Risk Factors for Serious Child Maltreatment in Families Investigated By CPS: A Case Control Study

Background and Purpose:  Children living in families with prior maltreatment allegations have between 3-5.9 times greater risk of fatality due to maltreatment.  Identifying characteristics of families in which serious subsequent child maltreatment occurs may guide the development of improved risk assessment tools to aid child welfare workers in determining which families are at greatest risk, requiring more intensive services and intervention.  The aim of this study is to determine if differences in characteristics exist between families investigated by child protective services (CPS) in which a child suffered from a serious child maltreatment event due to physical abuse (PA) or neglect compared to families previously investigated by CPS whose children did not experience that outcome. 

Methods:  A matched case control study was conducted of children less than 6 years of age who sustained a serious maltreatment ‘index event’, defined as hospitalization or death due to PA or neglect, and whose caregiver had a previous ‘baseline’ CPS investigation between 1999 and 2013.  Controls had to have a prior CPS investigation, yet no child in the home could have experienced an index event.  Controls were matched on child age at index event and date of the caregiver’s baseline investigation.  Potential risk factors such as family composition, caregiver mental health and alcohol or other drug (AOD) utilization, criminal arrests, domestic violence, Structured Decision Making® (SDM) risk assessment score, and prior CPS history were abstracted for both maternal and non-maternal caregivers from three county databases. 

Differences in demographic characteristics and risk factors between cases and controls were calculated. Multivariable conditional logistic regression was used to arrive at maternal and non-maternal caregiver models to identify risk factors associated with serious child maltreatment.

Results:  Of the 702 children and families included in the study, 234 were cases which were matched 2:1, resulting in 468 controls.  Conditional multivariable logistic regression found that variables associated with increased risk for serious maltreatment included male child gender, more than three children under 5 years of age living in the home, families in which at least one biologic child was not living with a primary caregiver (either by court order of voluntary family arrangement), younger caregivers, decreased housing stability, caregiver mental health utilization, increased number of CPS reports for non-maternal caregivers, and scoring above ‘low risk’ on the SDM or not having a risk assessment completed.  Identification of maternal involvement in intimate partner violence (IPV) significantly reduced the odds of serious maltreatment (OR=0.7; 95% CI: .49-.98) and protected against the outcome. 

Conclusions and Implications:  There were significant differences in the characteristics of households where there was a subsequent report of serious maltreatment.   When assessing risk of future incidents of serious maltreatment, CPS workers should pay special attention to young caregivers, those with mental health issues, housing instability, and instances where more than two children under the age of 5 years live within a home or a biologic child is not living with a primary caregiver.  Interventions put in place when IPV is identified are likely successful in preventing serious child maltreatment.