Risk assessment in child sexual abuse cases

Despite continuing improvements in risk assessment for child protective services (CPS) and movement toward actuarial prediction of child maltreatment, current models have not adequately addressed child sexual abuse. Sexual abuse cases present unique and ambiguous indicators to the investigating professional, and risk factors differ from those related to physical abuse and neglect. Incorporation of research on risk factors specifically related to sexual offender recidivism into existing CPS risk assessment models may improve the ability to assess the risk of future sexual maltreatment to children. This article reviews the literature on risk factors for sexual offense recidivism and discusses their relevance and application to CPS assessment models. An evidence-based model for assessing risk in child sexual abuse cases is proposed.     

Risk assessment in context

This article provides an overview of the context in which decisions about risk are made in child welfare including personal, task, and environmental factors that may contribute to uncertainty and less-than-optimal decision making, as well as some of the methodological challenges posed by the use of current risk assessment instruments. Actuarial, consensus-based, and clinical instruments are discussed and the more successful track record of actuarial decision-making in child welfare and related fields is highlighted. Methodological challenges to assessing risk are also presented including lack of reliability and validity of measures, definitional dilemmas, temporal issues such as changes in risk over time, absence of base rate data, predicting for individuals and sensitivity and specificity of measures. Implications for the design and implementation of risk assessment tools are considered in light of contextual influences and methodological limitations. Lastly, an overview of the contents of Part One of this special issue on risk assessment is provided.     

Actuarial risk assessment in child protective services: Construction methodology and performance criteria

Purpose

To prevent the recurrence of child maltreatment, actuarial risk assessment can help child protective services (CPS) workers make more accurate and consistent decisions. However, there are few published articles describing construction methodologies and performance criteria to evaluate how well actuarial risk assessments perform in CPS. This article describes methodology to construct and revise an actuarial risk assessment, reviews criteria to evaluate the performance of actuarial tools, and applies a methodology and performance criteria in one state.

Methods

The sample included 6832 families who were followed for two years to determine whether they were re-reported and re-substantiated for maltreatment.

Results

Both the adopted and the revised tools had adequate separation and good predictive accuracy for all families and for the state's three largest ethnic/racial groups (White, Latino, and African American). The adopted tool classified relatively few families in the low-risk category; the revised tool distributed families across risk categories.

Conclusions

The revised tool classified more families as low-risk, allowing CPS to allocate more resources to higher-risk families, but at the cost of more false negatives.     

Practical considerations in the interview and evaluation of sexual offenders

The evaluation and assessment of sexual offenders is different than any other type of evaluation, and most clinicians are not properly trained to interview this population. This article addresses the clinical and ethical issues particular to the interview, assessment, and evaluation of these types of offenders. It offers both practical information regarding the interview itself, along with an overview of classification systems, paraphilias, and assessment techniques used with this population. In addition, issues related to risk assessment and risk management are also addressed, and an introduction to the use of actuarial risk assessment instruments is provided.     

Practical Considerations in the Interview and Evaluation of Sexual Offenders

SUMMARY

The evaluation and assessment of sexual offenders is different than any other type of evaluation, and most clinicians are not properly trained to interview this population. This article addresses the clinical and ethical issues particular to the interview, assessment, and evaluation of these types of offenders. It offers both practical information regarding the interview itself, along with an overview of classification systems, paraphilias, and assessment techniques used with this population. In addition, issues related to risk assessment and risk management are also addressed, and an introduction to the use of actuarial risk assessment instruments is provided.     

Effect of child protective services system factors on child maltreatment rereporting

This study examined how child protective services (CPS) systems respond to initial and subsequent reports in the context of child maltreatment rereporting and to what extent CPS system factors are associated with the risk of rereporting after controlling for abuse type and child and family factors. This study followed 67,243 families who were reported to the CPS agencies in seven counties in Florida for child abuse and neglect over a period of 5.4 years and found that 14,218 families had one or more child maltreatment rereports. Key findings include that CPS system factors were significantly different from initial report to subsequent reports. Five CPS system factors, reporting source, contact by CPS workers, investigative level at intake, postinvestigation services, and duration ofCPS involvement were significantly associated with the risk of child maltreatment rereporting. Multivariate analyses found that CPS system factors were substantially different for three categories ofrereporting, unsubstantiated rereports, substantiated rereports, and recurrence reports. Interpretations and implications for practice are discussed.     

The Actuarial Assessment and Experiential Reality of Risk in Childhood

All children face risks in their everyday lives, although some experience more than others. Age, gender, geography and relative disadvantage are among the factors making a difference. Assessing and managing these risks has generated enormous academic interest, political activity, public debate, and emotion, but a major tension has arisen. This is between the actuarial models of risk assessment widely advocated and imposed by agencies including the government, even if prompted by individual instance and public outrage, and experiential models of risk assessment commonly adopted by children and their families. This gives rise to the issue of whether children should be protected at all cost because of the risk from both visible and hidden dangers, or whether they should be exposed to challenge and adventure to allow them to learn to assess and manage risk for themselves. It is unclear whether or not the world is a safer place for children than in the past, and it is apparent that risks constantly change. The challenge is to ensure that young people remain safe while at the same time gaining opportunities to experience excitement and develop their independence.     

Caregiver AOD use, case substantiation, and AOD treatment: studies based on two southwestern counties

This article includes two separate studies: the first explores the impact of caregiver AOD use on CPS case substantiation; the second compares CPS-involved and CPS-noninvolved females in AOD treatment systems. Results suggest that cases with indications of AOD use are more likely to be substantiated than cases without; and increasing numbers of children and younger maternal ages are risk factors for CPS involvement among AOD-using women. Related findings are also presented, followed by implications for practice and research.     

Building bridges: the interface between adult mental health and child protection

Bringing together two distinct professional systems such as adult mental health and child protection challenges our strategies for making effective working together/working in partnership arrangements. And yet failures to make these arrangements increase the risk for children who may be suffering or likely to suffer significant harm as an outcome of their parents'/carers' mental health problems. This paper offers an analysis of the challenges inherent in bringing these systems together at the assessment interface, and offers some insights into the contribution each system can make to an integrated assessment process for children and their families. Copyright © 1999 John Wiley & Sons, Ltd.     

The crucial role played by social outrage in efforts to reform child protective services

In this paper, we question the widely, if tacitly, held perspective that exceptional and immensely publicized instances of child abuse and neglect offer little guidance or understanding in improving the efficacy of child protective services (CPS). Using insights from Carl Jung, Max Weber and Henry Mintzberg, we argue that not only do such archetypical cases and the attendant moral outrage serve as catalysts for legislative and judicial actions; they also motivate structural and procedural changes in CPS operations. We propose extending to CPS a risk model commonly considered in the fields of environmental science, food safety and chemical engineering, where risk is conceptualized as a function of both technical hazard and moral outrage. We point out, however, that unlike in these non-CPS fields where the typical response is to ‘manage’ outrage via public education or public relations campaigns and to allow outrage to influence only the more immediate and exceptional decisions following an outrageous event, in the CPS field where children are the focal point, exceptional decision processes also seep into routine decision making by necessity. We term our proposed enhanced risk model the Socially Outraged Risk Expression (SORE). We conclude with recommendations for an empirical test of SORE.     

When practice and policy collide: Child welfare workers' perceptions of investigation processes

This qualitative study examines variability in practices surrounding Child Protective Services (CPS) investigations regarding the allegations of child maltreatment. Working under the auspices of a community-research collaboration with Department of Human Services officials, university researchers conducted a series of focus groups with CPS caseworkers in a state that was under court-ordered consent decree to improve child welfare investigations. Focus groups with caseworkers sought to better understand caseworkers' common investigative practices and their perceptions of best practices in conducting child welfare investigations. Two main areas were noted for improvement: (1) the need for ongoing training of CPS workers, particularly at the stage of initial intake of the allegations of maltreatment, and cross-training of police and hospital staff who regularly work with CPS, and (2) implementation of an improved risk assessment tool. These recommendations are discussed in detail.     

Predictors of school absenteeism severity at multiple levels: A classification and regression tree analysis

School attendance is an important foundational competency for children and adolescents, but rates of problematic school absenteeism have remained high and steady. Efforts to conceptualize problematic school absenteeism across its myriad psychiatric symptoms, risk factors, and intervention types have centered recently on multi-tiered systems of support models that arrange these variables into prevention, early intervention, and intensive intervention tiers. Unfortunately, research into absenteeism severity levels to demarcate these tiers remains sparse. The present study utilized nonparametric classification and regression tree analysis to examine multiple demographic and academic risk factors simultaneously in a very large and diverse community sample. Academic variables included grade level, letter grades, grade point average, individualized education plan eligibility, and participation in school sports. Demographic variables included youth age, gender, and ethnicity. The study aimed to identify risk categories for school absenteeism severity at the 1%+, 10%+, and 15%+ levels and across elementary, middle, and high school levels. Results indicated a more homogeneous set of risk factors at the 10%+ and 15%+ levels than the 1%+ level, in particular with respect to low GPA, age 15.5 + years, African American or American Indian ethnicity, and grades 1, 6, 7, 8, 10, 11, or 12. The results have implications for identifying highest risk youth to further improve assessment, prevention, and intervention practices for this population.     

Understanding and responding to chronic neglect: A mixed methods case record examination

Neglect is the most prevalent form of maltreatment, and thus comprises the bulk of cases for Child Protective Service (CPS) agencies, yet it remains under-studied. Cases in which children experience repeated or “chronic” neglect are particularly concerning. A growing body of research indicates that the effects of chronic neglect create a harmful accumulation of problems for child well-being, including detrimental impact on early brain development, emotional regulation, and cognitive development. The aim of this retrospective case record review study was to examine risk and protective factors of chronic neglect and relevant CPS agency responses and practices. Results demonstrated that families experiencing chronic neglect had multiple significant stressors (four or more stressors for all families in this study), such as domestic violence, poverty, children with behavioral problems, and/or substance abuse, indicating chaotic and toxic living environments. Key implications are outlined for strengthening CPS response to cases of chronic neglect, including the need for comprehensive assessment of families, more effective and consistent use of standardized risk assessment tools, and better recognition of past patterns of neglect to mitigate the risk of accumulation of harm.     

Differential response in child protection: How much is too much?

Recurring maltreatment can have devastating, lifelong consequences for children who are victims of abuse and neglect. The primary mission of child protection services (CPS) agencies is to prevent the recurrence of child maltreatment by offering families services designed to prevent future maltreatment. In order for these services to be effective, however, families must actually engage in them. This study focuses on how differential response programs impact families' successful engagement in services as indicated by long-term child safety outcomes.Differential response refers to a dual track system that allows public CPS agencies to respond to accepted reports of child abuse or neglect with either a traditional investigative response (TR) or an alternative response (AR). The AR is designed to be a less authoritative and less adversarial approach to families presenting a low- to moderate-risk of maltreatment. The AR involves collaboration with the family in a comprehensive assessment of the family's needs, risks and strengths and a referral to services on a voluntary basis. States implementing DR systems statewide vary greatly in the percentage of accepted reports that are assigned to the AR track. The goal of this study is to determine what rate of AR utilization is most effective in reducing subsequent reports of abuse and neglect for cases assigned to the AR.This study compares child safety outcomes for children assigned to the AR and those assigned to the TR within each of the fourteen states which implemented DR statewide between 2000–2012. The analysis uses Cox proportional hazards regression. Data for this observational study are drawn from the 2000–2012 data in the National Child Abuse and Neglect Data System (NCANDS) child files. Child safety is measured by re-reporting of the child to CPS.The theoretical model underpinning the study is McCurdy and Daro's (2001) Integrated Theory of Participant Involvement (ITPI) which outlines a conceptual model of parental engagement in services. This study hypothesizes that AR utilization rates affect the risk level of cases assigned to the AR. The ITPI model offers a possible explanation as to why higher risk cases may not be as responsive to the AR approach which depends upon the family's voluntary participation in services.The key finding of this study is that, in states assigning > 33% of reports to the AR, children on the AR track are being re-reported at equal or higher rates than those on the TR track. Only in those states utilizing the AR track for < 33% of the cases are AR cases being consistently re-reported at lower rates than those on the TR track. This article explores ways to improve the accuracy of track assignment decisions to prevent the assignment of higher risk families to the alternative response.     

An examination of relationships between children's protective services social worker assessment of risk and independent LONGSCAN measures of risk constructs

Risk assessment as a Child Protective Services (CPS) decision-making model has been implemented in the field since the late 1980s. Research activities on risk assessment have included comparative analyses, prioritization, classification studies, implementation, and cultural sensitivity analyses. In the last decade, the major research focus has been on studies related to predictive validity. Little research on risk assessment has focused on other types of construct validity, including convergent validity. Using data from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) and CPS investigation records, this study examined the correlations between CPS workers' ratings of risk on nine risk factors and independent measures of the same risk constructs collected by research interviewers. The data indicate significant correlations with caregiver risk factors such as physical/mental/emotional impairment, however there is little correlation with child risk factors associated with developmental or behavioral issues, or socio-economic factors such as stress and social support. Implications of the findings for policy and practice are discussed.     

Is child protective services effective?

A number of studies have concluded that there is little observable connection between CPS involvement and improved outcomes for children and families. Evidence of CPS effectiveness is complicated by the presence of selection bias and difficulty controlling for confounding. To understand outcomes by group and intervention effects, comparable groups are necessary and difficult to ascertain using CPS administrative case record data. This study examines the causal effect of CPS involvement on the likelihood of future maltreatment using administrative case management records from July 1, 2010 and June 30, 2011. The current study accounts for differences in pre-existing condition between groups to establish sound estimates of CPS involvement effects. Logistic regression models were used to examine the difference in subsequent substantiated investigation between families with comparable risk and differing service recommendation (p = 0.83), recurrence among families with comparable risk, the same service recommendation that did or did not receive services (p = 0.83). Hazard models were used to explore risk of substantiated investigation among families with comparable risk and differing service recommendation (p = 0.77). Results indicate receipt of CPS services had no observable effect on recurrence of maltreatment overall and among families with similar levels of risk of recurrence. Further inquiry into worker attributes, decision-making, types of and quality of services offered to families could help explain the effective, or ineffectiveness, or services.     

Child abuse/neglect risk assessment under field practice conditions: Tests of external and temporal validity and comparison with heart disease prediction

Objectives(1) Identify validation design and accuracy assessment standards for medical prognostic models applicable to evaluation of child abuse/neglect (CA/N) risk assessment models. (2) Assess the accuracy of the California Family Risk Assessment (CFRA) in predicting CA/N using the foregoing standards. (3) Compare the prediction accuracy of the CFRA with the prediction accuracy of coronary heart disease (CHD) prediction models.Questions addressed(1) What validation design and accuracy assessment standards are used to evaluate medical prognostic models? (2) What is the evidence for the accuracy of the CFRA using those standards? (3) How does the accuracy of the CFRA in predicting CA/N compare with the accuracy of CHD prediction models, which are a reasonable exemplar for the CA/N prediction effort?MethodAn external validation sample of 236 California reports of CA/N from San Luis Obispo and Sutter counties, and a larger temporal validation sample of 6307 California reports from Orange, Los Angeles, and Humboldt counties were investigated and assessed with the CFRA by line child welfare staff and were followed prospectively statewide for two years to discover reported, substantiated CA/N in any California county. CFRA accuracy in predicting substantiated CA/N was assessed by calibration and discrimination. Calibration was measured as the ratio of predicted to observed cases of CA/N seen during follow-up, with a ratio of 1.0 registering perfect calibration. Discrimination was measured by the area under the receiver operating characteristic (ROC) curve (AUC), with values from .60 to .85 found typical for medical prognostic models. CHD prediction literature was reviewed to acquire values of these accuracy measures for CHD prediction models. CFRA CA/N prediction accuracy and CHD prediction accuracy were then compared.ResultsFindings from external and temporal validation samples support the accuracy of CFRA prediction of CA/N. CFRA accuracy in predicting CA/N compared well with CHD prediction accuracy: (1) in the external validation sample, 43.42 CA/N cases were predicted during follow-up and 47 were observed, with consequent 7.6% deviation from perfect calibration. (2) In the temporal validation sample 857.49 CA/N cases were predicted and 801 were observed, with 7.1% deviation from perfect calibration. (3) The best performing of 20 Framingham CHD prediction models identified by systematic literature review predicted 222 CHD cases and 206 were observed, with 7.8% deviation from perfect calibration. (3) The CFRA external and temporal validation sample AUCs were .74 and .64, respectively. (4) For 26 CHD prediction cohorts found by literature review, the AUC mean and median values were .72 and .71, respectively, with a range from .60 to .84.Conclusions/practice implications(1) External and temporal validation results support the accuracy of the CFRA. (2) CFRA CA/N prediction accuracy parity with that for CHD prediction is encouraging, suggesting that wide use of the CFRA, properly implemented, could improve risk assessment accuracy in child protection. (3) Findings underline the importance of ensuring that no risk assessment model or method, including actuarial and consensus models and clinical judgment, is used in the field unless it has passed a test of external, or at least temporal validation.     

Women in Substance Use Treatment

Abstract

The objective of this study was to examine the differences between women with children in substance use treatment who are involved in Child Protective Services (CPS+) and those who are not involved (CPS-). Using a sample of all alcohol and other drug (AOD) clients (N = 6,023) receiving substance use treatment over a three-year period (1997-99), the study found that CPS+ women were more likely to be younger, have more children, have been arrested less often, be mandated to receive treatment, to have an unsatisfactory exit status or be transferred to another treatment program at discharge. CPS+ women were also more likely to have attended outpatient or day treatment for the AOD treatment. This study points out that there may be specific risk factors in place for a subgroup of women with children in AOD treatment.     

Child Abuse Investigations: Reasons for using Child Advocacy Centers and Suggestions for Improvement

Child protective service (CPS) and child abuse law enforcement (LE) investigators have been required by the majority of states to work together when investigating criminal cases of child abuse. Child Advocacy Centers (CACs) and other^. multidisciplinary models of collaboration have developed across the United States to meet these requirements. This study surveyed 290 CPS and LE investigators who use a CAC in their investigations of criminal cases of child abuse. Reasons given for using, centers, include legal or administrative mandate and protocol, child appropriate environment, support, referrals, capacity for medical exams, expertise of center interviewers and access to video and audio technology. Respondents also identified ways that centers could be more helpful.