A National Study of Child Maltreatment Risk and Reporting at the County Level: New Revelations about Rural Counties

Background.  Studies assessing community factors associated with child maltreatment have consistently found that child poverty rates are positively associated with child maltreatment reports, and that child poverty rates are critical for understanding varying child maltreatment report rates in communities with different racial/ethnic compositions.  Yet most community-level studies addressing relationships among child maltreatment, child poverty, and race/ethnicity have focused on populous communities and states.   Questions remain about rural communities, particularly rural counties with majority African-American or Latinx populations.  This study fills a knowledge gap by making use of data from all U.S. counties, including rural counties, to address the questions:  Throughout the U.S., how do child maltreatment report rates vary by county rurality, racial/ethnic composition, and rates of child poverty?  Are there race/ethnic-based or rurality-based disparities at the county-level in child maltreatment reporting?

Methods.  County-level child maltreatment data were merged with data from the U.S. Census for all counties with a sufficient child population to generate a child maltreatment report rate (n = 3,001).  Key independent variables at the county level included continuous measures of the child poverty rate, percentage rural, and percentages African-American, white, and Latinx.  State-level variables included the child welfare worker/child rate and an indicator of Medicaid accessibility.  Bivariate correlations and HLM multi-level regression models (with counties nested in states) were conducted to assess associations with the county-level maltreatment report rate.  Analyses addressed the years 2012-2015. 

Results. The county-level child maltreatment report rate ranged from less than 1/1,000 children to over 150/1,000 children.  At a bivariate level, the county-level maltreatment report rate was positively associated with the county-level child poverty rate and percentage rural.   In multi-level models accounting for child poverty, African-American population percentage and Latinx population percentage were negatively associated with the report rate, as was the interaction of the African-American population percentage and percentage rural.  Of county types based on rurality and race/ethnicity, rural majority African-American counties (n = 59) had the highest mean child poverty rate (43%), but lowest mean child maltreatment report rate (29/1,000).   Rural majority Latinx counties (n = 23) also had a higher mean child poverty rate (30%) and lower child maltreatment report rate (33/1,000) compared to rural majority white counties (24% and 40/1,000). 

Implications.   The study reveals new and surprising patterns about child maltreatment reports throughout the U.S., especially rural counties.   On average, maltreatment report rates were higher as child poverty rates were higher.  Average findings, however, did not apply to the comparatively small number of rural counties with majority non-white populations.  Rural, majority non-white counties have histories of oppression and marginalization, as well as persistently high child poverty, poor health outcomes, and low resources.   With many risk factors for child maltreatment, comparatively low child maltreatment report rates are hard to explain.   Low child maltreatment report rates in high risk, low resource counties may reflect lack of trust in public authorities (Finno-Velasquez et al., 2017) or norms of social support and self-sufficiency (Stack, 1974).  Future child welfare research should do more to explain and address county-level inequities in child welfare services.