Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page 25
4
Social Trends and Child
Maltreatment Trends
Key Points Raised by Individual Speakers
American families have been undergoing major changes in demo-
graphic structure, economic status, and health care coverage, all of
which can influence child maltreatment.
Many sources of data point to a substantial reduction in the incidence
of child physical and sexual abuse, but not neglect, over the past two
decades.
The causal factors behind changes in child maltreatment rates are
difficult to untangle, but an increased emphasis on prevention may
be responsible for the reduction in physical and sexual abuse.
Despite some positive trends, pockets of severe unmet need continue
to exist throughout the United States.
Multiple sources of data on child maltreatment are available, each
with strengths and weaknesses. Four speakers at the workshop explored
these various sources of data, thereby providing a valuable context for
the other workshop presentations. Data on child maltreatment also can be
compared with data on broad social trends to probe the causes and con-
sequences of child abuse and neglect. This chapter examines the broad
relationships between social trends and child maltreatment trends, while
the next chapter looks at more specific causes and consequences.
25
OCR for page 26
26 CHILD MALTREATMENT RESEARCH, POLICY, AND PRACTICE
SOCIAL TRENDS AND THEIR IMPLICATIONS
FOR UNDERSTANDING RATES OF CHILD
MALTREATMENT
Broad social and economic factors can influence trends in child mal-
treatment. The connection between the two is difficult to ascertain be-
cause of the uncertainties in the data and the complex causal relationship
factors that contribute to maltreatment. Nevertheless, it is important to
monitor and probe social trends to explore their possible effects on child
maltreatment, said Christina Paxson, dean of the Woodrow Wilson
School of International and Public Affairs and the Hughes Rogers Pro-
fessor of Economics and Public Affairs at Princeton University. Under-
standing these trends can indicate what might happen in the future as
social and economic influences continue to change and can shape the
research agenda to anticipate these changes.
Demographic Structure of American Families
American families look much different today than they have in the
past. In the 1950s, only about 5 percent of U.S. births were to unmarried
women. After a steady increase over the past five decades, that number is
today approximately 40 percent (Ventura, 2009). This does not mean that
children are living in households without men, said Paxson. Slightly
more than 50 percent of children who are born to unmarried women live
with parents who are cohabiting, and these relationships are often stable.
Nevertheless, the increase in unmarried births has focused the attention
of researchers on what happens in these families. For example, children
who are born to unmarried women, whether cohabiting or not, experi-
ence a greater frequency of transitions in living arrangements within their
households. They are more likely to live with nonbiological fathers, and
they are more likely to have step-siblings in a household. “How do these
different family structures influence children?” asked Paxson.
Longitudinal data are needed to understand how family structure is
related to maltreatment, said Paxson. Such data can reveal the family
transitions that have happened over time, how such transitions affect the
attachment of parents to children, and the types of risks to which children
are exposed. “This is an important area for research and one that is ne-
cessitated by the continuing trends that we see in the structure of Ameri-
can families,” Paxson said.
Another notable change has been in the birth rate for teenagers in the
United States, which has dropped by approximately 50 percent for all
OCR for page 27
27
SOCIAL TRENDS AND CHILD MALTREATMENT TRENDS
U.S. women ages 15-19 since 1970, reducing such births from a high of
about 600,000 in 1970 to about 400,000 today (Ventura and Hamilton,
2011). Research has suggested that children born to teenage parents are
at higher risk of maltreatment, and in that respect the decline in teen
births is a “good news story,” said Paxson. The reasons for this drop are
contentious because they involve such issues as the provision of birth
control and sex education for teens. But the drop provides an opportunity
for research to examine how changes in U.S. fertility patterns may have
influenced rates of child maltreatment.
Economic Status of American Families
The poverty rate among children is higher than for any other age
group in the United States. This rate has varied between about 25 and 15
percent over the past half-century, with a movement upward over the
past few years to about 22 percent in 2010 (DeNavas-Walt et al., 2011).
The percentage of children with unemployed parents has also gone up in
recent years, to about 9 percent in 2011. Increases in caseloads under the
Supplemental Nutrition Assistance Program grew from 9 percent of
Americans in 2007 to 14 percent in 2011, though growth of caseloads
under the Temporary Assistance for Needy Families program has been
slower (Isaacs, 2011).
Poverty is an important factor in child maltreatment, said Paxson,
and poverty has been worsening. One way to learn more about the effects
of poverty on child maltreatment would be to look at the uneven effects
of the recession on different parts of the United States. “This will be a
good opportunity to look at how economic factors influence maltreatment.”
Health and Health Care
The fraction of poor children without health insurance has been
dropping in recent years—from 23 percent of children below 200 percent
of the poverty line in 1997 to 12 percent in 2009—even as the percentage
of children without health insurance above this income level has re-
mained fairly stable (at about 5 percent) (HHS, 2011). This decrease,
made possible largely through Medicaid and state children’s health in-
surance programs, has been another success story, said Paxson.
The Affordable Care Act will further change access to health care by
providing more adults with health insurance. This change may provide
an opportunity to deal with some of the physical and mental health prob-
lems among adults that can contribute to child maltreatment, though
OCR for page 28
28 CHILD MALTREATMENT RESEARCH, POLICY, AND PRACTICE
many of these adults will be covered by state Medicaid programs that
may have limited resources to deal with such issues as substance abuse
and mental health.
In particular, substance abuse is an important factor in child mal-
treatment. Recent trends have seen a slight increase in marijuana use,
while cocaine use is down slightly (SAMHSA, 2011). “A continuing fo-
cus on substance abuse in adults who are parents or could become par-
ents is important,” said Paxson.
Fiscal Capacity of Governments
Projections of the fiscal capacity of governments to support children
and families point to “a really difficult time,” according to Paxson. Over
the past 20 years, funding to support at-risk families has shifted from
state and local budgets to federal budgets (CBO, 2011). This may pro-
vide insulation from the budgetary ups and down of state and local budg-
ets, but over the next few decades, federal expenditures could be severely
constrained. Support for children and families, as well as for research on
children and families, is very likely to be squeezed.
A major factor in the fiscal constraints at the federal level is the pro-
jected increase in healthcare spending. This is ironic, said Paxson, be-
cause in essence the federal government will be putting more resources
into health care and less into programs to support the health and well-
being of American families. Paxson suggested thinking hard about how
to use Medicaid as a vehicle for the prevention and treatment of child
maltreatment. The constrained fiscal outlook also calls for the develop-
ment of cost-effective primary prevention models, sophisticated tools to
assess the risk for secondary maltreatment (maltreatment in addition to
another kind of trauma identified as the primary descriptor for the situa-
tion, e.g., domestic violence), and better methods for tracking and moni-
toring high-risk families.
Child maltreatment imposes large costs on society in terms of pre-
vention, treatment, legal fees, foster care, and other expenditures, Paxson
stated, in addition to the costs to children. “Adding in these other costs is
important because it helps make the case that this is an issue that we need
to pay attention to.”
OCR for page 29
29
SOCIAL TRENDS AND CHILD MALTREATMENT TRENDS
DATA SOURCES FOR UNDERSTANDING CHILD
MALTREATMENT
Andrea Sedlak, a vice president of Westat, described the major data
sources used to assess national levels of child maltreatment and trends
over time.
National Child Abuse and Neglect Data System
The National Child Abuse and Neglect Data System (NCANDS) is a
data system created in response to the requirements of the Child Abuse
Prevention and Treatment Act (CAPTA). NCANDS centralizes the an-
nual collection, tracking, and analysis of child maltreatment information
as reported to CPS agencies in each of the 50 states, the District of Co-
lumbia, and the Commonwealth of Puerto Rico. In the early 1990s, states
submitted NCANDS data as aggregated counts. Since the mid- to late
1990s, NCANDS has been converting to a case-level data submission
system, which now encompasses 51 of the 52 jurisdictions.
NCANDS seeks to obtain a full census annually. States use their own
definitions and codes to classify cases and then map their state codes into
the NCANDS codes by agreed-upon rules. The original codings come
from workers in local agencies who use their state’s system, and these
codings are eventually reflected in the NCANDS data.
NCANDS data provide rich information, Sedlak observed. They
provide the numbers of screened-in versus screened-out referrals, report
dispositions, the sources of reports to CPS agencies, response times, and
CPS workforce and caseload levels. They classify child victims by mal-
treatment type, sex, age, race, ethnicity, disability status of the child,
caregiver domestic violence, and caregiver alcohol or drug abuse. They
report on fatalities, perpetrators of maltreatment, and services the cases
have received.
NCANDS classifies maltreatment into six categories: physical abuse,
sexual abuse, neglect, medical neglect, psychological maltreatment, and
other. NCANDS also provides indicators of compliance with federal
mandates on the absence of maltreatment recurrence, the absence of mal-
treatment in foster care, and first-time victims.
National Incidence Study
The NIS, which is also mandated by CAPTA, is conducted approxi-
mately once every decade under a contract from the Administration for
OCR for page 30
30 CHILD MALTREATMENT RESEARCH, POLICY, AND PRACTICE
Children and Families. It seeks to estimate broadly the national incidence
of maltreatment through both investigated and noninvestigated cases of
child abuse and neglect. The NIS collects and categorizes data according
to standardized definitions for types of child maltreatment, the severity
of maltreatment, and key demographic characteristics of maltreated chil-
dren and their families.
The NIS began with definitions for the Harm Standard in 1979-1980
and modified definitions for the Endangerment Standard in NIS-2 in
1986. The Harm Standard definitions are stringent in requiring that a
child already have experienced demonstrable harm from abuse or neglect
before they could be counted in NIS estimates. The Endangerment
Standard includes children who were endangered by the events of abuse
or neglect that they experienced.
Unlike NCANDS, which is a census-based approach, the NIS uses a
representative sampling of counties. The latest cycle (NIS-4) collected
data from a nationally representative sample of 122 counties in 2005 and
2006. Information gathered in each county includes CPS data, but it also
includes cases seen by individual sentinels, or community representa-
tives, in public schools, public health departments, public housing, juve-
nile probation, law enforcement, hospitals, day care centers, shelters, and
other institutions.
Also unlike NCANDS, which relies on the states’ definitions of
abuse and neglect, the NIS applies standardized definitions to case de-
tails. Its reports include the numbers and rates of maltreated children by
maltreatment type; child victims by sex, age, race/ethnicity, disability,
and school enrollment; family characteristics by employment, socioeco-
nomic status, family structure and living arrangement, grandparent care-
givers, family size, and metropolitan status of residence area; perpe-
trators’ characteristics; and maltreated children by the sources recogniz-
ing their maltreatment.
“We obtain narrative descriptions of what happened to this child,”
Sedlak explained. “Who did it? What have you seen in terms of injuries?
What were the actions or omissions going on? What else was going on?”
These reports are then evaluated in the terms of the standardized defini-
tions that the NIS applies to classify maltreatment events, injuries, and
circumstances.
The maltreatment classification has eight overarching categories:
physical abuse, sexual abuse, emotional abuse, physical neglect, educa-
tional neglect, emotional neglect, other maltreatment, and maltreatment
OCR for page 31
31
SOCIAL TRENDS AND CHILD MALTREATMENT TRENDS
that is not countable in the NIS. These eight categories encompass 60
separate codes that describe the nature of the maltreatment.
In addition, the NIS provides detailed information about CPS inves-
tigation rates by maltreatment type and recognition source, CPS agency
structure and practices related to investigation rates, CPS screening poli-
cies related to uninvestigated children, and sentinel training and reporting
of maltreatment.
Other Data Sources
The Adoption and Foster Care Analysis and Reporting System
(AFCARS) is a database of all case-level information on foster children
under the care of state child welfare agencies, including information on
foster and adoptive parents. States are required to submit AFCARS data
on a semi-annual basis to the ACF, which uses the data to inform a varie-
ty of initiatives.
AFCARS does not focus on abuse or neglect, but it includes the rea-
son for a child’s removal into foster care, such as physical abuse, sexual
abuse, neglect, and other potential reasons. Many states can now link
their NCANDS case-level data with AFCARS data to provide indicators
of maltreatment recidivism in foster care. Unfortunately, said Sedlak, this
system does not support tracking individual children across years.
Finally, Statewide Automated Child Welfare Information Systems
(SACWISs) are in place in 36 states, with 3 in development and the other
states using non-SACWIS models. SACWISs are comprehensive auto-
mated case management tools. States use their SACWIS data to provide
NCANDS and AFCARS reports.
From Data to Knowledge
Both the NIS and NCANDS reveal national trends. NCANDS pro-
vides annual trends, including trends in report sources, dispositions, re-
sponse times, and overall victimization rates. The NIS shows long-range
trends over 7- to 12-year periods in overall maltreatment and in major
maltreatment categories. It also provides significant changes in victimi-
zation rates (overall and by category) for subgroups (by child and family
characteristics).
However, NCANDS does not provide trends by maltreatment type,
although this information can be extracted from the raw data. Sedlak
urged that these important trends be part of the national analysis and dis-
tribution of the data, rather than having individual researchers extract the
OCR for page 32
32 CHILD MALTREATMENT RESEARCH, POLICY, AND PRACTICE
trends from the data. The NIS does not report trends in specific subforms
of maltreatment, though again more information can be extracted from
the data.
In NCANDS, states’ varied definitions of maltreatment can affect
trend statistics. By contrast, the NIS directly codes case-level descrip-
tions of maltreatment through notes and narratives. NCANDS loses some
maltreatment event information, whereas uninvestigated maltreatment is
filtered through sentinels’ observations in the NIS. Changes in sentinels’
processes can affect trend statistics, so NIS-4 established baselines to
calibrate these changes. An analysis done by Sedlak and her colleagues
showed the NIS found more multiple-maltreated children than NCANDS
sees from its CPS sources. “When you are using something for case
management, you suffice in terms of your coding,” she said. “But we are
losing stuff because of that, or we are not seeing it. It is buried.”
Future Opportunities to Enhance Use of Data Sources
Important uncertainties surround the meaning of findings from
NCANDS and NIS, said Sedlak. NCANDS makes little effort to under-
stand the findings in relation to agency policy or administrative practice.
Administrative changes in a few states that drive an overall trend are bur-
ied in appendixes or brief summary notes, with no analysis of trends. In
contrast, NIS has improved on this. The NIS-4 had included supplemen-
tary studies of CPS agencies’ organization, practices, and policies and
analyses to relate those results to the overall NIS results on investigation
rates and uninvestigated children. For example, analyses have found
lower rates of investigation in places that relied on referrals being filtered
through hotlines. “Things like that that are important to know about how
your practice [and] your policy may be affecting what you are seeing . . .
and how successful you are in reaching maltreated children,” said
Sedlak.
A major problem is that the findings from these data sources are not
being well disseminated, Sedlak stated. States hardly use, publicize, or
even know about their own NCANDS data trends. Many states do not
use or know how to use their SACWIS data to examine patterns in case-
loads, to compare to other systems’ data, to make sense of policy chang-
es, or to make other improvements. Federal clearance processes
introduce extensive delays in releasing reports on important findings, not
just in HHS, but in other departments as well.
National systems provide data on maltreated children, but they do
not regularly collect data on representative samples of both maltreated
OCR for page 33
33
SOCIAL TRENDS AND CHILD MALTREATMENT TRENDS
and nonmaltreated children to see how the risk of maltreatment varies
across settings and time periods. Nor are maltreatment data in other sys-
tems being used or improved. For example, the National Crime Victimi-
zation Survey interviews individuals ages 12 and older about their
criminal victimization experiences every 6 months, repeating these inter-
views for 3 years. Adding proxy interviews on victimization of younger
children could provide victimization data for all ages. Surveys with chil-
dren as young as 9 have been comprehensive, and tools exist for measur-
ing self-reports of neglect in very young children using picture
methodologies on computer-assisted systems.
Another missed opportunity is the National Incident-Based Report-
ing System, which provides detailed information about crimes known to
police, including injuries, offenders, and victims. Codes that show
whether law enforcement referred to CPS or vice versa and designating
offenders as caretakers or noncaretakers when victims are children would
provide a rich database on maltreatment.
Finally, Sedlak observed, no one knows how many children in the
United States are sexually abused or assaulted. Law enforcement data
cannot now be compared with NCANDS, NIS, or other data sources to
arrive at this number. “Given that this is such an important policy issue,
it is alarming to realize that we don’t know and we have no plans for get-
ting” this information. In addition, the other victimization experiences
children undergo, such as abduction by family and nonfamily members,
peer victimization, and dating violence, are largely undetected. Many
children are traumatized in multiple ways that do not come under the
jurisdiction of CPS agencies. “Without understanding that, we really
can’t understand what we need to do to intervene,” Sedlak concluded.
Discussion
During the discussion session, Bernard Guyer from Johns Hopkins
University raised several issues about the underlying theory of measure-
ment in the field of child maltreatment. Distinguishing incidence and
prevalence could make a big difference in looking at trends. Similarly, is
maltreatment an acute disease or a chronic disease? Once children have
been maltreated, are they maltreated for life? How are children seen in
multiple places for maltreatment tallied? Finally, he asked whether
changes in birth cohorts could account for the decline in abuse seen in
national data.
Sedlak responded that the NIS gives just period prevalence rates,
while NCANDS also gives the period rate and numbers for the children
OCR for page 34
34 CHILD MALTREATMENT RESEARCH, POLICY, AND PRACTICE
investigated over the course of the year. She also said that NCANDS and
NIS make efforts to deduplicate cases through data matching and model-
ing, and that considerable work has been devoted to improving the relia-
bility of individual data sources.
Richard Barth, University of Maryland, pointed to the use of vital
statistics such as birth records as a source of population information. By
linking birth records with other administrative data, important infor-
mation could be uncovered more quickly than in planned longitudinal
studies.
CHANGES IN RATES OF REPORTED CHILD
ABUSE AND NEGLECT
Lisa Jones, a research associate professor of psychology at the Uni-
versity of New Hampshire’s Crimes Against Children Research Center,
described one of the more notable—and contentious—data points dis-
cussed at the workshop.
Evidence for a Decline in Physical and Sexual Abuse
NCANDS data indicate a steady decline in physical abuse and sexual
abuse over the past two decades (Figure 3). According to these data, sex-
ual abuse has declined by 62 percent since 1990, while physical abuse
has declined by 56 percent. Neglect also has declined, but by much
less—just 10 percent since 1992. These data embody “one of the most
interesting and important events that have occurred in the epidemiology
of child maltreatment,” said Jones.
NCANDS data come from CPS agencies across the country and rep-
resent substantiated cases of maltreatment. Jones noted that the declines
are seen across the entire country, not just in a few states.
Some have expressed concerns that state and local finances or work-
er caseloads might be affecting CPS agencies in such a way that fewer
child maltreatment reports are being indicated or substantiated. However,
Harvard School of Public Health researchers explored this possibility and
found no evidence to support this (Almeida et al., 2008). Instead, they
found evidence that supports “a true decline in incidence of substantiated
child sexual abuse cases during the latter part of the 1990s” (p. 373). Fur-
thermore, research by Jones and colleagues (2001) found no evidence
that less severe abuse and neglect dropped more than severe types of mal-
treatment, which would be expected if CPS agencies were triaging cases.
OCR for page 35
35
SOCIAL TRENDS AND CHILD MALTREATMENT TRENDS
95
Rate per 10,000 Population <18 Years
85
Neglect: 10% decline
75
65
55
Physical Abuse (x2): 56% decline
45
35
Sexual Abuse (x3): 62% decline
25
Year
FIGURE 3 Substantiated cases of maltreatment compiled by NCANDS,
1990-2010.
SOURCE: Jones, 2012.
Other data sources such as the NIS support the trends seen in
NCANDS data. Between NIS-3 in 1993 and NIS-4 in 2005, sexual abuse
was down 44 percent and physical abuse was down 23 percent, even
though the sentinel data in the NIS come from a different source than the
NCANDS data.
Self-reported data from a school survey in Minnesota with 6th-, 9th-,
and 12th-graders show a decline of 28 percent in children reporting sex-
ual abuse and 20 percent in children reporting physical abuse from 1992
to 2010. Similarly, the National Crime Victimization Survey shows de-
clines in juvenile sex victimization of 52 percent between 1993 and
2005.
Many correlates of child maltreatment show remarkably similar
trends. Teen birth rates underwent a 48 percent decline from 1994 to
2009, youth runaways rates were down 66 percent from 1994 to 2009,
teen suicide declined 43 percent from 1994 to 2007, teen drug use was
OCR for page 36
36 CHILD MALTREATMENT RESEARCH, POLICY, AND PRACTICE
down 27 percent between 1997 and 2007, and domestic violence fell 60
percent from 1993 to 2005. “What is remarkable and convincing about
these trends is that we are not talking about just one data source, but ex-
tremely similar trend patterns coming from many different studies and
sources,” said Jones.
Possible Explanations for the Decline
Jones suggested several possible explanations for the declines. One
possible source could be economic fluctuations. The greatest declines
occurred in the 1990s, when the United States was going through a rela-
tively positive economic phase, with a slower decline in the past decade.
However, throughout the past decade, and even in the recent recession,
rates of physical abuse, sexual abuse, and neglect have continued to fall.
“This suggests that we need to look for other explanations,” Jones said.
An “optimistic possibility” is that the tremendous amount of work
done in the past several decades to prevent child maltreatment is having
an effect. An observation supporting this idea is that sexual abuse de-
clined first and then physical abuse. Sexual abuse received a lot of atten-
tion during the 1980s and early 1990s through, for example, prevention
programs in schools and increased protection efforts in youth programs
like the Boy Scouts. There is a possibility, said Jones, that these efforts
had an effect on maltreatment.
Also starting in the late 1980s and increasing in the 1990s, the crimi-
nal justice system became more involved in child abuse and domestic
violence. Consistent with the trend patterns, this involvement centered
more on sexual abuse and physical abuse and less on neglect. “It may be
that the increased incarceration and prosecution of offenders is having a
direct effect,” Jones said. “It may also be having a preventive effect as it
conveys the idea that these are serious crimes and that it is something
that officials take seriously.”
Better mental health and trauma treatment may have reduced child
maltreatment by reducing intergenerational transmission. In addition,
access to psychopharmacological medication to treat depression and anx-
iety may have had an effect.
Finally, Jones pointed to something less measurable: cultural norms
around caring for and protecting children. These may have improved as
researchers learned more about what children need. “On a national level,
some of that information [may have] gotten through to families in a way
that decreases the amount of maltreatment that we have been seeing.”
OCR for page 37
37
SOCIAL TRENDS AND CHILD MALTREATMENT TRENDS
Contrasting Indicators
Jones also cited two indicators from the child welfare data that do
not track the declines in sexual and physical abuse—neglect and child
fatalities. The much smaller decline in neglect may indicate that these
cases are harder to prevent and treat. Alternatively, a decline in child ne-
glect may not be showing up in the data because of changes in defini-
tions and increased awareness of the problem. As support for this
possibility, NIS data found reduced levels of physical and educational
neglect from 1993 to 2005. But a category called emotional neglect un-
derwent a dramatic increase. Researchers have found that this increase
was explained partly by an increase in the reporting of situations where
children were witnessing domestic violence and were in households ex-
posed to drug use. Shifting standards for the sentinels reporting on ne-
glect may explain these findings and mask what would otherwise be a
decline in neglect in recent decades.
Child maltreatment fatalities have increased since 1993, according to
NCANDS data. However, other child homicide data from the FBI and
other sources show declines in child fatalities. The data seem to indicate,
said Jones, that states are changing how they count child maltreatment
fatalities and how they are delivering that information to NCANDS.
Future Opportunities to Use Data
Jones urged that the data available today be used more effectively.
NCANDS and NIS data provide critical public health information on
child maltreatment trends, but this information is being underused. The
Children’s Bureau needs to publicize these data more effectively to help
professionals, media, and the public learn about and understand trends.
Also, delays in the release of NIS data have been troublesome and
have limited awareness about and impact of the findings that come from
those data.
Finally, more funding and research focused on epidemiological ap-
proaches to child maltreatment can reveal what is working so that inter-
ventions have an even greater effect than they have had in the past.
Discussion
The reliability of the data sources demonstrating a reduction in mal-
treatment rates were discussed throughout the workshop. Putnam said he
and his colleagues have seen dramatic increases in maltreatment in recent
years that are not being counted by data systems. For example, in Ohio in
OCR for page 38
38 CHILD MALTREATMENT RESEARCH, POLICY, AND PRACTICE
2010, just three of the seven children’s hospitals in the state reported 90
cases of inflicted head injury to CPS, yet the state’s SACWIS reported
just 10 cases for the same period. He asked, “How do we do better public
health surveillance? . . . How do we get a much better system that actual-
ly tracks what is happening not only at the state level, but at the commu-
nity level where we can intervene with preventative interventions?”
Sharon Newburg-Rinn from the Children’s Bureau raised the issue of
whether the increased use of differential response systems, which are
described in Chapter 7, could account for part of the drop in victimiza-
tion rates.
Leventhal pointed to data on hospitalizations of children that are col-
lected by all hospitals and are available through the Kids’ Inpatient Da-
tabase. Child abuse codes in that database are another way of examining
the occurrence of serious injuries to children due to abuse. According to
those data, he added, serious injuries of hospitalized children did not de-
cline from 1997 to 2009, in contrast to the NCANDS data.
CHILD MALTREATMENT REPORTING
PRACTICES AND PATTERNS
Melissa Jonson-Reid, a professor of social work and director of the
Brown Center for Violence and Injury Prevention at the George Warren
Brown School of Social Work, Washington University, discussed some
of the complications in the systems used to detect, report, measure, and
respond to child maltreatment.
First, she observed, different criteria lead to very different estimates
of the numbers of children subject to maltreatment. Using the more in-
clusive endangerment standard, NIS-4 arrives at a maltreatment inci-
dence of about 1 in every 25 children. Using official report data collected
by the states, NCANDS arrives at a figure of roughly 1 in 10 children as
alleged victims of maltreatment. In contrast, considering only victims
with substantiated reports brings the single-year count down to about 1 in
100 children.
However, Jonson-Reid took issue with the substantiation standard.
“Using substantiation or the level of harm standard as an indicator that
maltreatment has occurred or not in resource or policy is simply not a
good idea,” she said. Many children in the unsubstantiated category are
facing situations of equal risk. The substantiation standard was created as
a decision-making point in child welfare. Substantiation or something
OCR for page 39
39
SOCIAL TRENDS AND CHILD MALTREATMENT TRENDS
like it may be needed to guide decisions to refer to court, but in other
situations meaningful measures should be used that can be mapped onto
the need for services. In addition, Jonson-Reid said, the use of only sub-
stantiated cases in research can be misleading if unsubstantiated cases are
included in the controls.
Changing Definitions
National data systems have made important advances since 1992,
Jonson-Reid observed. However, state-level definitions of maltreatment,
requirements for services, and designation of professions required to re-
port undergo continual change can complicate these measures. For ex-
ample, as national measures of child maltreatment were declining over
the past decade, reports were increasing in the state of Oregon. National
studies of child maltreatment reporting and response need to be large
enough to control for state policy, researchers need to look at state-level
changes, or uniform national standards need to be adopted. “We have a
long way to go in coming to a consensus about what we mean by mal-
treatment from place to place and how best to measure it in relation to
child well-being,” she said.
Prevalence Estimates
Jonson-Reid also looked more closely at several existing prevalence
estimates. According to Finkelhor et al. (2005), about 1 in 7 children be-
tween the ages of 2 and 17 were victims of child maltreatment during a
1-year time frame. Estimates of prevalence among low-income popula-
tions were even higher. In the Cleveland area, life-table estimates indi-
cated that 49 percent of African American children and 21 percent of
white children would be subjects of reports of alleged child abuse or ne-
glect by their tenth birthday (Sabol et al., 2004). In a California study,
about one-third of African American children were reported by their fifth
birthday compared to less than 15 percent for other ethnic groups. Chil-
dren born to lower income families had a rate of referral over 2.5 times
higher than others (Putnam-Hornstein et al., 2011)—as high as 1 in 2.
Jonson-Reid also noted that mandated reporters do not receive standard-
ized training and, as a result, the level of understanding of what is to be
reported varies widely across districts.
Jonson-Reid and colleagues (2009) examined whether such results
are influenced by reporting bias as opposed to reflecting significant need.
Examination of different kinds of reports across groups indicates that the
OCR for page 40
40 CHILD MALTREATMENT RESEARCH, POLICY, AND PRACTICE
effects of bias are limited and that “there are pockets of unmet need in
our country, which in various respects should not be of particular sur-
prise.” This finding in turn affects consideration of whether the reporting
system should be limited or expanded. Families should not be over-
identified based on biases unrelated to maltreatment. On the other hand,
families that need services should not be underreported to avoid bias.
Data from a variety of sources suggest that the majority of families re-
ported to CPS have service needs, said Jonson-Reid. “I have difficulty
with thinking about shrinking what we have as the surveillance system,”
she concluded.
The reporting system could be expanded by increasing the pool of
mandated reporters or by increasing the types of reports considered mal-
treatment. However, if people are categorized as needing services, those
services should be available to them, Jonson-Reid argued. Today, rough-
ly one-third of the children with screened-in reports in CPS get some
kind of intervention, and most of those interventions consist only of as-
sessments or low-intensity case management approaches, which typically
depend on referrals to other sources. “My concern in expanding the sys-
tem at this point is that we are already underresourced and if we move it
to a broader level, we ought to be thinking about how we also expand
those resources.”
Measurement Issues
Some types of maltreatment classifications are extremely useful,
Jonson-Reid observed. Unmet medical needs or the occurrence of sexual
abuse demand responses. But in moving from immediate needs to longer-
term well-being, definitions of maltreatment become less clear. For ex-
ample, research indicates that neglect can have consequences as dire as
those associated with physical or sexual abuse. Furthermore, many chil-
dren experience more than one type of maltreatment. Research continues
to explore whether certain types or combination of types of maltreatment
are useful in informing responses.
Severity and the need for services raise other measurement issues.
For example, initial gatekeeping points are sometimes confused with as-
sessment of severity. In Missouri, which uses a highly structured and
computerized decision-making process, many more cases are screened in
than in other states. As a result, the child welfare population may be very
different in different places. Also, it is problematic to have recurrence be
part of how severity is measured as this means that a first report of mal-
treatment must have much higher levels of other harm to be considered
OCR for page 41
41
SOCIAL TRENDS AND CHILD MALTREATMENT TRENDS
severe than a second or third report of maltreatment. The resulting con-
cern is that this tends to delay intervention until after several CPS con-
tacts.
In general, most child welfare assessments are linked to safety and
permanence and less so to well-being. Few child welfare systems have
universal screening for other indicators of need such as a young child’s
developmental status or the presence of a mental health disorder. “While
much more attention has been paid to documenting outcomes, we are less
clear about ways to triage,” said Jonson-Reid. “This means consideration
of harm apart from safety in the context of developmental timing, family,
and community resources.”
Communication Among Systems
Finally, many of the children and families who come to the attention
of CPS are already engaged in multiple systems. For example, in re-
search Jonson-Reid has done, 25 to 30 percent of children already had
contacts in special education or mental health treatment prior to coming
into the system. When these children are followed over time, they have
high rates of emergency room use, juvenile delinquency, and so on.
The fact that these systems rarely “talk” to each other prevents re-
searchers and service providers from better understanding these families,
hinders cross-sector coordination and policy planning, and damages the
ability to estimate costs. Jonson-Reid said that integrated data systems
are needed to facilitate planning, contribute to cost estimates, and help
measure system-relevant outcomes.
Discussion: Data Lags
Several speakers raised the issue of how to get data from national
systems more quickly. “How do we get a system that is current for child
maltreatment?” asked Putnam. “We wouldn’t accept a 2-year lag for flu
cases or Salmonella.”
Jones agreed that the 2-year lag is “terrible” and should be improved.
But she also observed that the data systems have gotten better—for ex-
ample, by providing more disaggregated data. One need, as Jonson-Reid
pointed out, is for data systems that can work together. Today, criminal
justice data, CPS data, and medical data are not coordinated. Paxson
added that a shortcoming of the NIS is that it is done periodically. “We
wouldn’t monitor influenza every 5 years.” Computer technologies could
do continuous tracking of sentinels, which would provide more continu-
OCR for page 42
42 CHILD MALTREATMENT RESEARCH, POLICY, AND PRACTICE
ous data. In addition, household-level data are needed to go beyond the
population data from NCANDS and NIS.
Sharon Newburg-Rinn from the Children’s Bureau described some
of the difficulties in getting data processed and released quickly, such as
delays in court process and in the substantiation of reports. However,
recommendations from researchers to speed the process could have an
effect, she said.
