Earlier Identification of Families at Risk of Chronic Maltreatment: An Integrative Review

Background
Most families reported for maltreatment will have a single report; however, some families experience multiple subsequent reports, and the children in these families are considered to experience chronic maltreatment. Multiple reports increase the risk of adverse child outcomes. Additionally, there is a high cost to the child protective systems (CPS), disproportionately utilizing services and resources. To develop a comprehensive understanding of what is known about chronic maltreatment, this review aimed to answer the following research questions: (1) How are chronic families defined in the literature, both within text and in measurement? (2) How have researchers methodologically and analytically approached this topic?

Methods
The review included studies published between 2000-2022 using original empirical analyses, data from the United States, and analyses of subsequent maltreatment reports beyond a single recurrence. The search yielded 748 articles; thirteen were included. Two researchers independently reviewed and extracted data from each article. Most studies were quantitative (12 of 13); one was mixed methods. All used some administrative data; two incorporated survey data. Constant comparison method was used for analysis.

Results
Some key findings were that chronic maltreatment was inconsistently defined or not defined. To identify chronicity, most studies identified a period of time, ranging from 2-7 years, and a minimum number of reports, ranging from 3-5, and any family/child who fell into that category was classified as chronic. While no study explicitly referred to it, incidents in a period of time can be calculated as a rate, rather than a total, of CPS contact per year. Among studies where it was possible to calculate a rate (6/13), it varied from 0.38 to 1.0 incidents per year over at least 2 years. Other inconsistencies were what predictor variables were relevant and included; the unit of analysis which was split between families (6) and children (7); types of maltreatment to include; and how to include substantiation in analyses. Methodological choices were inconsistent, such as whether to include all reports or only substantiated reports. Limitations existed in the data resulting in limited generalizability or currently relevant practice guidance. This included the age of the data; initial CPS contact in 7 of the studies occurred before 2000 when the first of several major changes to federal CPS legislation went into effect; limited geographic representation, and the availability of different types of variables in administrative data. It was also not possible to estimate the percentage of children/families who would reach some threshold of chronicity.

Conclusions
Rather than considering chronic maltreatment as a category defined retrospectively, as a result of this review, we propose that chronic maltreatment would be more accurately conceptualized as a rate of reports per year, with a minimum number of reports and a minimum period of time (e.g. 3 reports within 3 years for a rate of 1 report/year). This would allow CPS agencies and researchers to identify families who were beginning to trend toward chronic maltreatment and distinguish chronic maltreatment that stretched over years from a few reports that might occur during an acute crisis.