Tanaka Sotaro, Mariko Inoue, Kazue Yamaoka
Teikyo University Graduate School of Public Health.
Yokohama City Northern Child Guidance Center.
Tohoku J Exp Med. 2025 Jul 17;266(3):295-303. doi: 10.1620/tjem.2024.J144. Epub 2024 Dec 12.
The number of temporary custody cases due to child maltreatment and other reasons at child guidance centers in Japan is increasing, prompting imperative scrutiny of re-entry risk assessment. We aimed to derive and internally validate a risk prediction model for re-entry into temporary custody. The risk prediction model was developed from an analysis of data from 725 children recruited in this retrospective single-center longitudinal cohort study conducted in Japan. The anticipated outcome was re-entry into temporary custody. Predictor variables were selected from 15 prospective variables concerning information on children and their familial contexts. A risk prediction model was developed using stepwise logistic regression. The final risk model was validated via C-statistic using cross-validation and bootstrap resampling methods. Calibration was assessed using the Hosmer-Lemeshow test. Of 725 children under temporary custody, 178 (24.6%) experienced re-entry into temporary custody. The predictors in the conclusive risk model were a history of temporary custody (p < 0.001), age at first birth of < 25 years (p < 0.002), single mother or stepfamily (p < 0.001), reasons for temporary custody including child abuse (p = 0.076) and child sex (p = 0.152), and child disability certificate (p = 0.252). Calibration scrutiny via the Hosmer-Lemeshow test revealed no discernible irregularities (p = 0.320). The naïve C-statistic of the model was 0.70, whereas the optimism-corrected C-statistics was 0.67-0.69. The presented risk prediction model showed acceptable calibration and discriminatory capability. The model can optimize limited human resources by providing valid risk estimates of the likelihood of re-entry to temporary custody within one year.
在日本，儿童咨询中心因虐待儿童等原因导致的临时监护案件数量不断增加，这促使人们必须对再次进入临时监护的风险评估进行审视。我们旨在推导并在内部验证一个用于再次进入临时监护的风险预测模型。该风险预测模型是通过对在日本进行的这项回顾性单中心纵向队列研究中招募的725名儿童的数据进行分析而开发的。预期结果是再次进入临时监护。预测变量是从15个关于儿童及其家庭背景信息的前瞻性变量中选取的。使用逐步逻辑回归开发了一个风险预测模型。最终的风险模型通过使用交叉验证和自助重抽样方法的C统计量进行验证。使用Hosmer-Lemeshow检验评估校准情况。在725名接受临时监护的儿童中，178名（24.6%）再次进入临时监护。最终风险模型中的预测因素包括临时监护史（p<0.001）、初产年龄<25岁（p<0.002）、单身母亲或再婚家庭（p<0.001）、包括虐待儿童在内的临时监护原因（p = 0.076）和儿童性别（p = 0.152），以及儿童残疾证明（p = 0.252）。通过Hosmer-Lemeshow检验进行的校准审查未发现明显异常（p = 0.320）。该模型的朴素C统计量为0.70，而经乐观校正的C统计量为0.67 - 0.69。所提出的风险预测模型显示出可接受的校准和区分能力。该模型可以通过提供一年内再次进入临时监护可能性的有效风险估计来优化有限的人力资源。
