Examining the Relationship of Risk for out of Home Placement in Early Childhood and Adolescent Placements in a California Cohort

Background and Purpose:

Children with a history of maltreatment are at increased risk for future maltreatment reports. The identification of those with the highest level of risk for child protective services (CPS) to intervene requires extensive amounts of information. This study examines the trajectories of risk scores for birth cohorts to identify how these profiles relate to placements experienced by transition aged youth.

Methods:

A cohort of children born in 2002 (n=361,713) were followed through their CPS interactions to age 16. Risk scores for likelihood of future out of home placement were calculated through a predictive risk model predicted whether a child would experience a placement within 2 years. Levels of risk were then assessed over childhood through age 12 to identify children who indicated high probability of future maltreatment (i.e., had a score in the top 20% of risk). The assessed risk was then compared with various placement outcomes occurring after the age of 16 (e.g., kin care, group home placement). Inclusion of the Healthy Places Index (HPI) components (e.g., education, poverty, park access) and urban status was done by census tract are for the residential address of the child from first contact with CPS. Multinomial logistic regression for the placement outcome was performed to obtain relative risk ratios with robust standard errors. Direct comparisons between counties were performed to assess heterogeneity across administrative areas.

Results:

Of all children reported to CPS, 11.0% experienced out of home placement at age 16 or later. Of children with a high risk score when young, 19.7% were in care in adolescence compared to 2.8% of those with low risk scores (Χ² = 2600, p < 0.001). Increased risk of placement was observed for all placement types when prior high risk was assessed: Kin Care (RR_KC = 3.58, CI = 3.16-4.06), Foster Care (RR_FC = 13.74, CI = 12.98-14.54), and Group Home (RR_GH = 9.99, CI = 9.62-10.38). Covariates by census tract showed significant negative association of likelihood for placement with economic factors (e.g., income; RR_Econ = 0.96, CI = 0.94-0.98) and housing factors (e.g., proportion own homes, uncrowded housing; RR_house = 0.88, CI = 0.86-0.90). Differences by county showed significant variability in the proportion placed in out of home care during adolescence (3.8-20.1%; Χ² = 2600, p < 0.001).

Conclusions and Implications:

Models for predicting risk of future involvement based on information gathered at the time of a report can provide supervisors with additional information to inform service provision. Fully attending to the ongoing needs of children that come to the attention of CPS can be aided by correctly identifying children at the highest levels of risk. While there are neighborhood level differences in the socioeconomic influences for adolescent out of home placements, there are also regional differences in how those at risk do get place in out of home care. Policy should examine how allocation of resources match socioeconomic characteristics of communities to address long-term risks of child welfare interactions.