RISK OF RE-REFERRAL AMONG INFANTS WHO REMAIN AT HOME
FOLLOWING REPORTED MALTREATMENT
Emily Putnam-Hornstein, PhD
James Simon, MSWJoseph Magruder, PhDBarbara Needell, PhD
Society for Social Work Research
San Diego, CA
Thank you to our colleagues at the Center for Social Services Research and the California Department of Social Services
Data linkages funded by the H.F. Guggenheim Foundation
Support for this and other research arising from the California Performance Indicators Project generously provided by the California Department of Social Services, the Stuart Foundation, & Casey Family Programs
acknowledgements
background
In 2011, referrals involving approximately 6.2 million children were made in the US, yet only 3 million were included in an investigation
California is one of the few states that collects data on these “evaluated out” cases
Large body of research indicates a limited ability to accurately and consistently determine if a child has been a victim, or to accurately discern future risk among investigated cases – are we better at screening out cases?
In this study we longitudinally follow a cohort of children remaining in the home following a referral for maltreatment during infancy We look at the cumulative risk of begin reported again over a five
year window We examine differences by CPS disposition/response
1. Among infants remaining in the home following a report of maltreatment, how many are re-reported within 5 years? How many infants who were evaluated out are
re-reported?
2. Do the risk factors observed at birth vary with the initial CPS response/disposition?
3. Does the likelihood of being re-reported vary by initial CPS response/disposition, after adjusting for baseline risk differences?
epidemiological questions addressed
data
File A File B
2006birth
records
infant cps records
91.9%
from birth to re-report…
variables
first referral disposition
• First Maltreatment
confounders
• Sex • Birth Weight• Race/Ethnicity (by birth place)• Prenatal Care • Maternal Age• Birth Order• Paternity• Birth Payment Method
outcome • Re-report
analysis
Evaluated Out
Unfounded/Inconclusive
Risk factors that
may influence
re-reporting
risk5 years
Re-Referral
(?)
χ2 tests used to assess covariate distributions across initial CPS response types
Cox Regression Models used to estimate relative diff erences in likelihood of being re-reported within 5 years
Substantiated, FM Services
Substantiated, No FM
Services
Population Characteristics
563,871 children born in California in 2006 5.2% (29,927) were reported for maltreatment before age 1 First reported maltreatment type:
82% = neglect; 9% = emotional abuse (e.g., DV exposure); 8% = at risk, sibling abused; 6% = physical abuse
89% of referrals received from a mandated reporter 29% of reported infants were reported to CPS within
three days of birth Not surprisingly, among these 3-day referrals, 98% involved
an allegation of neglect or substantial risk of maltreatment. Unfortunately, we do not have data as to how many of these
allegations involved maternal substance abuse70% of these infants had older siblings. And among
those with older siblings, 49% had an older sibling who had been referred for maltreatment prior to the infant’s birth.
infants reported for maltreatment
stark and consistent diff erences between overall birth cohort and infants reported for maltreatment
Question 1
Among infants remaining in the home following a report of maltreatment,
how many are re-reported within 5 years?
initial CPS response
563,871
5.2% (29,927)
24% (5,774)
61% (14,647)
15% (3,450)
41% (2,372)
59% (3,402)
47% of substantiated infants placed in foster care and
excluded (5,339)
82% of all referred infants remained at home,
10% received CPS FM services
we will see 6 out of every 10 of these infants again…
563,871
5.2% (29,927)
24% (5,774)
61% (14,647)
15% (3,578)
41% (2,372)
59% (3,402)
47% of substantiated infants placed in foster care and
excluded (5,339)
82% of all referred infants remained at home,
10% received CPS FM services
60%
61%
69%
64%
within a relatively short period of time.
24%
33%
39%44%
49%52% 54%
56% 58% 60%
cumulative percentage of children re-reported
50%
25%
25%
075
%
Prop
ortio
n R
e-R
epor
ted
0 1 2 3 4 5
Time from First Report (in Years)
Evaluated Out Unfounded Substantiated
Kaplan-Meier Failure Estimates
Question 2
Do the risk factors observed at birth vary by
initial cps response/disposition?
high risk (relative to full cohort) …diff icult to discern a risk pattern
among substantiated infants, suggestion of some triaging of highest risk infants to formal CPS services
Question 3
Does the likelihood of being re-reported vary by
initial cps response/disposition, after adjusting for baseline risk
differences?
Any Follow-up Report
(Unadjusted)
Any Follow-up Report
(Adjusted)
Follow-up Substantiation(Unadjusted)
Follow-up Substantiatio
n(Adjusted)
HR 95% CI HR 95% CI HR 95% CI HR 95% CI
Evaluated Out
1.09** (1.03, 1.14)
1.04 (0.99, 1.10)
1.19***
(1.07, 1.32)
1.12* (1.01, 1.24)
Unfounded Ref ----- Ref ----- Ref ----- Ref -----
Inconclusive
1.17** (1.12, 1.22)
1.13***
(1.08, 1.19)
1.47***
(1.34, 1.61)
1.40***
(1.28, 1.54)
Subst., no services
1.18*** (1.13, 1.24)
1.11***
(1.06, 1.17)
1.82***
(1.66, 2.00)
1.66***
(1.51, 1.83)
Subst., services
1.11** (1.04, 1.19)
1.07* (1.01, 1.14)
1.01 (0.90, 1.14)
1.00 (0.88, 1.12)
unadjusted and adjusted Cox Regression models (hazard ratios & 95% confi dence intervals)
Notes: *<.05, **<.01, ***<.001; adjusted models included sex, birth weight, birth abnormality race, maternal age, paternity establishment, prenatal care, birth order,
among infants remaining in the home following an initial report – rates of re-reports are VERY high Why wouldn’t they be? Fewer than 10% of these infants were
provided with formal services…not clear if these highly vulnerable/chaotic families with young infants can be informally served
infants initially evaluated out/screened out have a higher likelihood of being re-reported than infants who received an investigation in which the CPS worker deemed the referral to be unfounded Are we really able to effectively screen over the phone?
a story of missed opportunities – only 5% of all infants - yet the data indicate we do little by way of formal interventions…
conclusions
No counterfactual – it may be that absent whatever informal/formal services were provided – the rates of re-reporting would have been even higher (i.e., these data do not necessarily indicate our services are poor – although certainly we wish there was evidence they were better)
No information concerning informal/community based services
More careful modeling of family-level CPS history
Exploration of fi rst vs. follow-up substantiation timing and disposition dates – not sure what to make of it
limitations / next steps
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