October 4, 2010
Child Maltreatment Investigations Not Associated With Improvements In Household Risk Factors
Household investigations for suspected child maltreatment by Child Protective Services may not be associated with improvements in common, modifiable risk factors including social support, family functioning, poverty and others, according to a report in the October issue of Archives of Pediatrics and Adolescent Medicine, one of the JAMA/Archives journals.
"A Child Protective Services (CPS) investigation, regardless of outcome, signals a household at risk," the authors write as background information in the article. "In the years following CPS investigation, households are at increased risk for family violence and parental dysfunction, for child medical and behavioral problems, and for future incidents of maltreatment when compared with households not investigated by CPS."
Using data from the Longitudinal Studies of Child Abuse and Neglect, Kristine A. Campbell, M.D., M.Sc., of the University of Utah, Salt Lake City, evaluated a total of 595 children between the ages of 4 and 8 to evaluate if a CPS investigation for suspected child maltreatment is associated with subsequent improvements in household, caregiver and child risk factors. The authors used data from interviews conducted with the children's maternal caregiver first when the child was 4 years old and again at age 8.
Of the 595 children included in the study, 164 (27.6 percent) had a CPS investigation occur between the first and second interviews. Those in the investigated group experienced an average of 2.2 CPS investigations (with a range between one and nine investigations) during the time of the study. The investigation occurred an average of 18.7 months prior to the interview conducted at 8 years. Additionally, the investigations "resulted in at least one substantiated finding of child maltreatment between the interviews at ages 4 and 8 years in 74 investigated subjects (45.1 percent)."
The authors also found that during the interview at age 4, households of children in the investigated group had lower family function and more poverty than households of non-investigated children. Maternal caregivers of investigated children were older, had less education and had more depressive symptoms than caregivers of children in the comparison group. Investigated children also were more likely to be white and to have had previous CPS investigation. Analysis of interviews conducted at age 8 found that a CPS investigation was associated with higher levels of poverty, maternal depressive symptoms and child behavior problems.
The findings "identified no significant difference in social support, family function, poverty, maternal education and child behavior problems associated with CPS investigation. Maternal depressive symptoms were worse in households with a CPS investigation compared with those without an investigation." Based on these findings, the authors conclude that this study "provides an important perspective on the association between a CPS investigation for suspected child maltreatment and subsequent household, caregiver and child risk. Our finding that CPS investigation is not associated with improvements in common, modifiable risk factors suggests that we may be missing an opportunity for secondary prevention."
(Arch Pediatr Adolesc Med. 2010;164:943-949. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: Child Protective Services Has Outlived Its Usefulness
"The concept of Child Protective Services (CPS) was idealistic when it first came into being in the early 1970s," writes Abraham B. Bergman, M.D., of the University of Washington and Harborview Medical Center, Seattle, in an accompanying editorial. "Initially the task of identifying non-accidental trauma was relatively straightforward because it was the classic 'battered child' that was among most frequent diagnoses."
"Much has changed in the child welfare field over the past 40 years, notably the types of child maltreatment seen and the explosive growth of the foster care system," Dr. Bergman continues. "How has CPS responded to these changed responsibilities? Not well, according to this study by Campbell and colleagues in this issue of the Archives."
"This gloomy prognosis notwithstanding, the changed picture of child maltreatment in the United States demands, at the very least, that we begin a wide-ranging discussion and testing of alternative responses."
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