Caregivers' Health Concerns and the Recurrence of Child Maltreatment Reports

Background/Purpose

         The impact of parental physical health concerns on the risk of child maltreatment has received little attention in the literature. A single prior study investigated the role of physical health in relation to maltreatment risk but not recurrence (Slack et al, 2011) and this was limited to overall health rather than specific conditions. Beyond health concerns themselves, poor caregiver health may impact earnings or mental health, factors which may heighten the risk of maltreating behaviors. Families with young children may be at particular risk, given the greater need for caregiver supervision to provide for children’s safety, nurturance and cognitive stimulation at this age. This is the first known study to attempt to understand whether various forms of health care needs of CPS involved caregivers with young children are associated with maltreatment recurrence. 

Methods

          Data were drawn from two studies to that provide different forms of measurement of caregiver health and measure recurrent maltreatment. A sample of CPS involved families with young children (n=1,636) was drawn from a larger administrative data study to r analyze types of health care conditions while controlling for other factors. Cox regression was used to control for the time at risk of recurrence. The second dataset came from a small intervention study in the same region also with CPS involved families. Families in the treatment arm were asked about unmet needs (with separate health and dental questions). Because of the small sample size, analyses of the second study were restricted to Chi-square or Fisher's exact tests.

Results

           Caregivers’ health concerns whether measured by known conditions or reported need were significantly associated with recidivism. In the first study, caregivers with chronic or serious health concerns (e.g., cancer, diabetes, epilepsy, cardiac conditions) were more likely (HR= 2.81, p<.05) to have another report of child maltreatment. This was true controlling for other significant risks such as caregiver mental health or substance abuse diagnosis (HR= 2.00, p<.05), or record of cognitive delay (HR= 1.48, p<.05). In study two, nearly 25% of caregivers reported physical health care needs and over half reported dental care needs. Caregivers’ self-report of dental care needs was significantly associated with (χ2 (1, 64) = 4.59, p=<.05) recurrent reports.

Conclusions and Implications

           Both studies suggest that caregiver physical health may play a significant role in recurrence among CPS- involved families with young children. Child health is listed as part of the federal “well-being” standard for children with open CPS cases, but no similar requirement to assess or provide for caregiver health exists. Most CPS involved families have limited income and disparities in accessing quality health care for poor are well known (e.g., Shi & Stevens, 2005). More research is needed on whether access to quality physical as well as mental health care moderates or mediates the risk of maltreatment onset and recurrence. This has implications for developing service plans in CPS as well as potential impact of health care reform on child safety outcomes.