Drake Brett, Jonson-Reid Melissa, Sapokaite Lina
George Warren Brown School of Social Work, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO 63130, USA.
Child Abuse Negl. 2006 Nov;30(11):1201-26. doi: 10.1016/j.chiabu.2006.05.008. Epub 2006 Nov 16.
This study uses administrative data to track the first re-reports of maltreatment in a low-income, urban child welfare population (n=4957) while controlling for other public service involvement. Service system involvement is explored across the following sectors: Child Welfare, Income Maintenance, Special Education, Juvenile Court, and various forms of Medicaid-reimbursed medical or mental health care. This study builds knowledge by adding the services dimension to an ecological framework for analyses and by following recurrence for a longer period of time than prior investigations (7.5 years).
We model the re-reporting of a child for maltreatment as a function of child, caregiver, service, and neighborhood characteristics using data from birth records, child welfare, income maintenance, Medicaid, adult corrections, juvenile court, special education, law enforcement, and census sources. Bivariate and multivariate analyses are presented, the latter using Cox regression with a robust sandwich covariance matrix estimate to account for the intracluster dependence within tracts.
Key results across bivariate and multivariate analyses included a lower rate of re-reporting among children with parents who were high school graduates and/or permanently exited from the first spell on AFDC (p<.0001); and for children in families that received less intensive in-home services compared to those not receiving services, receiving intensive in-home, or foster care services (p<.0001). Higher rates of re-reporting were found for children with Medicaid mental health/substance abuse treatment records (p<.0001) and special education eligibility for emotional disturbance (p<.005).
Caretaker characteristics and non-child welfare service use patterns had a strong association with the likelihood of a child being re-reported to the child welfare agency and should be more heavily attended to by child welfare workers. High rates of service sector overlap suggest that interagency ties and cooperation should be strengthened. The lower risk associated with less intensive in-home services compared to un-served cases may indicate under-identification of in-home service eligibility following a first report of maltreatment.
本研究利用行政数据追踪低收入城市儿童福利人群（n = 4957）中虐待行为的首次再次报告情况，同时控制其他公共服务参与情况。在以下部门探讨服务系统参与情况：儿童福利、收入维持、特殊教育、少年法庭以及各种形式的医疗补助报销的医疗或心理健康护理。本研究通过在生态分析框架中增加服务维度，并比之前的调查（7.5年）更长时间地跟踪复发情况来积累知识。
我们使用来自出生记录、儿童福利、收入维持、医疗补助、成人矫正、少年法庭、特殊教育、执法和人口普查来源的数据，将儿童虐待行为的再次报告建模为儿童、照顾者、服务和社区特征的函数。呈现了双变量和多变量分析，后者使用具有稳健三明治协方差矩阵估计的Cox回归来考虑区域内的聚类内依赖性。
双变量和多变量分析的关键结果包括：父母为高中毕业生和/或首次领取贫困家庭临时援助（AFDC）后永久退出的儿童再次报告率较低（p <.0001）；与未接受服务、接受强化家庭服务或寄养服务的家庭相比，接受较少强化家庭服务的家庭中的儿童再次报告率较低（p <.0001）。有医疗补助心理健康/药物滥用治疗记录的儿童（p <.0001）和有情绪障碍特殊教育资格的儿童（p <.005）再次报告率较高。
照顾者特征和非儿童福利服务使用模式与儿童被再次报告给儿童福利机构的可能性密切相关，儿童福利工作者应更加重视。服务部门重叠率高表明应加强机构间联系与合作。与未接受服务的情况相比，强化家庭服务强度较低的风险较低，这可能表明在首次报告虐待行为后，家庭服务资格认定不足。
