Child Welfare. 2008; 87(3): 143-62
Jones BL, Royse D

Citizen Review Panels (CRPs) for Child Protective Services are groups of citizen-volunteers throughout the United States who are federally mandated to evaluate local and state child protection systems. This study presents a profile of 332 CRP members in 20 states with regards to their demographic information, length of time on the panel, and attitudes regarding the variables that promote and hinder collaboration between the panels and state child welfare agencies. Results indicate that the average review panel member tends to be a professional, middle-aged female with an advanced degree. Better communication (between child protective services and the CRPs) and clearer goals/objectives for CRPs were the most cited suggestions of how CRPs and child welfare agencies can work together. Lack of funding and the defensiveness of the child welfare agency were seen as the top obstacles to such collaboration. Policy implications and avenues of further study are discussed.

J Am Acad Child Adolesc Psychiatry. 2010 May; 49(5): 464-73
Proctor LJ, Skriner LC, Roesch S, Litrownik AJ

To identify trajectories of behavioral adjustment from age 6 through 14 years for youth placed in early foster care, and to examine links between trajectories and early cognitive ability and social competence, caregiver stability, and frequency, timing, and type of maltreatment.Participants were 279 youth from the Southwest site of the Consortium for Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). All youth had spent at least 5 months in out-of-home care before age 4 years because of substantiated reports of maltreatment. Behavioral adjustment was assessed using caregiver reports on the Child Behavior Checklist at ages 6, 8, 10, 12, and 14. Cognitive ability and social competence were assessed at age 6. Caregiver stability was recorded every 2 years from age 6 through 14 years and summed. Child protective services (CPS) maltreatment reports were coded for type and frequency.Growth mixture modeling identified three internalizing trajectories: stable adjustment (66.7%), mixed/decreasing adjustment (25.4%), and increasing adjustment (7.9%). Four externalizing trajectories were identified: stable adjustment (46.6%), mixed adjustment (28.7%), increasing adjustment (8.2%), and stable maladjustment (16.5%). Trajectories of stable or increasing adjustment were predicted by social competence, cognitive ability, placement stability, and low frequency of physical abuse from ages 6 through 14.Many youth who have spent time in early out-of-home care evidence stable, long-term positive behavioral adjustment. Trajectories reflecting more positive adjustment are associated with early child cognitive ability and social competence, long-term caregiver stability, and low frequency of physical abuse in middle childhood and adolescence.

Child Welfare. 2009; 88(3): 127-44
Ringstad R

This paper describes a study that explored the extent and nature of workplace violence in child protective services (CPS). A total of 68 workers and clients reported on their experiences. Of workers, 70% reported being the victim of client violence, and 22% reported they had perpetrated a violent act toward a client. Of clients, 55% reported being a victim of assault by a CPS worker, while 42% acknowledged perpetrating violence. Future research needs and recommendations for practice including training, reporting, and policy development are discussed.

Inj Prev. 2011 Feb; 17 Suppl 1: i28-33
Quan L, Pilkey D, Gomez A, Bennett E

Drowning is second cause of paediatric injury death in Washington State. Child death review (CDR) data provide the unique opportunity to identify regional risk factors and opportunities for drowning prevention.CDR teams' data for drowning deaths of children

Child Welfare. 2009; 88(4): 77-111
Weinberg LA, Zetlin A, Shea NM

This multiple-case study examines interagency collaboration between child protective services (CPS), local education agencies (LEAs), and other public agencies in seven California counties. These agencies were provided technical assistance to remove barriers impeding the education of children in foster care and improve their educational outcomes. Results of this study suggest that making changes to remove educational barriers for foster children and improve their educational outcomes requires successful collaboration between CPS and LEAs and strong leadership within at least one of the agencies.

J Interpers Violence. 2011 Jul; 26(10): 2042-72
Kaufman JS, Ortega S, Schewe PA, Kracke K,

The Safe Start demonstration projects, funded by the Office of Juvenile Justice and Delinquency Prevention (OJJDP) under the first phase of the Safe Start initiative, are primarily designed to influence change at the systems or macrolevels to reduce the incidence of and impact of exposure to violence for children aged birth to 6 years; direct services are also provided to young children and their families who were exposed to violence. The data presented in this article come from 10 communities that submitted data regarding the characteristics of young children exposed to violence to OJJDP. These data represent families who are typically not represented in the databases of state child protective services programs but instead have been identified by domestic violence advocates, early care and education providers, family members, court personnel, police, and other social service personnel as families with young children in need of intervention due to violence exposure.The purpose of this article is to describe the characteristics of young children and their parents who seek help for psychosocial problems related to exposure to family and community violence. Results indicate that one quarter of the children and nearly half of their parents evidenced clinical levels of stress, suggesting the need to intervene at the family level as well as at the individual level when working with young children exposed to violence. The information presented, including the extent of exposure to violence, the multiple types of violence to which children are exposed, the impact of this exposure on young children and their families, and the multiple ways in which families exposed to violence come to the attention of service providers is useful for policy makers and service providers who are interested in breaking the cycle of violence by meeting the needs of the children exposed to violence and their families.

Child Maltreat. 2011 Nov; 16(4): 287-99
Stacks AM, Beeghly M, Partridge T, Dexter C

This study describes the developmental trajectories of language skills in infants with substantiated maltreatment histories over a 5-year period and evaluates the effect of three different custodial placements on their language trajectories over time: in-home (remaining in the care of the biological parent/parents), nonkin foster care, and nonparental kinship care. Participants included 963 infants reported to child protective services prior to their first birthday and whose maltreatment was substantiated. Results from covariate-controlled growth modeling revealed no significant placement effects. Across all groups, children's auditory and expressive communication scores decreased significantly from Wave 1 (intake) in the infants' first year to Wave 4, when children were about 3.5 years of age, then improved to baseline levels by Wave 5, when children were about 6 years old. Despite these fluctuations, children's average language scores in each placement group remained below the population mean at each wave of the study.

Child Maltreat. 2010 Nov; 15(4): 282-92
Conley A, Duerr Berrick J

Traditionally, the American child welfare system intervenes in cases of evident and severe maltreatment. Families in need of help, but who have not reached a crisis, are excluded from typical services. Some suggest that if these families were served, few would be rereferred to the child welfare system. California's Differential Response (DR) has three tracks, of which ''Track 1'' targets families screened out of child protective services (CPS) and refers them to agencies that provide voluntary, home-based services and referrals. This study examined child-welfare trajectories for families receiving Track 1 DR services in one California county. Using survival analysis, treatment group children (N = 134) were compared to children eligible for services but denied due to program capacity (comparison group N = 511). Findings suggest no statistically significant differences between groups on the likelihood of a re-report following program participation, timing of maltreatment reports, or report investigations. The ability to draw strong conclusions from this study, however, is limited by selection bias because prior child maltreatment reports were more common in the treatment group. The intervention may provide families with important supports, but evidence for maltreatment prevention may not be supported. Future studies should examine potential effects on a range of family domains.

MMWR Morb Mortal Wkly Rep. 2008 Apr 4; 57(13): 336-9

During October 2005-September 2006 (federal fiscal year 2006), approximately 905,000 U.S. children were victims of maltreatment that was substantiated by state and local child protective services (CPS) agencies. Approximately 19% of child maltreatment fatalities occurred among infants (i.e., persons aged

J Health Care Poor Underserved. 2009 Aug; 20(3): 748-55
Chisolm DJ, Scribano PV, Purnell TS, Kelleher KJ

Children in out-of-home placements (foster children) often undergo multiple placement changes while under the care of child protective services. This instability can result in lack of health care continuity and poor health outcomes. This brief describes the development of a medical history profile, or passport, developed from Medicaid administrative data. A purposive sample of 25 youths was provided from a county child protective services agency. The patients were systematically matched with data from the state Medicaid agency. Using Medicaid claims/encounter data we generated health care profiles that provided information on historical use of ambulatory care, diagnoses, providers seen, medications used, and inpatient admissions. However, profiles were limited by missing provider information and non-specific diagnostic coding. Despite these limitations, Medicaid data-based profiles show the potential to be a cost efficient method for improving continuity of care for children in out-of-home placement.

J Public Health Manag Pract. 2011 Nov-Dec; 17(6): 542-9
Smith LR, Gibbs D, Wetterhall S, Schnitzer PG, Farris T, Crosby AE, Leeb RT

Reducing the number of largely preventable and tragic deaths due to child maltreatment (CM) requires an understanding of the magnitude of and risk factors for fatal CM and targeted research, policy, and prevention efforts. Public health surveillance offers an opportunity to improve our understanding of the problem of CM. In 2006, the Centers for Disease Control and Prevention (CDC) funded state public health agencies in California, Michigan, and Oregon to implement a model approach for routine and sustainable CM surveillance and evaluated the experience of those efforts.We describe the experiences of 3 state health agencies in building collaborations and partnerships with multiple stakeholders for CM surveillance.Qualitative, structured key informant interviews were carried out during site visits as part of an evaluation of a CDC-funded project to implement a model approach to CM surveillance.Key informants included system stakeholders from state health agencies, law enforcement, child protective services, the medical community, and child welfare advocacy groups in the 3 funded states.Factors that facilitated stakeholder engagement for CM surveillance included the following: streamlining and coordinating the work of Child Death Review Teams (CDRTs); demonstrating the value of surveillance to non-public health partners; codifying relationships with participating agencies; and securing the commitment of decision-makers. Legislative mandates were helpful in bringing key stakeholders together, but it was not sufficient to ensure sustained engagement.The engagement process yielded multiple benefits for the stakeholders including a deeper appreciation of the complexity of defining CM; a greater understanding of risk factors for CM; and enhanced guidance for prevention and control efforts. States considering or currently undertaking CM surveillance can glean useful insights from the experiences of these 3 states and apply them to their own efforts to engage stakeholders.

Child Abuse Negl. 2010 Jun; 34(6): 396-402
Palusci VJ, Wirtz SJ, Covington TM

To (1) test the use of capture-recapture methods to estimate the total number of child maltreatment deaths in a single state using information from death certificates, child welfare reports, child death review teams, and uniform crime reports; and to (2) compare these estimates to the number of maltreatment deaths identified through an in-depth "gold standard" review.Child maltreatment deaths were identified in four existing administrative data sources: (1) death reports in our state vital statistics (DC); (2) child death review team reports (CDR); (3) homicide reports filed by our state police agency as uniform crime report (UCR) supplements for the FBI; and (4) abstracted reports of a minor's death from our state child protective services (CPS) agency. Capture-recapture pair-wise and pooled comparisons were then applied to estimate the numbers of abuse and total maltreatment deaths and were compared to the number of cases identified by independent case review.There were a total of 194 child maltreatment deaths in Michigan during 2000-2001 with 66 due to physical abuse. Capture-recapture analysis estimated the mean number of total child maltreatment deaths as 101.02 (95%CI=92.52, 109.53), with abuse deaths of 64.55 (60.85, 68.25). Most pair-wise and pooled comparisons worked equally well for abuse deaths, but estimates for total child maltreatment deaths were low.Capture-recapture methods applied to existing administrative datasets produced accurate estimates of child abuse deaths but were not useful in producing reliable estimates of total child maltreatment deaths due to undercounting neglect-related deaths in all existing administrative data sets. The underlying assumptions for capture-recapture methods were not met for neglect deaths. Local and/or state teams conducting ongoing intensive case review may yet remain the best way to identify the total number of child maltreatment deaths.Capture-recapture methods allow for more accurate estimation of the true number of child physical abuse deaths than does using single existing sources of child fatality information, but deaths from causes other than abuse are undercounted. Child maltreatment fatality surveillance requires a systematic process and standard criteria for identifying cases of maltreatment, particularly neglect-related child deaths.

Am J Orthopsychiatry. 2011 Jul; 81(3): 327-36
Shapiro AF, Krysik J, Pennar AL

Despite substantial research documenting the importance of father-child relations, little is known about fathers in families considered at risk for child abuse, and this lack of information makes adequate targeting of fathers in interventions challenging. This research aims to provide information that will aid interventions in targeting fathers and addressing father-related family issues through: (a) providing descriptive information regarding fathers in families at risk for child abuse, and (b) examining aspects of family well-being relative to father involvement. Analyses were conducted on mother-report data in families eligible for the Healthy Families Arizona prevention program (N = 197). Results indicated that although only 15% of parents in the sample were married, 47% of families had resident fathers, and 77% of fathers had some contact with their new babies. Families with greater father involvement had better prenatal care, higher incomes, less maternal involvement in Child Protective Services, less physical domestic violence (DV), and greater maternal mental health reflected through less loneliness. These findings have implications for targeting nonresident as well as resident fathers in families at risk for child abuse and for exploring DV issues in families with noninvolved fathers.

Pediatrics. 2009 Mar; 123(3): 858-64
Dubowitz H, Feigelman S, Lane W, Kim J

Effective strategies for preventing child maltreatment are needed. Few primary care-based programs have been developed, and most have not been well evaluated.Our goal was to evaluate the efficacy of the Safe Environment for Every Kid model of pediatric primary care in reducing the occurrence of child maltreatment.A randomized trial was conducted from June 2002 to November 2005 in a university-based resident continuity clinic in Baltimore, Maryland. The study population consisted of English-speaking parents of children (0-5 years) brought in for child health supervision. Of the 1118 participants approached, 729 agreed to participate, and 558 of them completed the study protocol. Resident continuity clinics were cluster randomized by day of the week to the model (intervention) or standard care (control) groups. Model care consisted of (1) residents who received special training, (2) the Parent Screening Questionnaire, and (3) a social worker. Risk factors for child maltreatment were identified and addressed by the resident physician and/or social worker. Standard care involved routine pediatric primary care. A subset of the clinic population was sampled for the evaluation. Child maltreatment was measured in 3 ways: (1) child protective services reports using state agency data; (2) medical chart documentation of possible abuse or neglect; and (3) parental report of harsh punishment via the Parent-Child Conflict Tactics scale.Model care resulted in significantly lower rates of child maltreatment in all the outcome measures: fewer child protective services reports, fewer instances of possible medical neglect documented as treatment nonadherence, fewer children with delayed immunizations, and less harsh punishment reported by parents. One-tailed testing was conducted in accordance with the study hypothesis.The Safe Environment for Every Kid (SEEK) model of pediatric primary care seems promising as a practical strategy for helping prevent child maltreatment. Replication and additional evaluation of the model are recommended.

J Pediatr Psychol. 2011 Dec 13;
Woods SB, McWey LM

OBJECTIVE: To further test the validity of the Biobehavioral Family Model (BBFM), a biopsychosocial approach to explaining the effects of family processes on illness, by testing the model with adolescents with asthma involved in child protective services (CPS), a sample for whom the model's constructs are highly relevant. METHODS: Data are from the National Survey of Child and Adolescent Well-Being, CPS sample (n = 5,501). Adolescents with asthma (n = 101, ages 11-15 years) self-reported their negative family emotional climate (NFEC; caregiver psychological aggression and caregiver relationship quality), caregiver-adolescent relational security, and depressive symptoms. Caregivers rated adolescent health quality. Models were tested using path analyses and bootstrapping. RESULTS: Path analyses and bootstrapping results demonstrate support for the BBFM in explaining health quality for this sample. CONCLUSIONS: Applying the BBFM to families involved with CPS demonstrates pathways by which family processes affect health quality of adolescents with asthma, underscoring the need for biopsychosocial assessments and services.

Child Maltreat. 2011 Feb; 16(1): 41-50
Lindhiem O, Bernard K, Dozier M

In this study, we examined within-person variability in maternal sensitivity among a culturally diverse sample of high-risk mother-infant dyads (N = 25). We also examined incremental increases in effect sizes between maternal sensitivity and two related variables, attachment state of mind and child removal from the home, as a function of increasing observations of maternal sensitivity. The dyads were videotaped during 10 1-hour-long home visits and maternal sensitivity was coded using the abbreviated (25-item) version of the Maternal Behavior Q-Sort (MBQS). Attachment state of mind was assessed using the Adult Attachment Interview (AAI). Within-person variability in maternal sensitivity was greater for nonautonomous mothers compared to autonomous mothers. Mothers who were relatively low in maternal sensitivity were more likely to be nonautonomous and also more likely to have their child removed from their home by child protective services. Results from data sampling trials showed incremental increases in these effect sizes as the number of observations of maternal sensitivity increased. Fewer observations of maternal sensitivity resulted in systematic underestimates of effect sizes between maternal sensitivity and related variables. We discuss the implications for maltreatment researchers and interventionists.

Pediatrics. 2008 Apr; 121(4): 725-31
Kotch JB, Lewis T, Hussey JM, English D, Thompson R, Litrownik AJ, Runyan DK, Bangdiwala SI, Margolis B, Dubowitz H

The goal was to examine the association between early childhood neglect (birth to age 2 years) and later childhood aggression at ages 4, 6, and 8 years, compared with aggression's associations with early childhood abuse and later abuse and neglect.A prospective cohort of 1318 predominantly at-risk children, recruited from 4 US cities and 1 southern state, were monitored from birth to 8 years of age. Maltreatment was determined through review of local child protective services records. A hierarchical, linear model approach, a special case of general, linear, mixed modeling, was used to predict aggressive behavior scores, as reported by the child's primary caregiver at ages 4, 6, and 8 years.Only early neglect significantly predicted aggression scores. Early abuse, later abuse, and later neglect were not significantly predictive in a controlled model with all 4 predictors.This longitudinal study suggests that child neglect in the first 2 years of life may be a more-important precursor of childhood aggression than later neglect or physical abuse at any age.

Acad Pediatr. 2011 Nov-Dec; 11(6): 460-6
Sege R, Flaherty E, Jones R, Price LL, Harris D, Slora E, Abney D, Wasserman R,

This study examined the validity of primary health care providers' (PHCPs) assessment of suspicion that an injury was caused by child abuse and their decision to report suspected child abuse to child protective services (CPS).By using a subsample of injuries drawn from the 15,003 childhood injuries evaluated in the Child Abuse Recognition and Evaluation Study, PHCPs completed telephone interviews concerning a stratified sample (no suspicion of abuse; suspicious but not reported; and suspicious of abuse and reported) of 111 injury visits. Two techniques were used to validate the PHCPs' initial decision: expert review and provider retrospective self-assessment. Five child abuse experts reviewed clinical vignettes created by using data prospectively collected by PHCPs about the patient encounter. The PHCPs' opinions 6 weeks and 6 months after the injury-related visits were elicited and analyzed.PHCPs and experts agreed about the suspicion of abuse in 81% of the cases of physical injury. PHCPs did not report 21% of injuries that experts would have reported. Compared with expert reviewers, PHCPs had a 68% sensitivity and 96% specificity in reporting child abuse. A PHCP's decision to report suspected child abuse to CPS did not reduce the frequency of primary care follow-up in the 6 months after the index visit. PCHPs received information from their state CPS in 70% of the reported cases.Child abuse experts and PHCPs are in general agreement concerning the assessment of suspected child physical abuse, although experts would have reported suspected abuse to CPS more frequently than the PHCPs. Future training should focus on clear guidance for better recognition of injuries that are suspicious for child abuse and state laws that mandate reporting.

Child Abuse Negl. 2009 Apr; 33(4): 218-28
Connell CM, Vanderploeg JJ, Katz KH, Caron C, Saunders L, Tebes JK

This study examined risk of maltreatment among children exiting foster care using a statewide sample of children reunified between 2001 and 2004 in Rhode Island. The objectives were: (1) to compare rates of maltreatment following parental reunification for youth in care as a result of maltreatment with those in care for other reasons; and (2) to assess the effects of child, family, and case characteristics on rates of re-maltreatment among children placed in foster care due to maltreatment.A longitudinal dataset of all reunified cases was matched with state records of substantiated Child Protective Service (CPS) investigations. Two Cox proportional hazards models were tested. The first model compared rates of subsequent maltreatment for two groups: children in foster care as a result of maltreatment, and those in care for other reasons. The second model investigated the effects of child, family, and case characteristics on re-maltreatment rates for those in care as a result of maltreatment.Children in foster care due to maltreatment were significantly more likely to be maltreated following reunification. Among children in foster care due to maltreatment, factors that raised risk for re-maltreatment included a previous foster care placement, exiting care from a non-relative foster home, and removal due to neglect. Older adolescents had lower rates of re-maltreatment than infants. Child neglect was the primary type of recurrent maltreatment that occurred following reunification.Supports are needed for families about to be reunified, particularly when the removal was prompted by incidents of abuse or neglect. Incidents of neglect are particularly likely and appropriate services should specifically target factors contributing to neglect. Cases involving youth with a history of repeated foster care placement or in which non-relative placements are utilized may need additional supports.This study suggests that services should be developed to minimize the risk for recurrent maltreatment following reunification. Services would be most useful for high-risk cases prior to reunification and during the first year following reunification. Understanding the risks associated with maltreatment will help guide development of appropriate interventions.

Child Welfare. 2010; 89(4): 67-82
Risley-Curtiss C, Zilney LA, Hornung R

Inclusion of certain aspects of animal-human relationships (AHR), such as animal abuse and animal-assisted interventions, can enhance child welfare practice and there are resources available to promote such inclusion. However, there is little knowledge of whether this is being accomplished. This study sought to fill this gap by conducting a national survey of state public child welfare agencies to examine AHR in child protective services practice, their assessment tools, and cross-reporting policies.