbeing Study, a national urban birth cohort, to prospectively assess the adverse experiences and subsequent behavior problems of over 3000 children. Eight ACE categories to which a child was exposed by age 5 were investigated: childhood abuse (emotional and physical), neglect (emotional and physical), and parental domestic violence, anxiety or depression, substance abuse, or incarceration. Results from bivariate analyses indicated that Black children and children with mothers of low education were particularly likely to have been exposed to multiple ACE categories. Regression analyses showed that exposure to ACEs is strongly associated with externalizing and internalizing behaviors and likelihood of ADHD diagnosis in middle childhood. Variation in these associations by racial/ethnic, gender, and maternal education subgroups are examined. This study provides evidence that children as young as 9 begin to show behavioral problems after exposure to early childhood adversities.

Predicting Child Protective Services (CPS) Involvement among Low-Income U.S. Families with Young Children Receiving Nutritional Assistance.

This exploratory study examines combinations of income-tested welfare benefits and earnings, as they relate to the likelihood of child maltreatment investigations among low-income families with young children participating in a nutritional assistance program in one U.S. state (Wisconsin). Using a sample of 1065 parents who received the Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) benefits in late 2010 and early 2011, we find that relying on either work in the absence of other means-tested welfare benefits, or a combination of work and welfare benefits, reduces the likelihood of CPS involvement compared to parents who rely on welfare benefits in the absence of work. Additionally, we find that housing instability increases the risk of CPS involvement in this population. The findings from this investigation may be useful to programs serving low-income families with young children, as they attempt to identify safety net resources for their clientele.

Income and Child Maltreatment in Unmarried Families: Evidence from the Earned Income Tax Credit.

This study estimates the associations of income with both (self-reported) child protective services (CPS) involvement and parenting behaviors that proxy for child abuse and neglect risk among unmarried families. Our primary strategy follows the instrumental variables (IV) approach employed by Dahl and Lochner (2012), which leverages variation between states and over time in the generosity of the total state and federal Earned Income Tax Credit for which a family is eligible to identify exogenous variation in family income. As a robustness check, we also estimate standard OLS regressions (linear probability models), reduced form OLS regressions, and OLS regressions with the inclusion of a control function (each with and without family-specific fixed effects). Our micro-level data are drawn from the Fragile Families and Child Wellbeing Study, a longitudinal birth-cohort of relatively disadvantaged urban children who have been followed from birth to age nine. Results suggest that an exogenous increase in income is associated with reductions in behaviorally-approximated child neglect and CPS involvement, particularly among low-income single-mother families.

Home Foreclosure and Child Protective Services Involvement.

OBJECTIVE: We estimated associations between experiencing a home foreclosure filing and experiencing a child protective services (CPS) investigation or substantiation. METHODS: We linked a large sample drawn from administrative data on foreclosure filings, CPS involvement, and participation in a host of other public programs for >60,000 Wisconsin households over a 4-year period from 2008 to 2011. Our empirical analyses used piecewise exponential survival models to estimate the risk of CPS involvement (investigation or substantiation) as a function of a home foreclosure filing and a set of individual and household characteristics. We fitted these models with and without the inclusion of propensity score weights. RESULTS: Households that experienced a foreclosure filing had a much higher probability of CPS involvement. This was true in the year before the filing as well as the year after the foreclosure filing. However, these associations were generally largest in the period before or shortly afterward. CONCLUSIONS: Experiencing a foreclosure filing is associated with increased CPS involvement. However, it is not clear that this association is driven by the foreclosure filing action itself. Rather, increased risk of CPS involvement is apparent during the process of moving toward the filing as well as the year or so after the filing, both of which are likely characterized by limited economic resources as well as by financial and other stress.

The impact of health-promoting behaviors on low-income children's health: a risk and resilience perspective.

This study's objective was to examine whether five child health-promoting behaviors by caregivers would be associated with caregivers' assessments of their children's health as "excellent," controlling for an array of risk factors for adverse health outcomes. The study used the third and fourth waves of the Illinois Families Study--Child Well-being Supplement--a four-year panel study examining the impact of welfare reform on the well-being of the youngest children of current and former welfare recipients. Logistic regression techniques were used. The analytic results show that low-income children whose caregivers exercise child health-promoting behaviors (for example, mealtime routines, dental hygiene practices, safety practices), with the exception of having a regular bedtime, are more likely to be reported as having excellent health than their low-income counterparts. Moreover, a statistically significant cumulative effect above and beyond the individual effects of health-promoting behaviors was found. The findings suggest that child health-promoting behaviors by caregivers can make a difference in promoting better health for low-income children. Although large systemic changes (for example, changes in health care policy) are needed to reduce overall health disparities and to enhance health for all members of society, individual health-promoting behaviors may lead to incremental improvements in low-income children's health.

Caseworker-perceived caregiver substance abuse and child protective services outcomes.

The authors used data from the National Survey of Child and Adolescent Well-Being to examine associations of child protective services (CPS) caseworkers' perceptions of caregiver substance abuse with their perceptions of the severity of risk and harm a child experienced as a result of alleged maltreatment, as well as with whether a family experienced a range of CPS outcomes.The outcomes included whether the family received services from CPS, was substantiated for maltreatment, experienced child removal, and was subject to a termination of parental rights (TPR) petition. The authors also compared the magnitude of the association between caseworker-perceived caregiver substance abuse and each outcome to that of the association between other maltreatment-related risk factors and each outcome. Findings suggest that, all else equal, caseworker-perceived caregiver substance abuse is associated with increased caseworker perceptions that children have experienced severe risk and harm and also with an increased probability of each of the CPS outcomes except TPR. Moreover, these associations are equal in magnitude or larger than those between the other risk factors and the outcomes. These findings imply that CPS decisions are heavily influenced by caseworker perceptions of caregiver substance abuse, regardless of the presence of other risk factors for child maltreatment.