Elsevier

Child Abuse & Neglect

Volume 32, Issue 3, March 2008, Pages 377-391
Child Abuse & Neglect

Caseworker assessments of risk for recurrent maltreatment: Association with case-specific risk factors and re-reports

https://doi.org/10.1016/j.chiabu.2007.06.006Get rights and content

Abstract

Objective

This article focuses on caseworkers’ assessments of risk of maltreatment recurrence among families in contact with social services. Specifically, the article has two primary goals: (1) to examine the association between caseworkers’ risk assessments and demographic, child, parent and family-level risk factors; and (2) to examine agreement between caseworkers’ risk assessments and any subsequent report, or reports, of maltreatment.

Method

Data are from the baseline, 12-month, and 18-month assessments of the National Survey for Child and Adolescent Well-Being (NSCAW), a nationally representative sample of youth and families who were the subjects of allegations of maltreatment investigated by child welfare agencies. The sample consisted of a subset of NSCAW participants: cases with a report of child physical abuse or neglect who were not placed in out-of-home care (N = 2,139).

Results

Analyses indicated that parent-level risk factors and a prior report of maltreatment were most strongly associated with caseworkers’ assessments of risk for both physical abuse and neglect cases. A smaller set of factors, which varied by the type of maltreatment, were associated with a subsequent report of maltreatment. Despite some overlap in correlates of risk assessment and subsequent reports, analyses indicated that agreement between caseworkers’ assessments of risk and re-reports was low.

Conclusions

Findings suggest that although caseworkers’ assessments were associated with a limited set of risk factors from the literature, few of these factors also were associated with a recurrent report of maltreatment. Correspondence between caseworkers’ assessments of risk and a subsequent report of maltreatment was low, suggesting that considerable work may be needed to improve accuracy and identification of cases most at risk.

Practice implications

This study provides information to assist caseworkers, administrators, and policymakers in thinking critically about risk assessment policies and procedures. Although caseworkers’ assessments of risk were associated with some of the empirical predictors of recurrent maltreatment, their assessments were only slightly better than guessing. Agreement between caseworkers’ risk assessments and actual subsequent reports was better for low-risk cases, but primarily because the majority of cases did not have a subsequent report during the study period. Clearly, considerable improvement in risk assessment is needed so that at-risk families can be better identified and the limited services available can be directed toward those most in need.

Introduction

Child welfare agencies received more than three million reports of child maltreatment in 2003 (U.S. DHHS, 2005). Among those reports that are substantiated, approximately half do not receive services beyond the initial investigation (U.S. DHHS, 2005). Given the substantial volume of reports, caseworkers’ ability to determine which cases are at greatest risk of subsequent maltreatment deserves attention. Research in this area, however, has demonstrated that even among those considered to be “experts” in the field of child welfare, decisions about risk vary significantly from worker to worker (Rossi, Schuerman, & Budde, 1996). Additional research is needed on how caseworkers make decisions about risk, particularly in the current climate in which dissemination of formal risk assessment measures presents a viable option for enhanced accuracy. These measures have received significant attention, have evidence for improving assessment, but at the same time, have drawn criticism (Gambrill & Shlonsky, 2000). Therefore, it is necessary both to examine how caseworkers utilize the existing knowledge about predictors of maltreatment recurrence and to examine the degree to which these factors relate to accuracy or inaccuracy of risk classification.

Despite inconsistencies in caseworkers’ decision-making, the literature is relatively consistent with regard to factors associated with maltreatment recurrence. Factors reviewed here include those at the family, parent, and child-level. In the area of family-level factors, larger numbers of children in the household (DePanfilis and Zuravin, 1999, DePanfilis and Zuravin, 2002; Johnson & L’Esperance, 1984), domestic violence (Baird, Wagner, & Neuenfeldt, 1993), and low family income (Levy, Markovic, Chaudhry, Ahart, & Torres, 1995; Rittner, 2002) have been associated with the recurrence of child physical abuse and neglect. Parent-level factors associated with recurrence include single parent status (Sedlack & Broadhurst, 1996 [Third National Incidence study of Child Abuse and Neglect]), parents’ own history of abuse (Gaudin & Dubowitz, 1997), substance abuse (Baird, 1988; English, Marshall, Coghlan, Brummel, & Orne, 1999), high levels of stress (Baird et al., 1993; DePanfilis & Zuravin, 2001), low levels of social support (Baird et al., 1993; DePanfilis & Zuravin, 1999) and mental health problems (Rittner, 2002; Sedlack & Broadhurst, 1996). There also is some evidence that parental ethnicity may be related to recurrence, with Asian/Pacific Islanders having the lowest rates of recurrence (Fluke, Yuan, & Edwards, 1999). Child-related factors include younger age (English et al., 1999; Fryer & Miyoshi, 1994), physical health problems, and/or vulnerability (DePanfilis and Zuravin, 1999, DePanfilis and Zuravin, 2002).

In addition to family, parent, and child-level factors, the type of maltreatment and having a prior report, or reports, of maltreatment have been associated with recurrence. Of all the factors, a prior report of maltreatment may have the most empirical support in predicting subsequent maltreatment (e.g., Baird et al., 1993; Fuller, Wells, & Cotton, 2001). Among types of maltreatment, child neglect appears to recur more frequently than other types of maltreatment (e.g., Fluke et al., 1999, Levy et al., 1995; Marks & McDonald, 1989). In addition, although studies often combine maltreatment types, research has indicated that different forms of maltreatment may have some distinct predictors (Marks & McDonald, 1989). For example, parents’ own history of maltreatment, low social support, and high family stress have been more strongly linked with recurrence of neglect (DePanfilis, 1996; Gaudin & Dubowitz, 1997).

Given this accumulated knowledge, over the past 20 years researchers have attempted to utilize these findings systematically to improve the accuracy and objectivity of caseworkers’ risk assessment (Children's Research Center, 1999, Johnson and L’Esperance, 1984). In large part, these efforts were guided by research on decision-making in other fields in which increased accuracy was demonstrated with the utilization of actuarial assessment tools. These risk assessment measures, which formulaically combine empirically supported risk factors, improve accuracy both by increasing reliance on factors from the empirical literature and by decreasing reliance on clinical judgment and intuition (Baird & Wagner, 2000; Grove & Meehl, 1996). Ideally, with the assistance of such tools, caseworkers can more quickly and efficiently assess and triage the growing number of reports to CPS, leaving more time and energy to be spent on identifying, acquiring, and/or providing appropriate intervention services to prevent future maltreatment.

Although actuarial models hold promise for improving assessment of risk, there have been a number of problems with their implementation. First, dissemination and adoption has been somewhat limited. Although the majority of CPS agencies in the United States have instituted some form of risk assessment system, few of them are actuarial (Baird & Wagner, 2000; Camasso & Jagannathan, 2000; Children's Research Center, 1999; Grove & Meehl, 1996). Second, research on utilization of actuarial model in CPS and in other fields (e.g., criminal justice) suggests that even when available, practitioners may not implement the models as intended or may override them entirely (DePanfilis & Zuravin, 2001). As a result, although some states and agencies have experienced success with actuarial models, on the whole, a significant level of skepticism continues to exist (Munro, 1999; Wald & Woolverton, 1990) and “clinical prediction continues to thrive” (Gambrill & Shlonsky, 2000).

Given these difficulties with formal risk assessment models, it is important to assess the degree to which caseworkers utilize knowledge from the empirical literature on recurrence of child maltreatment, regardless of child welfare agencies’ chosen decision-making tool, particularly as caseworkers may not rely on it entirely. Gaining insight into caseworkers’ utilization of research findings can inform ongoing attempts to improve child welfare's identification of children and families at greatest risk of subsequent maltreatment. Although a sizeable body of research exists on different aspects of caseworker decision-making and risk assessment, the majority of these studies involve small samples and/or are from a single programmatic source or are geographically restricted, thus limiting the ability to generalize the findings. Data for the current study are from the National Survey for Child and Adolescent Well-Being (NSCAW; NSCAW Research Group, 2002), a nationally representative sample of youth and families who were the subjects of maltreatment allegations investigated by child welfare agencies. The national scope and inclusion of a large representative sample address most of the methodological issues in prior research (e.g., geographically restricted samples, small samples).

The current study focuses on assessment of risk for a subsample of children and adolescents involved with child welfare: those who remained in their homes following a report of maltreatment. The focus is on this group for three reasons. First, empirical studies of caseworkers’ decision-making for cases in which children remain with their families have been relatively limited. The majority of research attention has focused on factors associated with need for out-of-home placement (DePanfilis & Scannapieco, 1994). Second, although cases resulting in out-of-home placement often constitute the most serious incidences of maltreatment encountered by CPS (DePanfilis & Zuravin, 2001), case dispositions in which children remain with their families comprise the majority of reports to CPS (ACF; U.S. DHHS, 2005). Third, these latter cases represent those for whom ongoing or repeated maltreatment is a more probable occurrence, as children who remain in the home often also remain in the familial or environmental context in which the maltreatment originally occurred (Rittner, 2002).

Therefore, from an intervention perspective, these cases are of particular interest in that improved assessment of risk will assist CPS in reaching their dual goals of keeping children safe and keeping families together.

The objective of the current longitudinal study was threefold. First, the association between caseworkers’ knowledge of risk factors and their assessments of risk of maltreatment recurrence was examined. The risk factors included were drawn from the literature outlined previously and included family, parent, and child-level factors, as well as type of maltreatment and prior report(s) of maltreatment. Second, “accuracy” of the caseworkers’ decision-making was examined. Accuracy was defined by the agreement between classification of risk for future maltreatment and any subsequent reports of maltreatment among those families categorized by caseworkers as low- and high-risk. Subsequent reports of maltreatment were examined at two follow-up interviews occurring approximately 12 and 18 months after the report that resulted in inclusion in the NSCAW sample (hereafter referred to as the index report). Finally, factors associated with “mistakes” in classification of risk were examined among families inaccurately classified by caseworkers as low-risk. This final purpose provided an opportunity to determine if any particular risk factor(s) were being overlooked or should have been given more attention during the decision-making process. According to Gambrill and Shlonsky (2001), identifying where decision-making biases and errors occur provides an opportunity to improve upon the “hit rate” of accurate identification of families and children most at risk.

In the present study, empirical factors associated with mistakes in classification were examined only among families inaccurately classified as low-risk. Examination of mistakes was restricted to this group for two reasons. First, cases classified as high-risk without reports of re-abuse are right-censored. That is, cases could have new reports of maltreatment following to the study's 18-month follow-up period, which would indicate that the cases were not inaccurately classified as high-risk. Second, caseworkers were asked about predictions of subsequent maltreatment reports if the family did not receive services. Although research suggests that rates of maltreatment recurrence are not necessarily lower among those families receiving services (Fryer & Miyoshi, 1994; Levy et al., 1995, Wood, 1997), the true rate of maltreatment recurrence, in the absence of intervention, cannot be determined as families in the high-risk group may have received services (Gambrill & Shlonsky, 2000).

Section snippets

Method

The National Survey for Child and Adolescent Well-Being was designed by the Department of Health and Human Services to examine the relationships among child and family well-being, family characteristics, experience with the child welfare system, community environment and other factors (Dowd et al., 2001). Institutional review board (IRB) approval for the NSCAW study was obtained from Children's Hospital-San Diego. Informed consent was obtained from the caregiver and assent was obtained from the

Descriptive and demographic characteristics

Table 1 presents descriptive and demographic statistics on the child, parent, and family-level factors for the total NSCAW sample included in this analysis (column 1) and for the four groups created by categorizing the sample by caseworkers’ assessment of risk and any subsequent report(s) of maltreatment (columns 2–5). For the entire sample, the child's average age was 6.8 and the ethnicity of half of the sample was White. Caseworkers reported that approximately one-fifth of parents had a

Discussion

Caseworkers’ assessments of risk for subsequent maltreatment predominantly were associated with parent-level risk factors, which varied across physical abuse and neglect cases. These factors overlapped minimally with a smaller set of factors that predicted actual subsequent maltreatment reports. Caseworkers’ assessments of risk were more accurate for low-risk than for high-risk cases.

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    Work on this manuscript was funded by the NIMH, Caring for Children in Child Welfare project (CCCW) (MH59672) and the Child and Adolescent Intervention Research Network (CAIRN: R24 MH067377). Data come from the National Survey of Child and Adolescent Well Being (NSCAW), which was developed under contract with the Administration on Children and Families, US Department of Health and Human Services.

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