Longitudinal Experiences of Children Remaining at Home after a First-Time Investigation for Suspected Maltreatment

Objective To describe longitudinal change in risk for children remaining at home following a first-time investigation for suspected maltreatment. Study design A retrospective cohort study of children remaining at home following first-time investigation for maltreatment using a nationally representative sample of households involved with Child Protective Services. Outcomes include poverty, social support, caregiver depression, intimate partner violence (IPV), drug/alcohol dependence, corporal punishment, and child behavior problems at baseline, 18, and 36 months following first-time Child Protective Services investigation. We present longitudinal models to estimate prevalence of risk factors at each timepoint; and (2) examine associations between risk-specific service referrals and longitudinal change in risk factor prevalence. Results Our sample represented 1 057 056 US children remaining at home following first-time investigation for maltreatment. Almost 100 000 (9.2%) children experienced out-of-home placement within 36 months. The prevalence of poverty (44.3%), poor social support (36.3%), caregiver depression (24.4%), IPV (22.1%), and internalizing (30.0%) and externalizing (35.8%) child behavior problems was above general population prevalence at baseline and remained high over the next 36 months. Referral to risk-specific services occurred in a minority of cases, but was associated with significant longitudinal reductions in IPV, drug/alcohol dependence, and externalizing child behavior problems. Conclusions Children remaining at home following a first-time investigation for maltreatment live with persistent risk factors for repeat maltreatment. Appropriate service referrals are uncommon, but may be associated with meaningful reduction in risk over time. Pediatricians and policy makers may be able to improve outcomes in these families with appropriate service provision and referrals. (J Pediatr 2012;161:340-7).