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

questions?ehornste@usc.edu