Child Maltreatment Fatalities Among Families Struggling with Addiction

Background and Purpose: Annually 1,500-2,000 U.S. children die from abuse and/or neglect. Child maltreatment fatalities (CMFs) have received increasingly levels of attention over the past several decades, but one area that remains under-studied is the connection between addiction and CMFs. This is especially timely given the recent surge in opioid use and its impact on child welfare services. In 2018, 1.7 million people in the U.S. had a substance abuse disorder, which when combined with parenting, places children at an increased risk for abuse and/or neglect. Thus, this paper examines: (1) among families struggling with addiction, what places a child at increased risk for CMF and (2) among all CMF cases in a year, how are families struggling with addiction different from those who are not?

Methods: These research questions were examined using the 2016 National Child Abuse and Neglect Data Set. For Q1, the sample was restricted to families with a caretaker struggling with addiction, n=423,485; logistic regression was used to predict the dichotomous outcome variable of fatality. Variables in the model included sociodemographic child and parent characteristics and other risk factors, including domestic violence, financial instability, and housing concerns. For Q2, the sample was restricted to CMF cases where comparisons could be made between caretaker with substance addiction and caretaker without addiction, n=616. Bivariate analyses were used; victim families were compared on the same list of sociodemographic child and parent characteristics and risk factors listed for Q1.

Results: Q1. Using multivariate, logistic regression: among families struggling with addiction, the characteristics which place at child more at-risk for CMF are being younger, being African American/black, and having inadequate housing – at the p≤.05 level. Q2. Using cross-tabulation: among all CMF victims, families struggling with addiction had higher rates of emotional problems, domestic violence in home, inadequate housing, family financial problems, and public assistance; CMF victims with families struggling with addiction were also more likely to receive case management, counseling, daycare, education, family planning, and transportation services – at the p≤.05 level.

Conclusions and Implications: This study is among the first to examine the role of addiction in maltreatment deaths. It offers the unique perspective of considering both (1) what places a child at risk for CMF among families with addiction concerns and (2) among all cases where a child died, how are families struggling with addiction different from those which do not? The results will be discussed with regard to policy and practice implications, risk assessment, and when intense services might be most beneficial.