Predictors of Childhood Injury in Children Reported to Child Protective Services: The Need for ACEs-Informed Care

Purpose: Adverse childhood events (ACEs), such as child maltreatment, have been shown to result in negative health outcomes throughout an individual’s life. Previous research has found that children with a prior allegation of maltreatment die due to unintentional injuries at twice the rate of children who were not reported to Child Protective Services (CPS). While death is one outcome of injury, a large number of unintentional injuries do not result in death. Over 6.9 million children in 2010 were treated for a nonfatal injury in an Emergency Department. The purpose of this study is to conduct a secondary analysis of Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) data and examine predictors of injury in children whose family has been reported to CPS utilizing the ecological-developmental framework theoretical domains which guided LONGSCAN: maltreatment risk of history, child characteristics, family/parent characteristics, parental and family functioning, extrafamilial relationships, community ecology, child outcomes, and systems of care factors.

Methods: LONGSCAN is a consortium of five sites located across the U.S. that each conducted a longitudinal study focusing on the etiology and impact of child abuse utilizing multiple sources including interviews with children, their parents, and their teachers. Variables of interest at age 6 included those from the Neighborhood Risk Assessment, School Safety Questionnaire, Life Events Scale for Children, and several more. Data collected between ages 7 and 11 were utilized to assess if the participant at age 6 was later injured during their childhood. This analysis utilized a sample of 473 children who had been reported to CPS. The majority of the sample was English speaking (98.66%) and slightly over half of the sample was female (50.11%). Children were predominately black (40.17%) or white (34.04%).

Results: The bivariate analysis revealed that children who were injured between the ages of 5 and11, were more likely at age 6 to know someone who died in the previous year (χ2 = 7.82, p<.05), have repeated a grade (χ2 = 6.27, p<.05), have developmental issues (χ2 = 3.80, p<.05), not recognize or appropriately respond to cues of ending a conversation (χ2 = 8.47, p<.01), always have a good place to play in their neighborhood (χ2 = 12.69, p<.01), and have used educational services (χ2 = 3.78, p<.05) than children who were not injured between the ages of 5 and 11. The logistic regression model, for the extrafamilial relationships domain, showed that the likelihood of childhood injury significantly increased for those who did not recognize or appropriately respond to cues of ending a conversation (OR=.39). For the community ecology domain, the odds of being injured as a child were significantly higher for those who always have a good place to play in their neighborhood (OR=1.46).

Implications: This study supports the need for social workers to practice evidence-based ACEs-informed care interventions when working with children experiencing ACEs. Understanding the predictors of injury is necessary to implement interventions targeting the unique needs of this vulnerable population and increase awareness of prevention strategies to reduce childhood injuries.