Caregiver Physical Health Issues and Maltreatment: An Exploration

Background/ Purpose: Research has identified a link between health problems in adulthood and adverse experiences across the life course including early trauma and socioeconomic disadvantage (Almeida et al., 2005; Danese et al., 2009; Schurr & Green, 2004), factors that also increase the risk of abusive or neglectful parenting behaviours (Pears & Capaldi, 2001).  While research has explored the influence of child physical health issues on maltreatment dynamics, few studies have examined the impact of parental health problems on abusive and neglectful caregiving. The purpose of this analysis is to explore the characteristics of child welfare investigations involving caregivers with physical health issues and to determine whether these families are more likely to receive services.

Methods: Using a sample of 5,265 maltreatment-related investigations from the Ontario Incidence Study of Reported Child Abuse and Neglect 2013, we conducted descriptive and bivariate chi-square analysis to explore the characteristics of investigations involving a caregiver with physical health issues. Regionalization and annualization weights were applied to generate annual provincial estimates resulting in a total weighted sample of 125,281 investigations. Logistic regression was used to predict transfer to ongoing services.

Results: Seven percent (an estimated 8,187 investigations) of maltreatment-related investigations noted physical health problems for the primary caregiver. Most of these caregivers with physical health issues were biological parents (89% or an estimated 7,299 investigations), however 7% were grandparents (an estimated 572 investigations). Caregivers with physical health issues were significantly more likely to be grandparents compared to caregivers without these issues (chi-square=58.70, p<.001).

Caregiver physical health issues commonly co-occurred with other risk factors such as mental health issues, substance abuse, cognitive impairments, few social supports, and a history of foster care/group home. In addition, caregivers with physical health issues were more likely to live in conditions of socioeconomic disadvantage. Children of caregivers with physical health problems also struggled with issues such as depression, attachment issues, intellectual/developmental disabilities, and academic difficulties. Over one-third of investigations involving a caregiver with physical health issues focused on allegations of neglect (35% or an estimated 2,831 investigations), while over one-quarter of investigations involved a concern about the risk of future maltreatment (26% or an estimated 2,101).

Caregiver physical health issues significantly predicted the decision to transfer an investigation to ongoing child welfare services (OR=1.42, p<.001). However, several other case characteristics more strongly predicted this decision, including caregiver mental health issues (OR=3.074, p<.001), few social supports (OR=2.92, p<.001), and previous child welfare investigations (OR=1.94, p<.001).

 

Conclusions: Caregivers with physical health issues investigated by child welfare services are more likely to live in the context of a constellation of individual and structural risk factors. Despite the association between physical health issues and other risks, investigating workers appear to attend more closely to other indicators of need when deciding whether to transfer to ongoing services. Physical health issues may be an indicator of a history of trauma and disadvantage and should be carefully considered alongside other risks. Implications for policy and practice will be discussed.