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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., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To evaluate whether maltreatment investigated during infancy affects high-acuity health care utilization patterns during early childhood., Methods: Retrospective case-control study based on linked data between child protection and hospital encounter records conducted to review health records of infants investigated for abuse and/or neglect. Cases and controls were followed longitudinally through the Rady Children's Hospital electronic health records for 4 years starting at the age of 1 year., Results: A total of 3692 children were investigated for maltreatment within the first year of life. When comparisons were made between children reported for maltreatment and matched controls, children with infancy maltreatment reports had significantly more high-acuity health care encounters than matched controls (average treatment effect = 1.53, 95% Confidence Interval 1.08-1.99, P < .001)., Conclusions: Infants investigated for maltreatment have greater high-acuity health care utilization in early childhood. These findings highlight this population's need for well-defined medical homes to ensure appropriate health care. Further understanding of the underlying reasons for this increased health care burden will help inform these efforts., Competing Interests: Declaration of Competing Interest Each author confirms that they have no conflicts of interest related to this publication., (Published by Elsevier Inc.)

Objective: Infants affected by prenatal alcohol and drug use are more likely to be removed from parental custody than those in the general population, although it is unclear whether their custody outcomes differ from infants investigated by child protection systems (CPS) for other reasons. This analysis seeks to compare trajectories of involvement and custody outcomes among infants investigated by CPS with and without documentation of prenatal substance exposure (PSE)., Method: We used vital birth records linked to administrative CPS records to examine the timing of system involvement and 3-year custodial outcomes among investigated infants with and without identified PSE. We defined PSE according to documentation on the state's standardized hotline screening form, which CPS completes upon referral for alleged maltreatment. We estimated the likelihood a child was in nonparental custody at age 3 by specifying multivariable generalized linear models, adjusted for covariates available in the birth record., Results: In our sample of 22,855 infants investigated by CPS in 2017 in California, more than 26% had documentation of PSE. These infants experienced an accelerated timeline of system penetration and were 2.2 times as likely to be in nonparental placement at age 3., Discussion: PSE confers an independent risk of custody interruption among infants investigated by CPS. The younger age of these infants, complexity of parental substance use, and potential misalignment of administrative permanency timelines with parental recovery all suggest the need for increased research, policy, and programmatic interventions to serve this vulnerable population., (© 2023. The Author(s).)

Background: Mechanisms for reporting child maltreatment (CM) were affected by changes in service provision immediately following the onset of the COVID-19 pandemic., Objective: To examine changes in counts and CPS reporting of CM medical encounters before and after the onset of COVID-19., Participants and Setting: All emergency department and inpatient medical encounters with at least one CM diagnosis during the study period at Rady Children's Hospital San Diego, the largest pediatric hospital in California between 2016 and November 2021., Methods: Using linked medical record and CPS administrative data, interrupted time series models tested for changes in monthly counts and percentages of CM medical encounters reported to CPS with the onset of COVID-19. Logistic regression tested for the likelihood of a CPS report being associated with a CM encounter., Results: CM medical encounters totaled 2528, including 793 after the onset of COVID-19. Interrupted time series models indicated with the onset of the pandemic, the counts of CM encounters increased 18 % (RR: 1.18, 95 % CI 1.03-1.34) and the percentages reported to CPS increased 10 % (RR: 1.10, 95 % CI: 1.05-1.17). CM encounters that occurred after the onset of the COVID-19 pandemic had increased odds of a CPS report (fully adjusted model: OR: 1.08; 95 % CI: 1.05-1.12)., Conclusions: This study found increases in monthly counts and a higher percentage of CM medical encounters with CPS reports after the pandemic onset., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

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.

Objective: To assess the counts of infant maltreatment-related medical encounters at a large medical system during a 21-month span of the COVID-19 pandemic., Methods: Retrospective data for this study came from all inpatient and emergency department medical encounters for infants from January 1, 2016, through November 30, 2021, at a single children's hospital system in California. Distributions of medical encounters were tabulated and plotted over time. Interrupted time series models were used to evaluate changes in child maltreatment medical encounters., Results: Medical encounters for infants with child maltreatment diagnoses increased following the onset of COVID-19. Monthly counts of encounters with indicated maltreatment trended upward following the start of the pandemic. Interrupted time series models showed that the count of maltreatment encounters increased 64% with the onset of COVID-19., Conclusions: We found an increase in infant maltreatment medical encounters during a 21-month period following the onset of COVID-19. These findings suggest that the pandemic may have adversely affected the safety of infants and ongoing work is needed to understand better the pandemic impacts on child maltreatment., Competing Interests: Declaration of Competing Interest Funding for this project came from NICHD R21HD105907. The Children's Data Network also receives essential infrastructure funding from First 5 LA, the Conrad N. Hilton Foundation, The Reissa Foundation, and the Heising-Simons Foundation. The authors do not have conflicts of interest to disclose. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or any other funder or data partner., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: The health services literature indicates that the day and time of a medical encounter is often significant factor in patient outcomes, yet little is known about the role of temporal dimensions in child maltreatment reporting or substantiation., Objective: We examined time-specific dynamics of screened-in reports of alleged maltreatment from different reporter sources, including their relationship to the likelihood of substantiation., Participants and Setting: We used a population-based dataset of administrative records for 119,758 child protection investigations involving 193,300 unique children in Los Angeles County, California, between 2016 and 2017., Methods: For each report, we coded three categorical temporal dimensions of the maltreatment report: season, day of the week, and time of day. We descriptively examined how temporal characteristics varied by reporting source. Finally, we ran generalized linear models to estimate the likelihood of substantiation., Results: We observed variability overall and by reporter type for all three measures of time. Reports were less likely during summer months (22.2 %), during the weekend (13.6 %), and after midnight (10.4 %). Counts of reports from law enforcement were more common after midnight and contributed to a greater proportion of substantiations over the weekend than other reporter types. Weekend and morning reports were nearly 10 % more likely than weekday and afternoon to be substantiated, respectively. Reporter type was the most prominent factor for substantiation regardless of temporal dimensions., Conclusions: Screened-in reports varied by season and other classifications of time, but temporal dimensions exhibited only a modest influence on the likelihood of substantiation., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Child maltreatment recidivism is typically measured and studied at the individual level. Conditions that give rise to child abuse and neglect, however, typically affect multiple children in a given family. In the current study, we estimated maltreatment recidivism at the maternal level and examined its risk as a function of maternal sociodemographic characteristics that may change over time. Using linked administrative records, we identified a subset of first-time mothers in California whose first child was reported to the child protection system (CPS) between birth and age 5 and who then gave birth to another child ( n = 14,715). Following the firstborn child's CPS reporting, nearly half of these mothers (43.3%) were re-reported concerning the non-firstborn children during the first 5 years of the child's life. Risk factors consistently documented across births were associated with a heightened risk of maternal CPS recidivism. Our study advances an understanding of the full extent of maltreatment recidivism by broadening the focus from individual children.

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., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Palmer et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: To determine the population prevalence of diagnosed mental health disorders among Medicaid-insured children <18 years old in California based on levels of current and past child protection system (CPS) involvement., Study Design: In this retrospective, population-based study, we examined the full population of children enrolled in California's Medicaid program for at least 1 month between 2014 and 2015 and who had at least 1 claim during that period (n = 3 352 886). Records for Medicaid-insured children were probabilistically linked to statewide CPS records of maltreatment and foster care placements since 1998. A primary or secondary mental health diagnosis was classified using International Classification of Diseases codes., Results: Overall, 14% (n = 470 513) of all children insured through Medicaid in 2014-2015 had a documented mental health diagnosis. Among children with a diagnosis, the percentage with CPS involvement (ie, any report for maltreatment) was nearly twice that of the Medicaid population overall (50.4% vs 26.9%). This finding held across all diagnostic groups but with notable variations in magnitude. A graded relationship emerged between the level of CPS involvement and the likelihood of a mental health diagnosis. Diagnoses among children reported for maltreatment were common, regardless of placement in foster care., Conclusions: Findings document high rates of both mental health diagnoses and past child protection involvement in a population of Medicaid-insured children. Most children reported for maltreatment will never be placed in foster care, underscoring the importance of ensuring that the children who remain at home receive the proper array and coordination of services., (Copyright © 2022. Published by Elsevier Inc.)

Childhood maltreatment involves dynamics between the type of maltreatment experienced and the context of maltreatment. Reports of alleged maltreatment to child protective services may overlap and shift over time, complicating understanding of their independent and interacting nature, including how child protection systems respond. Latent class analysis (LCA) and latent transition analysis (LTA) were used to construct data-based models of longitudinal dynamics of alleged maltreatment throughout childhood. We sought to identify patterns leading to system decisions to substantiate allegations of maltreatment and place children in foster care. Using linked birth and child protection records, we defined a cohort of children born in California in 1999, 29.4% of whom had at least one referral for alleged maltreatment before their 18th birthday. Maltreatment and perpetrator indicators were coded, and LCA identified five alleged maltreatment classes and one class of children without referrals. LTA determined consistency of classifications and estimated transitions between classes over age periods. Children with multitype maltreatment patterns or experiences of neglect were most likely to experience future maltreatment allegations. Estimated probabilities of placement indicated children with Multitype Maltreatment allegations were more likely to experience substantiated maltreatment allegations and out-of-home placements. Findings identify a repeatable method for better understanding complex systems.

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.

Research on secondary prevention is mixed as to whether referrals to evidence-based practices and other community interventions reduce maltreatment recidivism. This evaluation sought to rigorously assess whether a community service-linkage model to evidence-based programs decreased subsequent reports of abuse and neglect among families reported to the child protection system (CPS). Between 2016 and 2018, administrative CPS records were used to identify families with at least one child under 5 years of age recently reported for maltreatment in Orange County, California, but where no follow-up services were mandated. Families were randomized to one of two community outreach and engagement conditions (i.e., targeted provider outreach vs. treatment-as-usual). Re-reporting outcomes were tracked in administrative records for a period of 12 months. A total of 4873 families met eligibility criteria, with 2231 (45.0%) randomized to the intervention arm and 2642 (54.0%) families to the control group. Among families in the intervention group, 811 (36.4%) were successfully contacted by a community provider. Of those families contacted, 145 (18.0%) agreed to participate in voluntary services. Overall, we did not detect any significant difference in re-reporting between our treatment and control groups (P = .433). Likewise, no significant differences in re-reporting were observed when we stratified the treatment group by levels of outreach and service engagement. Findings indicate low levels of successful engagement of families in voluntary services. Notwithstanding the absence of significant findings, this study demonstrates the potential for using community-based RCTs and administrative records to rigorously evaluate secondary prevention programs in the child protection system., (© 2021. Society for Prevention Research.)

Purpose: The purpose of this study was to provide a population-based analysis of child protection system (CPS) involvement among children and adolescents who died by suicide., Methods: We performed a case-control study of child and adolescent suicide and CPS involvement. Using linked birth, death, and CPS records, we longitudinally followed all children born in California in 1999 and 2000 (N = 1,052,333) in CPS and death records through 2017. Cases were defined as children who died in California and had a manner of death coded as suicide using the International Classification of Diseases, 10th revision (n = 170). Each suicide case was matched to four living controls, and children were classified based on CPS exposure: no history, reported for alleged child maltreatment, substantiated for child maltreatment, and placed in foster care. Crude suicide rates were documented, and conditional logistic regression models were used to estimate the adjusted odds of suicide., Results: Among children and adolescents who died by suicide, 56.5% had a history of past allegations of abuse or neglect. Children with any CPS history had three times the odds of suicide compared to children with no history. No additional risk was found for children substantiated or placed in foster care compared to children with only an allegation., Conclusions: Suicide risk is not isolated to the relatively small group of children and youth placed in foster care. Findings reinforce the importance of increased attention to the experiences of the larger universe of children who remain at home after alleged or substantiated maltreatment., (Copyright © 2021 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: To examine whether postneonatal infants reported for maltreatment face a heightened risk of deaths attributable to medical causes., Methods: Birth and death records for all children born in California between 2010 and 2016 ( N = 3 455 985) were linked to administrative child protection system records. Infants were prospectively followed from birth through death or age 1 year. Reports of maltreatment and foster care placement episodes were modeled as time-varying covariates; sociodemographic characteristics at birth were modeled as baseline covariates. Stratified, multivariable competing risk models were used to estimate the adjusted relative hazard of postneonatal infant death attributed to a medical cause ( n = 1051)., Results: After adjusting for baseline risk factors, and compared with infants never reported for maltreatment, the medical-related mortality risk was almost twice as great among infants reported once for maltreatment (hazard ratio: 1.77; 95% confidence interval: 1.36-2.30) and 3 times greater if there was >1 maltreatment report (hazard ratio: 3.27; 95% confidence interval: 2.48, 4.30). Among infants reported for maltreatment, periods of foster care placement reduced the risk of death by roughly half., Conclusion: Infants reported for alleged maltreatment had a higher risk of death from medical causes, with foster care emerging as protective. Targeted support services for parents and improved communication between the child protection system and the pediatric health care community is needed, especially when infants who may be medically fragile remain at home after an allegation of abuse or neglect., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2021 by the American Academy of Pediatrics.)

Background: Research has indicated an association between child abuse and adolescent suicide. Little population-based information exists, however, about the nature of maltreatment experiences or interactions with the child protection system (CPS)., Objective: To examine child maltreatment characteristics and system-level responses associated with risk of adolescent suicide., Participants and Setting: Linked vital death records and CPS records were used to identify the population of adolescents who died by suicide in California between 2010 and 2017 and who had a history of at least one report to CPS prior to death., Method: A case control design was used, with cases defined as a suicide of an adolescent with a history of CPS involvement. Using CPS records, living controls were then matched to cases based on year of birth, sex, race and ethnicity, and age of first child maltreatment allegation. A conditional logistic regression model was used to estimate the adjusted odds of adolescent suicide across various CPS and maltreatment characteristics., Results: Recent CPS involvement, allegations of physical abuse, and allegations of sexual abuse emerged as significant risk factors for death by suicide. No differences in suicide risk were observed between youth with unsubstantiated or substantiated allegations., Conclusions: Suicide risk appears to be more closely tied to specific maltreatment experiences than to substantiation or placement into foster care. As adolescent suicide rates rise, better a understanding of risk factors among already vulnerable populations of youth is critical., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objectives. To document the cumulative childhood risk of different levels of involvement with the child protection system (CPS), including terminations of parental rights (TPRs). Methods. We linked vital records for California's 1999 birth cohort (n = 519 248) to CPS records from 1999 to 2017. We used sociodemographic information captured at birth to estimate differences in the cumulative percentage of children investigated, substantiated, placed in foster care, and with a TPR. Results. Overall, 26.3% of children were investigated for maltreatment, 10.5% were substantiated, 4.3% were placed in foster care, and 1.1% experienced a TPR. Roughly 1 in 2 Black and Native American children were investigated during childhood. Children receiving public insurance experienced CPS involvement at more than twice the rate of children with private insurance. Conclusions. Findings provide a lower-bound estimate of CPS involvement and extend previous research by documenting demographic differences, including in TPRs. Public Health Implications. Conservatively, CPS investigates more than a quarter of children born in California for abuse or neglect. These data reinforce policy questions about the current scope and reach of our modern CPS.

Importance: Nearly 6 million children are reported as allegedly experiencing abuse or neglect in the US annually. Child protection agencies are increasingly turning to automated predictive risk models (PRMs) that mine information found in routinely collected administrative data and estimate a likelihood that an individual will experience some future adverse outcome., Objective: To test if a PRM used at the time of referral for alleged maltreatment, which automatically generates a risk stratification score indicating the relative likelihood of future foster care placement, is also predictive of injury hospitalization data., Design, Setting, and Participants: This retrospective cohort study based on a probabilistic association between child protection and hospital encounter data was conducted in Allegheny County, Pennsylvania, and at Children's Hospital of Pittsburgh (Pittsburgh, Pennsylvania). Participants included children referred for alleged neglect or abuse in Allegheny County between April 1, 2010, and May 4, 2016., Exposures: Risk score generated from the PRM., Main Outcomes and Measures: Medical encounters (emergency department and inpatient hospitalizations) for any-cause injuries, suicide or self-inflicted harm injuries, and abuse injuries between 2002 and 2015 for children classified by the PRM to different risk levels at the time of a maltreatment referral. Cancer encounters were used as a placebo test., Results: Of 47 305 participants, 23 601 (49.9%) were girls, the mean (SD) age at referral was 8 (5.7) years, 28 211 (59.6%) were black, and 19 094 (40.4%) were nonblack. Children who scored in the highest 5% risk group by the PRM were more likely to have a medical encounter for an injury during the follow-up period than low-risk children (ie, those in the bottom 50% of risk). Specifically, among children referred for maltreatment and classified as highest risk, the rate of experiencing an any-cause injury encounter was 14.5 (95% CI, 13.1-15.9) per 100 compared with children who scored as low risk who had an any-cause injury encounter rate of 4.9 (95% CI, 4.7-5.2) per 100. For abuse-associated injury encounters, the rate for high-risk children was 2.0 (95% CI, 1.5-2.6) per 100 and that of low-risk children was 0.2 (95% CI, 0.2-0.3) per 100; for suicide and self-harm, the high-risk encounter rate was 1.0 (95% CI, 0.6-1.4) per 100 and that of low-risk children was 0.1 (95% CI, 0.1-0.1) per 100. There was no association between risk scores and cancer encounters., Conclusions and Relevance: Findings confirm that children reported for having experienced alleged maltreatment and classified by a PRM tool to be at high risk of foster care placement are also at increased risk of emergency department and in-patient hospitalizations for injuries.

Objectives. To document ethnic disparities in childhood abuse and neglect among New Zealand children. Methods. We followed the 1998 New Zealand birth cohort of 56 904 children through 2016. We determined the cumulative childhood prevalence of reports to child protective services (CPS), substantiated maltreatment (by subtype), and out-of-home placements, from birth to age 18 years, by ethnic group. We also developed estimates stratified by maternal age and community deprivation levels. Results. We identified substantial ethnic differences in child maltreatment and child protection involvement. Both Māori and Pacific Islander children had a far greater likelihood of being reported to CPS, being substantiated as victims, and experiencing an out-of-home placement than other children. Across all levels of CPS interactions, rates of Māori involvement were more than twice those of Pacific Islander children and more than 3 times those of European children. Conclusions. Despite long-standing child support policies and reparation for breaches of Indigenous people's rights, significant child maltreatment disparities persist. More work is needed to understand how New Zealand's public benefit services can be more responsive to the needs of Indigenous families and their children.

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.

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., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Infants have the highest rates of maltreatment reporting and entries to foster care. Prenatal substance exposure is thought to contribute to early involvement with child protective services (CPS), yet there have been limited data with which to examine this relationship or variations by substance type. Using linked birth, hospital discharge, and CPS records from California, we estimated the population prevalence of medically diagnosed substance exposure and neonatal withdrawal disorders at birth. We then explored the corresponding rates of CPS involvement during the first year of life by substance type after adjusting for sociodemographic and health factors. Among 551,232 infants born alive in 2006, 1.45% (n=7994) were diagnosed with prenatal substance exposure at birth; 61.2% of those diagnosed were reported to CPS before age 1 and nearly one third (29.9%) were placed in foster care. Medically diagnosed prenatal substance exposure was strongly associated with an infant's likelihood of being reported to CPS, yet significant variation in the likelihood and level of CPS involvement was observed by substance type. Although these data undoubtedly understate the prevalence of prenatal illicit drug and alcohol use, this study provides a population-based characterization of a common pathway to CPS involvement during infancy. Future research is needed to explicate the longer-term trajectories of infants diagnosed with prenatal substance exposure, including the role of CPS., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objectives: To determine if children identified by a predictive risk model as at "high risk" of maltreatment are also at elevated risk of injury and mortality in early childhood., Methods: We built a model that predicted a child's risk of a substantiated finding of maltreatment by child protective services for children born in New Zealand in 2010. We assigned risk scores to the 2011 birth cohort, and flagged children as "very high risk" if they were in the top 10% of the score distribution for maltreatment. We also set a less conservative threshold for defining "high risk" and examined children in the top 20%. We then compared the incidence of injury and mortality rates between very high-risk and high-risk children and the remainder of the birth cohort., Results: Children flagged at both 10% and 20% risk thresholds had much higher postneonatal mortality rates than other children (4.8 times and 4.2 times greater, respectively), as well as a greater relative risk of hospitalization (2 times higher and 1.8 times higher, respectively)., Conclusions: Models that predict risk of maltreatment as defined by child protective services substantiation also identify children who are at heightened risk of injury and mortality outcomes. If deployed at birth, these models could help medical providers identify children in families who would benefit from more intensive supports., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2018 by the American Academy of Pediatrics.)

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., Competing Interests: The authors declare no conflicts of interest.

Research identifying racial and ethnic disparities in child protective services (CPS) involvement in the U.S. has focused on the overrepresentation of Black children and the growing Latino child population. Little attention has been paid to children of Asian origin, the most underrepresented group of children in the U.S. CPS system. The objective of this analysis was to examine subgroup patterns of CPS involvement in California for Asian and Pacific Islander (API) children prospectively based on maternal nativity and ethnic origin. We extracted data for API children born in California in 2006 and 2007 (N=138,858) from population-based birth records and linked those records to CPS records spanning the first 5 years of life (through 2012). We assessed distributional differences in risk indicators for the full birth cohort of API children and calculated a summary risk variable representing the cumulative number of risks present at birth. Generalized linear models were used to estimate API children's adjusted relative risk of CPS report by subgroup. Overall, 12.2% of children born in California in the 2006-2007 birth cohort were API. The majority of API children had foreign-born mothers (80.9%). Children of U.S.-born Hawaiian, Guamanian, or Samoan mothers had the highest rate, with 20.4% being reported to CPS by their 5th birthday. The lowest rates of child abuse and neglect reporting were observed among children of foreign-born Asian Indian (2.5%), Korean (2.7%), and Chinese (2.8%) mothers, compared to 5.4% of all Asian and Pacific Islander children, and 14.8% of children in general population. Findings underscore the presence of disparities in CPS involvement among API children, which has implications for health and well-being across the life course and for targeted maltreatment prevention strategies., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Childhood maltreatment is associated with a variety of young adult adversities including homelessness. This study used linked administrative records to develop a population-level, epidemiological characterization of the child protection histories of young adults accessing homelessness services. The records of all 17- to 24-year-olds receiving homeless services between 2011 and 2014 in San Francisco County, California (n = 2241) were probabilistically linked to statewide child protective service (CPS) records. Findings document that 50.0% of young adults had been reported for maltreatment at least once during childhood, yet the prevalence of past CPS involvement varied across demographic and child welfare characteristics. Homeless female youth were significantly more likely to have a CPS history than male youth (58.1% vs. 41.5%). Nearly twice as many Black clients accessing homelessness services had a CPS history as did White clients (59.8% vs. 31.8%). Roughly half (47.3%) of those with a childhood history of reported maltreatment had been last reported for maltreatment in another California county. Targeting services that address past trauma and instability among homeless young adults may be justified given the prevalence of CPS history in this population., (© Society for Community Research and Action 2017.)

Introduction Official statistics have confirmed that relative to their presence in the population and relative to white children, black children have consistently higher rates of contact with child protective services (CPS). We used linked administrative data and statistical decomposition techniques to generate new insights into black and white differences in child maltreatment reports and foster care placements. Methods Birth records for all children born in Allegheny County, Pennsylvania, between 2008 and 2010 were linked to administrative service records originating in multiple county data systems. Differences in rates of involvement with child protective services between black and white children by age 4 were decomposed using nonlinear regression techniques. Results Black children had rates of CPS involvement that were 3 times higher than white children. Racial differences were explained solely by parental marital status (i.e., being unmarried) and age at birth (i.e., predominantly teenage mothers). Adding other covariates did not capture any further racial differences in maltreatment reporting or foster care placement rates, they simply shifted differences already explained by marital status and age to these other variables. Discussion Racial differences in rates of maltreatment reports and foster care placements can be explained by a basic model that adjusts only for parental marital status and age at the time of birth. Increasing access to early prevention services for vulnerable families may reduce disparities in child protective service involvement. Using birth records linked to other administrative data sources provides an important means to developing population-based research.

The objective of this study was to identify individual, family and caregiver risk factors for serious child maltreatment, resulting in hospitalization or death, among children and families investigated by Child Protective Services (CPS). We conducted a matched case-control study of 234 children who sustained fatal or serious nonfatal maltreatment due to physical abuse or neglect and whose mother was named in a CPS investigation between 1999 and 2013. A total of 702 children and their caregivers were included in the study with 234 cases matched 2:1,resulting in 468 controls. Data on potential risk factors were abstracted from three county administrative databases. Differences between cases and controls were calculated and multivariable conditional logistic regression was used to estimate risk models. Variables associated with increased risk for serious maltreatment included male child gender,younger caregivers, three or more children under the age of 5 living in the home, families in which a biologic child was not living with either parent, and scoring moderate or high on the Structured Decision Making Risk Tool ® . Caregiver involvement in intimate partner violence (IPV) and child enrollment in public health insurance appears to mitigate the risk of serious maltreatment., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: Substance exposure is thought to contribute to reports of suspected maltreatment made to child protective services (CPS) at or shortly after birth. There are limited data, however, on whether clinicians are more likely to report black and Hispanic substance-exposed infants compared with white infants., Methods: We examined racial differences in diagnosed substance exposure and subsequent maltreatment reports by using linked birth, hospital discharge, and CPS records. Diagnostic codes were used to document substance exposure; CPS records provided information on maltreatment reports. Prevalence of infant exposure was calculated by race or ethnicity, substance type, and sociodemographic covariates. We estimated racial differences in maltreatment reporting among substance-exposed infants using multivariable models., Results: In a 2006 population-based California birth cohort of 474 071 black, Hispanic, and white infants, substance exposure diagnoses were identified for 1.6% of infants (n = 7428). Exposure varied significantly across racial groups (P < .001), with the highest prevalence observed among black infants (4.1%) and the lowest among Hispanic infants (1.0%). Among white and Hispanic infants, the most frequently observed substances were amphetamine and cannabis; for black infants, cannabis was the most common, followed by cocaine. After adjusting for sociodemographic and pregnancy factors, we found that substance-exposed black and Hispanic infants were reported at significantly lower or statistically comparable rates to substance-exposed white infants., Conclusions: Although we were unable to address potential racial and ethnic disparities in screening for substances at birth, we found no evidence that racial disparities in infant CPS reports arise from variable responses to prenatal substance exposure., (Copyright © 2016 by the American Academy of Pediatrics.)

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., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Context: Early sexual debut and unprotected sexual activity place adolescents at risk of adverse sexual health outcomes. Adolescents involved with child protective services (CPS) may be a particularly vulnerable population., Methods: California birth records for 86,946 adolescents who became first-time mothers in 2008-2010 were probabilistically linked to statewide CPS records from 1998 and later. The prevalence of STDs at birth and of abortion history were explored by preconception CPS involvement. Generalized linear models, adjusted for health, socioeconomic and demographic characteristics, were used to assess correlates of current STDs and history of abortion., Results: At the time they gave birth, 1% of adolescents had a documented STD, and 5% reported a previous abortion. After adjustment for other characteristics, CPS involvement was associated with a significantly elevated prevalence both of STDs (relative risk, 1.2) and of previous abortion (1.4). Other characteristics also were associated with both outcomes, but not always in the same direction. For example, delaying prenatal care until after the first trimester or getting none at all was associated with an increased prevalence of STDs (1.3), but a reduced prevalence of abortion (0.8-0.9); having public insurance coverage for the birth was associated with a reduced STD prevalence (0.9) and an elevated abortion history prevalence (1.2)., Conclusions: To assess whether adolescents with a history of CPS involvement need targeted sexual health interventions, further research is needed on the mechanisms that underlie associations between CPS involvement and adverse sexual health outcomes., (Copyright © 2015 by the Guttmacher Institute.)

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., (© The Author(s) 2014.)

We followed Latino infants prospectively through age 1 to determine whether maternal foreign-born status conferred a protective advantage against reported and substantiated maltreatment across Hispanic-origin groups, and whether the likelihood an infant was reported or substantiated for maltreatment varied by Hispanic origin. We drew data for all Latino infants born in California between 2000 and 2006 (N = 1,909,155) from population-based birth records linked to child protective services data. We used χ(2) tests to assess distributional differences in covariates and utilized generalized linear models to estimate the adjusted relative risk of report and substantiation in models stratified by nativity. We observed significant health advantages in reported and substantiated maltreatment for infants of foreign-born mothers within every Hispanic-origin group. Risks of report and substantiation among infants of Mexican and Central/South American mothers were consistently lower than Puerto Rican and Cuban mothers despite socioeconomic disadvantage. The presence of disparities among Hispanic-origin groups in child maltreatment report and substantiation during infancy has implications for the health of Latinos across the life course. Further research is warranted to unravel the complex processes underlying observed relationships.

For teenage mothers in California, we generated population-level estimates of the relationship between maternal history of maltreatment and next-generation abuse and neglect. California birth records for all infants born to primiparous teen mothers in 2006 or 2007 were linked to statewide child protective services (CPS) records. For each birth, we used CPS records to document 1) whether the teen mother had a history of reported or substantiated maternal maltreatment at or after age 10 years and before the estimated date of conception and 2) whether the teen's child was reported or substantiated for maltreatment before age 5 years. We fitted multivariable survival models to examine the association between a teenage mother's CPS involvement and child maltreatment, after adjusting for a range of sociodemographic variables. Our final data set included 85,084 births to first-time mothers aged 15-19 years. Significantly heightened rates of abuse and neglect were observed for children of mothers who had been reported to CPS as possible victims of maltreatment (P < 0.001). After adjustment for other risk factors, a maternal history of either unsubstantiated (hazard ratio = 2.19, 95% confidence interval: 2.06, 2.33) or substantiated (hazard ratio = 3.19, 95% confidence interval: 3.00, 3.39) maltreatment emerged as a strong predictor of maltreatment and CPS involvement in the next generation., (© The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Importance: Child maltreatment is a risk factor for poor health throughout the life course. Existing estimates of the proportion of the US population maltreated during childhood are based on retrospective self-reports. Records of officially confirmed maltreatment have been used to produce annual rather than cumulative counts of maltreated individuals., Objective: To estimate the proportion of US children with a report of maltreatment (abuse or neglect) that was indicated or substantiated by Child Protective Services (referred to as confirmed maltreatment) by 18 years of age., Design, Setting, and Participants: The National Child Abuse and Neglect Data System (NCANDS) Child File includes information on all US children with a confirmed report of maltreatment, totaling 5,689,900 children (2004-2011). We developed synthetic cohort life tables to estimate the cumulative prevalence of confirmed childhood maltreatment by 18 years of age., Main Outcomes and Measures: The cumulative prevalence of confirmed child maltreatment by race/ethnicity, sex, and year., Results: At 2011 rates, 12.5% (95% CI, 12.5%-12.6%) of US children will experience a confirmed case of maltreatment by 18 years of age. Girls have a higher cumulative prevalence (13.0% [95% CI, 12.9%-13.0%]) than boys (12.0% [12.0%-12.1%]). Black (20.9% [95% CI, 20.8%-21.1%]), Native American (14.5% [14.2%-14.9%]), and Hispanic (13.0% [12.9%-13.1%]) children have higher prevalences than white (10.7% [10.6%-10.8%]) or Asian/Pacific Islander (3.8% [3.7%-3.8%]) children. The risk for maltreatment is highest in the first few years of life; 2.1% (95% CI, 2.1%-2.1%) of children have confirmed maltreatment by 1 year of age, and 5.8% (5.8%-5.9%), by 5 years of age. Estimates from 2011 were consistent with those from 2004 through 2010., Conclusions and Relevance: Annual rates of confirmed child maltreatment dramatically understate the cumulative number of children confirmed to be maltreated during childhood. Our findings indicate that maltreatment will be confirmed for 1 in 8 US children by 18 years of age, far greater than the 1 in 100 children whose maltreatment is confirmed annually. For black children, the cumulative prevalence is 1 in 5; for Native American children, 1 in 7.

Purpose: To document the abuse and neglect histories of adolescent mothers using official child protection records., Methods: Vital birth records were used to identify adolescents 12-19 years of age who were born in California and gave birth in 2009. These records were linked to statewide child protective service data to determine maternal history of alleged and substantiated maltreatment victimization, as well as placement in foster care., Results: A total of 35,098 adolescents gave birth in 2009. Before conception, 44.9% had been reported for maltreatment, 20.8% had been substantiated as victims, and 9.7% had spent time in foster care., Conclusions: These population-based data indicate that many adolescent mothers have had contact with child protective services as alleged or substantiated victims of abuse or neglect. Understanding the impact of childhood and adolescent maternal maltreatment on both early childbearing risk and subsequent parenting capacity is critical to the development of responsive service interventions., (Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Using linked administrative data from child protection and birth records in California, this study examined whether the mandated status and type of reporter are independent predictors of substantiation among infants and young children across maltreatment types and after adjusting for characteristics of the child and family. Of the 59,413 children born in 2002 who were reported and investigated for maltreatment before the age of 5 years, 26% were substantiated. Reports originating from mandated sources were 2.5 times as likely (95% confidence interval, CI [2.40, 2.60]) to be substantiated as those from nonmandated reporters. Findings demonstrated that children whose allegations were reported by law enforcement, medical professionals, and workers in public agencies were consistently substantiated at higher rates than allegations from other mandated reporters. Results also indicated that the relationship between reporter type and the likelihood of substantiation varied by maltreatment type. Children reported by law enforcement for physical abuse were 6.3 times as likely (95% CI [4.86, 8.04]) to be substantiated as those reported by nonmandated sources.

Objectives: We examined variations in children's risk of an unintentional or intentional fatal injury following an allegation of physical abuse, neglect, or other maltreatment., Methods: We linked records of 514 232 children born in California from 1999 to 2006 and referred to child protective services for maltreatment to vital birth and death data. We used multivariable Cox regression models to estimate variations in risk of fatal injury before age 5 years and modeled maltreatment allegations as time-varying covariates., Results: Children with a previous allegation of physical abuse sustained fatal injuries at 1.7 times the rate of children referred for neglect. Stratification by manner of injury showed that children with an allegation of physical abuse died from intentional injuries at a rate 5 times as high as that for children with an allegation of neglect, yet faced a significantly lower risk of unintentional fatal injury., Conclusions: These data suggest conceptual differences between physical abuse and neglect. Findings indicate that interventions consistent with the form of alleged maltreatment may be appropriate, and heightened monitoring of young children referred for physical abuse may advance child protection.

A growing body of research links child abuse and neglect to a range of negative short- and long-term health outcomes. Determining a child's risk of maltreatment at or shortly after birth provides an opportunity for the delivery of targeted prevention services. This study presents findings from a predictive risk model (PRM) developed to estimate the likelihood of substantiated maltreatment among children enrolled in New Zealand's public benefit system. The objective was to explore the potential use of administrative data for targeting prevention and early intervention services to children and families. A data set of integrated public benefit and child protection records for children born in New Zealand between January 1, 2003, and June 1, 2006, was used to develop a risk algorithm using stepwise probit modeling. Data were analyzed in 2012. The final model included 132 variables and produced an area under the receiver operating characteristic curve of 76%. Among children in the top decile of risk, 47.8% had been substantiated for maltreatment by age 5 years. Of all children substantiated for maltreatment by age 5 years, 83% had been enrolled in the public benefit system before age 2 years. This analysis demonstrates that PRMs can be used to generate risk scores for substantiated maltreatment. Although a PRM cannot replace more-comprehensive clinical assessments of abuse and neglect risk, this approach provides a simple and cost-effective method of targeting early prevention services., (Copyright © 2013 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

In this article, we argue for expanded efforts to integrate administrative data systems as a "practical strategy" for developing a richer understanding of child abuse and neglect. Although the study of child maltreatment is often critiqued for being atheoretical, we believe that a more pressing concern is the absence of population-based and prospective epidemiological data that can be used to better understand the distribution and interacting nature of risk and protective factors for maltreatment. We begin by briefly addressing the relevance of empirical observations to etiological theories of child maltreatment. Although the latter is widely cited as critical to the development of effective prevention and intervention responses, less attention has been paid to the role of population-based data in the development of theories relevant to highly applied research questions such as those pertaining to child abuse and neglect. We then discuss how child protection data, in isolation, translates into a relatively narrow range of questions that can be asked and answered, with an inherently pathology-focused construction of risks and little attention paid to strengths or protective factors. We next turn to examples of recent findings--spanning multiple countries--emerging from information integrated across data systems, concluding by calling for expanded administrative data linkages in an effort to better understand and prevent child maltreatment., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objective: Data from the United States indicate pronounced and persistent racial/ethnic differences in the rates at which children are referred and substantiated as victims of child abuse and neglect. In this study, we examined the extent to which aggregate racial differences are attributable to variations in the distribution of individual and family-level risk factors., Methods: This study was based on the full population of children born in California in 2002. Birth records were linked to child protective service (CPS) records to identify all children referred for maltreatment by age 5. Generalized linear models were used to compute crude and adjusted racial/ethnic differences in children's risk of referral, substantiation, and entry to foster care., Results: As expected, stark differences between Black and White children emerged in the rates of contact with CPS. Black children were more than twice as likely as White children to be referred for maltreatment, substantiated as victims, and enter foster care before age 5. Yet, there were also significant differences across racial/ethnic groups in the distribution of socioeconomic and health factors strongly correlated with child maltreatment and CPS involvement. After adjusting for these differences, low socioeconomic Black children had a lower risk of referral, substantiation, and entry to foster care than their socioeconomically similar White counterparts. Among Latinos, before adjusting for other factors, children of U.S.-born mothers were significantly more likely than White children to experience system contact, while children of foreign-born mothers were less likely to be involved with CPS. After adjusting for socioeconomic and health indicators, the relative risk of referral, substantiation, and foster care entry was significantly lower for Latino children (regardless of maternal nativity) compared to White children., Conclusions: Race and ethnicity is a marker for a complex interaction of economic, social, political, and environmental factors that influence the health of individuals and communities. This analysis indicates that adjusting for child and family-level risk factors is necessary to distinguish race-specific effects (which may reflect system, worker, or resource biases) from socioeconomic and health indicators associated with maltreatment risk. Identifying the independent effects of these factors is critical to developing effective strategies for reducing racial disparities., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

In this article we examine risk factors for severe and fatal child maltreatment. These factors emerge from studies based on different data sources, including official child maltreatment data, emergency department and hospitalization data, death certificates, and data from child death review teams. The empirical literature reflects a growing effort to overcome the measurement uncertainties of any one individual data system. After review and reflection upon what is known, we consider how integrating this information can advance efforts to protect children, providing examples where the use and linkage of multiple sources of data may enhance surveillance, improve front-end decisionmaking, and support cost-effective research and evaluation.

Objective: This study used group variations in child injury fatality rates to assess racial bias in the population of children identified as victims of maltreatment., Methods: Injury fatality and maltreatment data from California were compiled for the years 1998-2007. Death and maltreatment risk ratios (RRs) and 95% confidence intervals (CIs) were computed by race and age. Rates of excess child injury mortality by race were derived from three different baseline rates of death. Substantiations per excess injury death were calculated., Results: compared with white children, black children faced a risk of substantiated maltreatment that was more than twice as great (black RR: 2.39, 95% CI 2.37, 2.42) and were fatally injured at nearly twice the rate (black RR: 1.89, 95% CI 1.68, 2.12). Per excess death, however, black children had rates of substantiated maltreatment allegations that were equivalent to or lower than the rates for white children., Conclusions: These data support claims that, at least in California, black-white racial disparities observed in maltreatment rates reflect real group differences in risk. These data provide no evidence of systematic racial bias in the child protective services' substantiation process.

This article presents a population-based study of early childhood injury mortality following a nonfatal allegation of maltreatment. Findings are based on a unique data set constructed by establishing child-level linkages between vital birth records, administrative child protective services records, and vital death records. These linked data reflect over 4.3 million children born in California between 1999 and 2006 and provide a longitudinal record of maltreatment allegations and death. Of interest was whether children reported for nonfatal maltreatment subsequently faced a heightened risk of unintentional and intentional injury mortality during the first 5 years of life. Findings indicate that after adjusting for risk factors at birth, children with a prior allegation of maltreatment died from intentional injuries at a rate that was 5.9 times greater than unreported children (95% CI [4.39, 7.81]) and died from unintentional injuries at twice the rate of unreported children (95% CI [1.71, 2.36]). A prior allegation to CPS proved to be the strongest independent risk factor for injury mortality before the age of five.

Overrepresentation of certain racial/ethnic groups in the foster care system is one of the most troubling and challenging issues in child welfare today. In response, many states have started reporting outcomes by race and ethnicity to identify disproportionately high rates of system contact. The identification of disproportional representation is the first step in developing targeted strategies to address disproportionality--highlighting where resources should be directed and guiding future research. However, present and future efforts to address disproportionality must be accompanied by statistically sound and meaningful methods of measurement. In this article, we argue for the adoption of a relative rate measure of representation--a "Disparity Index"--as the primary instrument for assessing racial disparity in child welfare.