Predictors of Child Maltreatment Among Substance Abusing Families

Michael S. Shafer, Ph.D., Lela Williams, Ph.D., Bonnie Carlson, Ph.D., Charles Davis & Richard Rivera, M.A. Arizona State University, Center for Applied Behavioral Health Policy

BackgroundDemographic Characteristics

Initial Maltreatment

Reports

Methods

Grant support provided by the Arizona Department of Economic Security, Division of Children, Youth, & Families

Sample• Cross-sectional administrative sample of 1,888 families under the investigation of Child Protective

Services in Arizona.• Families represented cases wherein an allegation if child maltreatment had been filed and/or a

child had been placed in out of home care, pending the conclusion of investigation.• Families had been referred to a statewide program, known as Arizona Families F.I.R.S.T (Families

in Recovery Succeeding Together; AFF), due to suspected parental substance abuse.• AFF Program delivered through a network of nine community-based agencies under contract

with CPS and/or the state single authority (SSA) for substance abuse treatment services.

Data Sources• All data used in this study were harvested from electronic administrative records.• Client and Family characteristics of the parents and families are captured through standardized

assessments that are conducted with each referred client at the time of program enrollment.• Allegations and findings of child maltreatment is maintained within the CHILDS Data Base,

operated and maintained by the Arizona Child Protective Services . These data include the type ofmaltreatment allegation (e.g., sexual abuse, physical abuse, neglect), the date of the allegedmaltreatment, the report allegation finding (substantiated or unsubstantiated) and the relativerisk associated with the allegation (1-5 Likert Scale). Additional information regarding eachmaltreatment incident, including the identity of the perpetrator, relationship to the child, andother information, was obtained but not utilized for these analyses.

• For the purposes of these analyses, information regarding all allegations and reports of childmaltreatment for children associated with individuals who were referred to the AFF programduring the period of July 1, 2004 – June 30, 2005 were obtained.

• Maltreatment allegations and reports associated with these AFF families that occurred betweenthe period of July 1, 2004 and March 30, 2010 were used for these analyses.

This research was approved by the Arizona State University’s Institutional Review Board andclassified as an expedited project. A HIPPA Business Associates agreement between the ArizonaDepartment of Economic Security, Child Protective Services, and Arizona State University wasestablished to ensure the security of relevant health protected information.

Individuals Referred to the AFF Program

07/01/2004 – 06/30/2005

n = 1,888

Individuals with Maltreatment Report in

SFY 2005

n = 1,834 (97.14%)

Individuals Referred to AFF with a Maltreatment Report

Preceding Referral

n = 1330 (72.52%)

AFF Clients with at Least 1 Report of Maltreatment

Recurrence

n = 707 (53.16%)

AFF Clients with no Subsequent Reports of

Maltreatment

n = 623 (46.84%)Individuals Referred to AFF with a Maltreatment Report

Proceeding Referral

n = 504 (27.5%)Individuals with No Maltreatment Report in

SFY 2005

n = 54

0%

10%

20%

30%

40%

50%

0 1 2 3 4 5 6 7 8 9 12

% o

f SF

Y 2

00

5 A

FF C

lien

ts

# of Subsequent Maltreatment Reports

Mean # of Subsequent Maltreatment Reports Among Families with Subsequent Reports; M = 2.10 (sd = 1.49)

Each year, more than 3.5 million children are suspected to havesuffered maltreatment at the hands of their parents or othersignificant caregivers with close to 1 million (872,000) confirmed.Typically, such child maltreatment is classified as neglect although asubstantive representation of more active forms of psychological,sexual, and emotional abuse are reported as well. Children who arevictims of maltreatment are significant risk of conduct disorders inschool and dysfunction as adults including serious mental, behavioral,and social problems including substance use disorders. Childhoodvictimization has also been demonstrated to be a significant predictorof child maltreatment perpetration as adults. As such, understandingthe correlates and effective intervention strategies for the treatmentof child maltreatment is a significant social issue.

While much research has been done on the predictors of childmaltreatment in general, and recurrent/chronic patterns of childmaltreatment, the relationships between parental substance usedisorders and child maltreatment has been less well documented.Likewise, the impact of parental substance abuse treatment upon therecurrence of child maltreatment has not been the focus of extensiveresearch.

ContextArizona Families FIRST is a statewide program designed toprovide assertive outreach and engagement to child welfareinvolved parents under investigation for child maltreatment,coupled with substance abuse treatment services. AFFservices are delivered through a network of nine community-based agencies under contract with the Arizona Department ofEconomic Security, which operates Child Protective Services,and in partnership with the Arizona Department of HealthServices, the single state authority for substance abusetreatment services.

Research QuestionsThe purpose of this study was to assess the rates of childmaltreatment among families participating in the ArizonaFamilies FIRST program over period of 5.75 years. Amongthose clients referred to AFF during SFY 2005 (July 1, 2004 – June30, 2005) and tracked through March 30, 2010, the followingresearch questions were posited:

1. What was the relative rate of child maltreatment recurrenceduring the study period?

2. What characteristics of AFF clients at the time of intake ,including self-reported substance use, were associated withthe recurrence of maltreatment?

3. Did greater participation in the AFF program predictmaltreatment recurrence?

Recurrence of Maltreatment Report

Yes No Total

n= 707 623 1,330

% % %Gender

Male 30.64% 34.41% 32.40%Female 69.36% 65.59% 67.60%

RaceCaucasian/White 83.65% 83.64% 83.65%

African American/Black 3.98% 4.01% 3.99%

American Indian/Alaska Native 3.83% 3.67% 3.76%Other 8.54% 8.68% 8.61%

Ethnicity

Hispanic/Latino 27.89% 26.41% 27.19%

Not Hispanic or Latino 72.11% 73.59% 72.81%

Language

English 97.84% 97.05% 97.47%

Spanish 2.16% 2.95% 2.53%

Educational Level

< High School 48.62% 46.69% 47.75%High School or GED 29.97% 35.66% 32.55%

> HS 21.41% 17.65% 19.70%

Reported Family Size 58.58% 56.27% 57.50%(for those with Family) Mean* 3.76 3.52 3.65

SD 1.70 1.46 1.60

Reported Monthly Income(for those with income) Mean 1045.71 1755.46 1378.30

SD 1311.00 6546.34 4589.51

*p < .05 (2-tailed); Chi-square or t-test where appropriateMissing Values: nGender = 3, nEthnicity=54, nLanguage=26, nEducation=731, nfamily=3, nIncome=180

Recurrence of Maltreatment Report

Yes No Total

n= 707 623 1,330

Duration from Maltreatment Report to AFF Referral (months)

Mean 1.87 1.66 1.77

SD 2.43 2.21 2.33

Length of Stay (First to Last AFF Service Encounter) (months)

Mean*** 25.87 20.73 23.54

SD 19.93 18.91 19.63

Duration from AFF referral Date to Subsequent Maltreatment Report

Mean 19.93 NAP NAP

SD 16.10 NAP NAP

***p < .0001 (2-tailed); t-test

Recurrence of Maltreatment Report

Yes No Total

n= 707 623 1330

% % n

Index Allegation Maltreatment Type*

Sexual Abuse 48.28% 51.72% 29

Physical Abuse 57.93% 42.07% 271

Neglect 52.01% 47.99% 1021

Index Allegation Finding

Substantiated 55.80% 44.20% 647

Unsubstantiated 50.66% 49.34% 677

* When multiple allegations contained in single report, most severe allegation counted following procedures of Fuller & Nieto,2009

Recurrence of Maltreatment Report

Yes No Total

396 460 856

% % %

None or No substance abuse last 30 days 32.58% 30.00% 31.19%

Alcohol 44.70% 40.00% 42.17%

Marijuana** 46.21% 37.39% 41.47%

Methamphetamine* 50.51% 43.70% 46.85%

Cocaine/crack 15.91% 15.43% 15.65%

Heroin/opioids 3.54% 2.83% 3.15%

Other 18.43% 19.78% 19.16%

Unknown* 42.68% 50.87% 47.08%

Note: Above categories are Not mutually exclusive; for 1st Assessment Date Subsequent to 1st referral in SFY 2005

* p <.05, ** p <.01; 2-tailed Z test

Cycle Times

Self-Reported Substance Use at

Intake

ConclusionsAmong 1,330 individuals referred to a substance abuse treatment program for parents under investigation for child maltreatment, 53% committed at least one subsequent reportable incident of child maltreatment within five years. Among these individuals, maltreatment recurred an average of 2 months following treatment referral. Neither the type of maltreatment (abuse vs. neglect) nor the allegation finding on the initial maltreatment report was observed to correlate to the likelihood of subsequent maltreatment. This finding is in conflict with previous research which has generally shown that neglect is more likely to recur, relative to more active forms of maltreatment such as sexual and physical abuse. Individuals with recurrence of maltreatment had higher reported cannabis and methamphetamine use at intake; more children; were in treatment longer. Families with recurrence of maltreatment reports were in treatment longer, supporting previous research that has documented a positive relationship between post-investigation services and maltreatment recurrence. The causal relationships among these variables are unclear from these findings and those of previous research, leading to speculations that more impaired (and higher risk individuals require more and lengthier treatment) or if continuing service engagement simple affords greater surveillance opportunities. Additional research is needed to better examine parental and family characteristics that are associated with maltreatment recurrence and the effect that reductions in parental substance use and dependence may play in the amelioration of child maltreatment.