Do Home-Based Prevention Services After an Initial Child Abuse Investigation Matter? Post-Investigation Outcomes of At-Risk Children

Objective:

Each year, about 6 million children are referred to a local Child Protective Services (CPS) agency because of alleged child abuse or neglect.  In 2010, approximately 700,000 children were victimized, more than 200,000 children were removed from their families, and over 4 million children received a post-investigation services response with the remaining children receiving no services at all.  For the children who remain at home, they are offered home-base prevention services that target factors associated with future maltreatment risk. Despite decades of research, knowledge of long-term safety and permanency outcomes for children whose families receive these services remain inconsistent.  In response to this gap, the present analysis examined the relationship among various post-investigation outcomes following an initial CPS investigation and compared them by post-investigation service response, Community-Based versus CPS-Based.

Method:

The sample consisted of 23,137 children whose families received their first CPS investigation between July 2006 and April 2011.  To be included in the analysis, four additional criteria must have been met: (1) the child referred for maltreatment must have been age five or younger, (2) the CPS referral must have resulted in an unfounded or inconclusive finding, (3) an assessment of risk must have indicated moderate or high risk of future maltreatment, and (4) the child must not have been placed in out-of-home care. Our analyses describes post-investigation outcomes in the aggregate and then compares the outcomes by post-investigation service response. For this analysis, we compared outcomes for children whose families received (a) Community-Based prevention services (n=6,323), (b) CPS-Based prevention services (n=555), and children who received neither the Community-Based nor CPS-Based prevention services (n=16,259).  We used Chi-square analysis to test bivariate associations among the three service response groups and multivariate logistic regression analysis to examine predictors of the likelihood of post-investigation outcomes.   

Results:

Most families did not receive a post-investigation response (70%).  Among those who did, 27.5% received Community-Based prevention services and 2.5% received CPS-Based prevention services.  Nearly half the children in the sample were re-referred for suspected maltreatment, a little more than 25% had a substantiated re-referral, approximately 16% had a case opened, and 12% were placed in out-of-home care.  In general, children whose families received either Community-Based or CPS-Based prevention services had fewer re-referrals, substantiations, case openings, and out-of-home placements than children who received neither response. At the multivariate level, receiving Community-Based prevention services was associated with a reduced risk of re-referral (OR=.74; 95%CI=.70-.79) and child placement (OR=.57; 95%CI=.52-.63) but a slightly elevated risk of substantiation and case opening.   Receiving CPS-based prevention services was not significantly associated with re-referral or substantiation but was significantly associated with a marked increase in the risk of child placement (OR=1.85; 95%CI=.1.51-2.26). 

Conclusions/Implications:

These findings highlight the complexities of providing prevention and postinvestigation services as well as the disparate postinvestigation outcomes by service type and ethnicity.  The results suggest that receiving prevention services after an initial CPS investigation might be associated with some beneficial outcomes but that more research is needed to unravel these complexities.