Child Fatality Cases with Prior Child Welfare Contact: Do Those with and without Intimate Partner Violence Differ

Background: Intimate partner violence (IPV) and child maltreatment co-occur, but the degree of overlap and how this may vary by maltreatment type and comorbid risks is not established. In 2018, 1,700 child fatalities were known to Child Protective Services (CPS). While prevention of fatalities as recorded by CPS is a major prevention and policy focus, those children with CPS histories but without CPS reports linked to later preventable deaths are overlooked. Few studies have been able to capture the full range of such fatalities and none have focused on how cases differ by known IPV.

Methods: Data were drawn from publicly available records from Florida’s Innocents Lost report. Data included 532 children from 501 families who died from 2008 to 2015 following at least one contact with CPS. Variables abstracted for this study included child demographics, known child health concerns, prior CPS reports, known IPV concerns, and mental health, criminal history, or substance abuse for caregivers. Community poverty and demographics were obtained from the American Community Survey. Bivariate analyses were conducted to compare child fatalities with and without known IPV concerns with a sample of 501 children after randomly selecting one child per family for analysis. Logistic regression analyses controlling for county clustering was limited to cases (n = 155) that had additional criminal justice and/or death review documentation as these were more likely to have complete information on variables of interest.

Results: Among the 501 children, the age of death for children in CPS/IPV involved families (n = 328) was higher than CPS alone (n=173) (3.4 vs. 2.5 yr, p < .009). The cause of death in CPS/IPV involved families was most likely to be aggravated child abuse or murder (44%) compared to CPS alone which were mainly neglect (67.3%) (p < .0001). CPS/IPV families had over 4 times the proportion of deaths due to weapons (15.5 vs. 3.5%). There was no difference by county level poverty. A logistic regression model found that CPS/IPV cases were twice as likely to include primary caregiver substance abuse concerns (AOR = 2.72, p < .05), older children (AOR = 2.34, p < .05), a secondary caregiver with at least one prior criminal offense (AOR = 2.41, p < .05), and larger families (AOR = 3.05, p < .05). Both CPS/IPV and CPS only cases had a median of three prior CPS reports and 32% of CPS/IPV cases noted prior referrals for some IPV service. While only about 24% of secondary caregivers were paramours, 61.3% of these had prior criminal records.

Conclusions: The low rate of known prior referrals for IPV concerns may indicate a window of opportunity for prevention if CPS more thoroughly screened for need and coordinated with IPV services. Most families had more than one prior CPS contact providing the opportunity for more in-depth assessment. Findings also suggest the need for greater attention to effective substance abuse services for CPS parents. Finally, family violence prevention efforts for males with criminal justice histories are needed in preventing both CF and IPV.