Prevention and Post-Investigation Service Need and Utilization

Objective:

Millions of children across the U.S. are reported to Child Protective Services agencies (CPS) for suspected child abuse and neglect annually and a substantial number of them receive home-based, post-investigation services (HBPS) to prevent future maltreatment. In 2013, an estimated six million children were reported of whom nearly 1.2 million children received HBPS because they were safe enough to remain at home but still at risk of abuse and/or neglect (USDHHS, 2013). CPS agencies target family need after a child abuse investigation through the provision of an array of services including concrete, educational, and clinical services. However, the scant research that exists indicate that HBPS may address concrete need related to poverty but may not adequately meet clinical need related to domestic violence and substance abuse. In response, we aim to understand the “fit” between family need and post-investigation service utilization by using multiple indicators of need among a large and diverse sample of families after their first CPS investigation.

Methods:

The sample consisted of 2,723 families with children who remained at home after an initial CPS investigation between July 2006 and December 2010. Eligible families had a child 5 or younger, an unfounded or inconclusive CPS investigation, and were assessed to be at moderate to high risk of future maltreatment.  Multiple indicators were utilized to measure three types of family need (concrete, clinical, and educational need), and families received one or more of the following HBPS: concrete, educational, and clinical services.  Caregiver demographics consisted of ethnicity, age, education, household income, number of caregivers, number of children, and history of abuse.  Bivariate chi-2 analyses were utilized to identify significant demographics and family needs for inclusion in a final multivariate model that regressed significant areas of need per service type while controlling for demographics.

Results:

Concrete need related to financial conditions was most often met with concrete services (OR=2.31; 95% CI=1.71, 2.63), educational need related to child development was met with educational services (OR=1.37; 95% CI=1.05, 1.77), and clinical need related to emotional stability and aggression/anger was met with clinical services, (OR=1.81; 95% CI = 1.37, 2.41) and (OR=1.35; 95% CI = 1.03, 1.76), respectively. In addition, uncooperative caregivers with clinical need related to cooperation (i.e., they were uncooperative) were less likely to receive clinical services (OR = 0.68; 95% CI = 0.53, 0.89). Clinical need related to substance abuse and depression was not associated with clinical services.

Conclusions/Implications:

The provision of various HBPS to families at-risk of maltreatment continues to be an important role of CPS agencies in collaboration with community-based organizations. Many caregivers received needed concrete services and clinical services addressing emotional stability and anger/aggression. However, caregivers with clinical need related to depression and substance abuse do not appear to be receiving adequate services, so social workers should spend extra time assessing and engaging caregivers with clinical need. Results from this study highlight the complexity of addressing family need with voluntary services after a CPS investigation, especially for uncooperative caregivers needing educational and clinical services.