Child Maltreatment Reports As a Tool to Locate and Provide Early Intervention

Background and Purpose: Young children are particularly vulnerable to untoward outcomes from abuse and neglect because early childhood is a critical period for brain development. Recurring maltreatment heightens this risk of negative outcomes. Research points to the need for effective health and mental health intervention at the earliest possible stage.  The questions become, how do we locate these children and, once located, can we engage them in services? This presentation illustrates the use of administrative data to identify missed opportunities and the translation of findings into a real world approach to intervention.  Data are presented from two NIMH-funded research projects; (1) A longitudinal and multi-system funded study of services and outcomes for children reported for maltreatment, and (2) a resulting translational study aimed at preventing ongoing maltreatment and cognitive and emotional disability by engaging families in early intervention services. Questions were: Can administrative data be used to find gaps in services and identify vulnerable children early?  If we can use such data as a signal for need, can we engage families in services?

Methods: Administrative data from birth records, health and mental health records, emergency room records, child abuse and neglect reporting, child welfare services, income assistance, juvenile court, and special education were linked and examined prospectively to identify critical periods and warning signs for intervention.  The sample includes low-income children first reported for maltreatment prior to the age 5 in a large Midwestern metropolitan region (n=2,932). Next, process data for 98 children and 118 caregivers are presented from “Early Childhood Connections”, a project created in response to the missed opportunity to intervene identified with young children reported to child protective services.

Results: Study 1: Data clearly identified a high-need population with significant delays in services. Over 66% of children had allegations of neglect. Nearly 30% of children reported prior to 12 months entered foster care and 48% had later mental health treatment.  One in three children reported prior to age four had a later delinquency petition and 39% received special education services. Intervening after a first report was rare. Between 33 and 47% of mental health treatment encounters occurred after 4 reports.  Although few received services before age five, between 46 and 52% of children who received in-home or foster care services had at least 4 prior reports. Translational study: The aims of the translational study were to engage families of very young children (under 2.5 years) with first contact with child welfare with available in-home parenting services, and determine if these services could help moderate untoward outcomes. 75 families were engaged with a specialized warm handshake protocol with 75 usual-care controls. While obtaining referrals was problematic, once referred the consent rate was about 90%.  Number of ongoing visits with families has varied greatly by home visitor. 

Conclusions and Implications: This translational study indicates strong potential for using administrative data to identify opportunities for the targeted linkage of early childhood services. Implications for early intervention with young families contacting child welfare are discussed.