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CPS records able to identify children at risk of maltreatment, death
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Children at high risk of maltreatment can be identified effectively through prior encounters with child protective services and are significantly more likely to experience both intentional and unintentional injury-related death as well as sudden infant death syndrome.
”The early identification of children at risk for maltreatment using linked administrative data and predictive risk models has been shown to be both theoretically possible and practically feasible,” Rhema Vaithianathan, PhD, from the Center for Social Data Analytics at Auckland University of Technology, Auckland, New Zealand, and colleagues wrote. “The richness of administrative data coupled with advances in technology mean that computerized predictive risk models can be deployed to cost-effectively screen entire populations of newborns.”
To examine if a predictive risk model could effectively recognize young children at high risk of maltreatment, injury and mortality, the researchers developed a model that was used in New Zealand for children born in 2011. Children were considered high risk if placed in the top 10% of scores for maltreatment. The researchers also assessed outcomes when high risk was defined as the top 20% of scores. Both groups were compared with children of lower risk in the population.
Of the children born in 2011 in New Zealand, those who were born to a single mother (88.2% vs. 23.0%), a mother aged younger than 20 years (26.7% vs. 6.1%) and into a household with increased parenting demand (30.7% vs. 6.6%) were more likely to be at high risk of verified maltreatment (top 10%). Children who have been involved or were currently involved with child protective services (CPS) were more frequently placed as very high risk when compared with the entire cohort.
Additionally, more than one in two children at very high risk were born to a mother who was reported to CPS as a child (53.8% vs. 10.1%), and nearly one in five children at very high risk of maltreatment was born 1 year after an older sibling was reported to CPS (20.1% vs. 2.1%).
Mothers of children who were at increased risk of verified maltreatment were more likely to collect welfare (76.3% vs. 13.9%), were more likely to have received a criminal sentence up to 5 years before birth (25.6% vs. 3.8%) and more frequently had a record of mental health concerns (36.6% vs. 8.5%). Results were similar for children in the top 20% of the cohort.
Children recognized in the top 10% by this model were 4.8 times more likely to experience infant mortality (95% CI, 3.2-7.2), and most were unintentionally injured during the postneonatal period. Those identified at very high risk were 9.9 times more likely to experience mortality compared to all other children in the cohort (95% CI, 4.2-23.3%) and accounted for 57.1% of all unintentional deaths. The risk ratio for children experiencing injury-related deaths was 9.0 overall (95% CI, 3.9-20.7) and was 8.5 for children experiencing sudden unexpected infant death (SUID; 95% CI, 4.4-16.5).
Of all mortalities experienced in this group, nearly 43% of injury-related deaths and approximately 50% of children who experienced SUID scored in the top 10% for risk of maltreatment. Comparable results were observed regarding mortality for those in the top 20% of the cohort.
“Determining the true prevalence of childhood abuse and neglect is inherently difficult because what constitutes maltreatment varies over time and by cultural norms,” Vaithianathan and colleagues wrote. “Although administratively recorded substantiations by CPS are a ‘noisy’ and inexact approximation of maltreatment subject to detection bias, our findings document that CPS records can be used as the target variable for predictive models designed for use in child maltreatment prevention efforts.” – by Katherine Bortz
Disclosure: The authors report no relevant financial disclosures.
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