Maltreatment Referrals Involving Caretakers with Mental Illness: What Keeps Their Children Safe in the Home?

Background: Preventing and intervening on child maltreatment is a national priority.  Maltreatment is associated with psychiatric disorder and lower educational and occupational achievement.  Approximately 30% of new maltreatment cases involve parents with mental illness, and children of these parents face triple the odds of serious child welfare involvement and out-of-home placement.  However, this population is notoriously under-researched, and little is known about the protective factors that keep their children safe in the home when they are referred for maltreatment.  Short of this knowledge, systems of care may be unable to effectively address the elevated risk of custody loss among parents experiencing mental illness.  Our study responds to this service gap by empirically identifying factors that protect against the decision that children of caretakers experiencing mental illness are unsafe in the home.

Methods: The study analyzed data from 990 Structured Decision Making (NCCD, 2015) safety and risk assessment pairs administered in 2011 in one urban county in a large western state.  The safety assessment measures 13 threats to child safety and 10 protective factors, including capacity to participate in interventions, and ability to make use of resources and supports.  Moderation analysis was used to measure the main and interactive effects of protective factors on the relationship between caretaker mental illness and a protection worker’s decision whether or not a child was safe in the home.  Covariates included significant child medical or mental disorder and presence of physical abuse allegations.

Results: Twenty percent of all caretakers reported ever having mental illness, and their estimated odds of an unsafe safety decision were nearly four times those of caretakers with no history of mental illness (OR=3.19, p<0.001).  Although cumulative number of protective factors predicted lower estimated odds of unsafe safety decision overall (OR=0.87, p=0.001), it was not a significant moderator of the effect of caretaker mental illness on safety decision.  Individually, only one protective factor (willingness to accept assistance from supports) interacted significantly with caretaker mental illness (LR test chi2(1) = 5.23, p=0.022), reducing the predicted probability of an unsafe safety decision by an estimated 65%.

Implications: We found that the willingness of caretakers experiencing mental illness to accept assistance from supports significantly protected against their children being deemed unsafe in the home.  When serving families affected by caretaker mental illness, child welfare workers may find that encouraging caretakers to accept assistance from support networks may help to prevent more serious child welfare involvement.  However, that only one of ten factors analyzed was identified as significantly protective speaks to how little we know about reducing risk of out-of-home placement in this population.  Further protective factor research has the potential to inform practice that better serves caretakers experiencing mental illness, thereby reducing risk of out-of-home placement and supporting the healthy development of their children.