research
research
American Journal of Epidemiology, https://doi.org/10.1093/aje/kwaf055
We examined mortality rates of adolescents and young adults before and after exiting foster care. We used administrative records to identify individuals born in California 1985-2005 who had a foster care episode on or after their 16th birthday. We linked these records to vital death records through 2022 to identify deaths occurring age 16-23. We defined three care statuses: pretransition, transition, and posttransition. Pretransition was age 16 to the last day of care. Transition was the first 120 days after exiting care. Posttransition was all days after transition. We calculated gender-standardized mortality rates (SMRs) and used a Cox proportional hazards model adjusted for demographics to estimate hazard ratios of total mortality. In total, 1,743 deaths occurred among 144,128 individuals. SMRs for pretransition, transition, and posttransition per 100,000 person-years were 116, 259, and 209, respectively. Time-varying hazards models detected that these high and disparate rates were driven by higher risk during transition and posttransition for those leaving care before age 20. Moreover, the transition period featured particularly heightened risk for those leaving care before age 18. Results suggest targeted support during the transition period could help safeguard this population from harm.
Policymakers rely on sources of administrative child protection system (CPS) data to inform policies that prevent harm to children and support families. One frequently used indicator contained in these sources is whether maltreatment allegations have been substantiated, or confirmed, by a CPS agency. For decades, there has been debate about how we should translate and use data about substantiation. In addition to case facts, the decision to substantiate likely reflects the policy and practice of CPS agencies. For example, substantiation may be required to refer families to services. It also may function as a pathway to certain outcomes, such as mandated court supervision, removal of a child, and placement of a caregiver on a central registry of child maltreatment perpetrators. In this three-paper dissertation, I use a data-driven approach and a source of population-based data from California. In paper I, I calculate rates of substantiated child maltreatment reports across county-years. I then test organizational theories by examining the association between county-level agency and substantiation rates. I expand on previous studies by adjusting for a more robust set of community characteristics and examining the relationship over several years. In paper II, I use model-based clustering to categorize substantiated reports into distinct, underlying typologies based on child and report characteristics. In paper III, I examine the distribution of clusters identified in paper II and the extent to which these clusters are explained by county systems. To explore why some counties have a higher rate of reports from a particular cluster, I employ regression analyses with substantiation typology as the outcome, adjusting for annual investigation count as well as report and community characteristics. Taken together, results of the papers demonstrate that substantiation rates are indicative of organizational context and that there are numerous typologies of substantiated cases. Furthermore, county jurisdictions vary in their propensities to substantiate typologies of cases, beyond their propensity to substantiate an average case. Given that substantiation operates as a pre-requisite to services and sanctions, research must consider how to ensure administrative indicators reflect sufficient dimensions of risk and need such that they are useful in identifying appropriate, effective responses.
Child Abuse & Neglect, https://doi.org/10.1016/j.chiabu.2022.105887
Child protective services (CPS) agencies use risk assessment tools to augment decision making about alleged child maltreatment. Under the Family First Prevention Services Act, states and tribes are permitted to claim federal reimbursement for prevention services for children at imminent risk of entering foster care based on assessment tools and protocols. In this context, existing tools are being repurposed. It is critical to reassess the evidence supporting their use. We aimed to synthesize the evidence pertaining to validity and reliability of specific risk assessment tools designed for CPS agencies, summarize how this work has been carried out, and review the conceptual dimensions of risk included in each tool. Overall, research about the validity and reliability of risk assessment tools is dated and heterogeneous in methodology. There was a general dearth of evidence that supported the use of tools across demographic subgroups. Heterogeneity of studies assessing tool validity and reliability suggests a lack of agreement about how to assess tools and makes it difficult to interpret findings across studies.
Journal of the Society for Social Work and Research, https://doi.org/10.1086/731490
Objective: We examine whether young children in Douglas County, Colorado, whose families receive cash assistance (in the form of Temporary Assistance for Needy Families, TANF) in combination with childcare subsidies are referred to child protective services (CPS) at differential rates compared to children whose families receive cash assistance alone. Method: Using unique IDs, we linked TANF, childcare, and CPS records. We identified a cohort of
children born between 2016 and 2020 whose families were associated with a cash assistance record and followed them longitudinally through 2021. Using logistic regression, we estimated the odds of being referred to CPS after starting cash assistance conditional on childcare subsidy.
Results: Of 323 children with cash assistance, half received childcare subsidies (n = 157, 48.6%) and one third (n = 102, 31.6%) had a CPS referral. Adjusted regression results indicate that childcare subsidies were associated with increased odds of a CPS referral after cash assistance. Conclusions: In our study cohort of cash assistance recipients, children who received childcare subsidies were more likely to be reported to CPS compared to their peers. We explore explanations for this finding.
Antenatal care (ANC) is a means to identify high-risk pregnancies and educate women so that they might experience a healthier delivery and outcome. There is a lack of evidence about whether receipt of ANC is an effective strategy for keeping women in the healthcare system so they partake in other maternal and child interventions, particularly for poor women. The present analysis examines whether ANC uptake is associated with other maternal and child health behaviors in poor mothers in Guatemala, Honduras, Nicaragua, and Mexico (Chiapas). We conducted a cross-sectional survey of women regarding their uptake of ANC for their most recent delivery in the last two years and their uptake of selected services and healthy behaviors along a continuity of maternal and child healthcare. We conducted logistic regressions on a sample of 4844 births, controlling for demographic, household, and maternal characteristics to understand the relationship between uptake of ANC and later participation in the continuum of care. Our results demonstrate that uptake of the WHO-recommended four ANC visits has limited effectiveness on later uptake of services in some poor populations in Mesoamérica. Our study highlights the need for continued and varied efforts in these populations to increase both the uptake and the effectiveness of ANC in encouraging positive and lasting effects on women’s uptake of health care services.