Mental Illness and Child Protection Decision-Making: A Study of Mediating Factors

Introduction: Preventing and addressing maltreatment is a priority for ensuring the healthy development of children.  Maltreated children whose parents suffer from mental illness face triple the odds of serious child protection involvement and out-of-home placement (Park, Solomon, & Mandell, 2006).  As of yet, however, the factors that mediate this effect have not been targets of scholarly inquiry.  If specific safety threats explain the relationship between parental mental illness and child protection decision-making, this will help clarify why children of parents with mental illness are at higher risk for serious child protection involvement, thereby informing targeted intervention strategies.

Methods: Demographics and maltreatment referrals were merged with safety assessments in one urban county in a large western state from 2007 to 2015.  Assessments were administered using the Structured Decision Making^® (SDM) model for child protection, and pertained to 11,826 children reported for maltreatment.  Fifteen safety threats were identified and analyzed as possible mediators of the effect of primary caretaker mental health status (PCMHS) on child protection decisions using multiple logistic regression in STATA SE 14.1.

Results: Of all children reported since 2007, 50% were screened in and receive a safety assessment.  Eleven percent of assessments resulted in the decision that a child was unsafe in the home.  Children of primary caretakers with mental illness represented 10% of children who received assessments.  The odds of being assessed as unsafe in the home were five times higher among children with mentally-ill primary caretakers (OR=5.06, p<0.001).  Forty-seven percent of the effect of PCMHS on the safety decision was explained by serious caretaker impairment due to emotional stability, developmental status, or cognitive deficiency.  Failure to meet a child’s immediate needs accounted for 16% of the association, but this effect was non-significant after controlling for serious caretaker impairment.  Serious caretaker impairment also explained 19% of the effect of comorbid mental illness and substance use on safety decision.  Crucially, safety threats such as physical abuse, threats of physical harm, excessive discipline, and sexual abuse were not significantly associated with PCMHS.

Conclusions: Results of mediation analyses suggest that nearly half of the effect of PCMHS on the safety decision is explained by serious caretaker impairment due to emotional stability, developmental status, or cognitive deficiency.  None of this effect was found to be attributable to physical abuse, threats of physical harm, excessive discipline, or sexual abuse.  These results have critical implications for social work practice.  Child welfare workers should connect mentally-ill parents to psychotherapy/psychiatry, disability services, and neuropsychiatric testing.  Family interventions should focus on restoring parent-child interactions affected by mental health impairments.  Lastly, providers should bear in mind that early empirical evidence against the association of mental illness with violence pertains to parents as well.  Timely and specific interventions for families with a mentally-ill parent may guard against more serious child protection involvement, and foster recovery and healthy development among maltreated children.