Characteristics of Maltreatment and System Involvement Outcomes of CPS-Involved Children with Behavioral and Emotional Problems

Background & Purpose

Children involved with CPS often face behavioral and emotional challenges, including behavioral problems, emotional disturbance, and substance use. Early maltreatment is strongly linked to these concerns, and exposure to multiple types of maltreatment further heightens the risk for complex, chronic conditions. However, the relationships among maltreatment characteristics, behavioral health outcomes, and developmental stages remain underexplored in large administrative datasets. This study examines how children with documented behavioral or emotional problems differ from their CPS-involved peers in maltreatment experiences and system involvement across preschool, school-age, and adolescence. Findings aim to inform policies and practices that better support children in CPS.

Methods

Using NCANDS data from 11 states, this study created a baseline sample of children referred to CPS in 2017, with a two-year look-back and follow-up period (2015–2019). Children were stratified into three age groups: preschool (ages 3–5, n ≈ 80,000), school-age (6–11, n ≈ 155,000), and adolescence (12–17, n ≈ 110,000). Behavioral outcomes included five categories: no concern, only behavioral problem, only emotional disturbance, only drug abuse, and more than one behavioral or emotional concern. Multilevel binary logistic regression models compared each behavioral group to the reference, adjusting for demographics, maltreatment types, and prior system involvement. Count outcomes (e.g., re-reports, foster care entries) were analyzed using multilevel Poisson models with state-level random intercepts. Model diagnostics indicated no overdispersion. Predicted probabilities and counts were generated to visualize differences by behavioral group and age.

Results

Across all age groups, CPS-involved boys were more likely than girls to be identified with behavioral or emotional concerns. Hispanic children were consistently under-identified, while multiracial children were overrepresented. Black children were less likely to be identified in early and middle childhood but more likely in adolescence. Children with behavioral health concerns had more extensive histories of maltreatment and system involvement, especially those with multiple co-occurring concerns. Emotional disturbance was associated with prior emotional abuse, while drug abuse was more linked to neglect among older youth. Although behavioral health identification was relatively rare in early childhood, early maltreatment, especially sexual abuse, was significantly associated with later behavioral health concerns. Children with identified concerns had higher predicted probabilities of report substantiation and foster care placement, particularly in early childhood. Behavioral problems predicted greater risk of re-reporting among children under age 10, though this effect diminished with age. Most concern types did not predict long-term outcomes, except for increased foster care involvement.

Conclusions and Implications

This study underscores strong links between maltreatment history, foster care involvement, and behavioral health concerns among CPS-involved children. Adolescents had the highest prevalence of emotional disturbance and substance use, while boys and multiracial youth were disproportionately affected. Early childhood sexual abuse was strongly associated with later concerns. Foster care history was a consistent predictor across behavioral health outcomes, highlighting the need for trauma-informed placements, improved behavioral health screening, culturally responsive services, and stronger family support within child welfare systems.