Early career scientist, Oregon Social Learning Center, Eugene, Oregon.
Professor, Department of Psychiatry and Behavioral Science; professor, Department of Medical Social Science; professor, Department of Preventive Medicine, Northwestern University, Chicago, Illinois.
N C Med J. 2021 Jul-Aug;82(4):229-238. doi: 10.18043/ncm.82.4.229.
Decision makers face challenges in estimating local risk for child maltreatment and how best to prioritize which factors to intervene upon.
Using US Census and survey data for all US counties (N = 3141), we derived US county profiles characterized by the severity of child maltreatment risk factors observed at the county level, such as parental health, health care access, and economic distress. We estimated how five child maltreatment outcomes would vary across the profiles for North Carolina counties (n = 100): total maltreatment reports (including unsubstantiated and substantiated), substantiated neglect, substantiated abuse, whether services were received, and reported child's race/ethnicity.
We derived three profiles of county-level child maltreatment risk: high, moderate, and low risk, denoting that predicted risk factors means within profiles were all high, moderate, or low levels compared to counties in other profiles. One risk factor did not follow this pattern: the drug overdose death rate. It was highest in the moderate-risk profile instead of the high-risk profile, as would have been consistent with other factor levels. Moderate-risk counties had the highest predicted rate of child maltreatment reports, with over 20 more reports per 10,000 residents compared to low-risk counties (95% CI, 1.38, 38.86).
We included only factors for which aggregate, county-level estimates were available, thus limiting inclusion of all relevant factors.
Results suggest the need for increased family-based services and interventions that reduce risk factors such as economic distress and drug overdose deaths. We discuss the implications for tailoring county efforts to prevent child maltreatment.
决策者在估计儿童虐待的当地风险以及如何最好地确定优先干预哪些因素方面面临挑战。
使用美国普查和所有美国县的调查数据（N=3141），我们得出了美国县的概况，这些概况的特点是在县一级观察到的儿童虐待风险因素的严重程度，如父母的健康、获得医疗保健的机会和经济困难。我们估计了北卡罗来纳州各县（n=100）的五种儿童虐待后果将如何在这些概况中变化：总虐待报告（包括未经证实和证实）、证实的忽视、证实的虐待、是否获得服务以及报告的儿童种族/族裔。
我们得出了县一级儿童虐待风险的三个概况：高、中、低风险，表示预测的风险因素意味着在每个概况内的因素水平都高于、等于或低于其他概况中的因素水平。有一种风险因素不符合这种模式：药物过量死亡率。它在中风险概况中最高，而不是在高风险概况中，这与其他因素水平一致。中风险县的儿童虐待报告预测率最高，每 10000 名居民的报告数超过 20 份，比低风险县多（95%CI，1.38，38.86）。
我们只包括了可以提供总体、县级估计的因素，因此限制了所有相关因素的纳入。
结果表明，需要增加以家庭为基础的服务和干预措施，以减少经济困难和药物过量死亡等风险因素。我们讨论了根据县一级的情况调整预防儿童虐待工作的意义。
