Who’s watching the children? Abuse more likely when child is with male caregiver

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Kevin Daniel Jackson, 28, accused of killing his girlfriend’s son: WDIO.com

When a child is found to be seriously or fatally abused, the perpetrator is often found to be a  male caregiver. But a new study using data from pediatric emergency rooms provides powerful evidence of the correlation between caregiver characteristics and the likelihood of abuse.

The new study is the first to compare caregiver features among children with injuries due to abuse to those with accidental injuries. The article was published in the Journal of Pediatrics, and a summary is available online on the Science Daily website. The authors used data on 1615 children under four who were brought to a pediatric emergency department. Overall, 75% of the injuries were classified as accidents, 24% as abuse and 2% as indeterminate.

The differences between the likelihood of abuse versus accident among different groups of caregivers are striking. Abuse was determined to be the cause of injury to only 10% of the children for whom a female was the only caregiver at the time of injury and fully 58% of children who were with a male caregiver when injured. There was a big difference between fathers and boyfriends however; an “alarmingly high” 94% of the children who were alone with the mother’s boyfriend at the time of injury were determined to be abused, as compared to “only” 49% of injured children who were with their fathers at the time of injury.

Analysis of the 83 cases of severe injury (including fatalities) provided even stronger evidence of the connection between male caregivers and abuse. The authors found that “nearly all cases of severe injury in which fathers and boyfriends were present involved abuse, and for fatalities, the fathers and boyfriends were most commonly present as lone caregivers. Mothers were rarely present alone when severe abusive injuries occurred.”

Among female caregivers, one group was more likely associated with injuries and that was babysitters. Fully 34% of the children left alone with babysitters were found to be victims of abuse

The researchers point to several policy implications of their study. First, they highlight the importance of asking who was caring for the child at the time of injury as part of the investigation to determine whether an injury is the result of abuse. Second, they call for abuse-prevention strategies to focus on male caregivers and female babysitters.  (Currently, such programs, like shaken baby education, often focus on mothers.)

But the authors do not mention another policy implication that is equally important. Ensuring that all low-income children have access to high-quality early care and education (ECE) is a logical implication of the study.

As I have written in an earlier post, there are many pathways by which ECE can prevent maltreatment. Free, high quality ECE would provide mothers with an alternative to leaving their children with caregivers who are unsuitable to the task–be it boyfriends, fathers, or babysitters. ECE has other child welfare benefits as well. Staff who are trained as mandatory reporters ensures that more adults will be seeing the child and able to report on any warning signs of maltreatment. Quality ECE programs that involve the parents can also improve child safety by teaching parents about child development, appropriate expectations, and good disciplinary practices. They may also connect parents with needed supports and resources in the community and help them feel less isolated and stressed.

Of course the benefits of ECE extend far beyond child welfare in the narrow sense. We are worried about school readiness for low-income children and we know that much of brain development occurs between the ages of 0 and 3. That’s why quality ECE has been such a priority for the early childhood community. But  child welfare policymakers have not yet caught onto the importance of ECE as a means of preventing child maltreatment.

An excellent issue brief from the Administration on Children and Families recommends improving access to ECE for families that are already involved with child welfare. That is a great proposal, but the child welfare field is beginning to focus on prevention rather than only treatment. We must explore ways to provide access to ECE among children who are at risk of child abuse and neglect. Expanding access to subsidized child care among lower-income families, because income is so highly correlated with child maltreatment, would be a good beginning.

Prevention is the word of the day in child welfare. A key part of prevention is making sure children spend their time with caregivers who will not harm them.

 

 

An Overlooked Approach to Child Maltreatment Prevention

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Image: Policy Lab

 

April is child abuse prevention month, and many organizations are offering recommendations on how to prevent child maltreatment. Typically these recommendations do not include one approach that may promise the most success–prevention of teenage, unplanned and closely spaced pregnancies.

Sarah Brown, founder of the National Campaign to Prevent Teen and Unplanned Pregnancy (now Power to Decide) gave a lecture in December 2015 that brought home this unfortunate omission. She reported being struck by “the total absence of pregnancy planning, spacing and prevention in virtually all discussions of how to improve overall child and family well being.” As she put it, many groups concentrate on services after the child is born, but “rarely do they mention the time when decisions are made about when with whom and under what circumstances to become pregnant or cause a pregnancy.”

There is no lack of research on the connection between pregnancy timing and child maltreatment. There is a strong association between child maltreatment and the mother’s age at the birth of the child. California researchers Emily Putnam-Hornstein and Barbara Needell found that babies born to mothers who were under 20 were twice as likely to be reported to child protective services (CPS) by the child’s fifth birthday as those born to mothers 30 or older. Among children referred to CPS by age five, almost 18 percent were born to a teenage mother and 50 percent were born to a mother younger than 25. Among children with no CPS contact, only 8 percent were teen births and 30 percent were born to a mother under 25.

There is also strong evidence that family size and child spacing are correlated with child maltreatment. Putnam-Hornstein and Needell found that children who fell third or higher in the birth order were more than twice as likely to be the subject of a report as first children. Moreover, a large study published in 2013 found that women who gave birth to another child within 24 months of the previous child were 80 percent more likely to have a substantiated CPS report.

And research suggest that the interaction between birth order and maternal age  creates the highest risk for a child maltreatment fatality. A study using linked birth and death certificates for all births in the U.S. between 1983 and 1991 found that the most important risk factors for infant homicide were a second or subsequent infant born to a mother less than 17 years old. These infants had 11 times the risk of being killed compared with a first infant born to a mother 25 years old or older. A second or subsequent infant born to 17 to 19-year-old mother had nine times the homicide risk of the first infant born to the older mother.

And setting the research aside for a moment, anyone who has worked for or with CPS, or in foster care, knows the prevalence of larger families with closely-spaced children in the system, often with a mother that started childbearing as a teen. The same pattern has been observed among families that experience a child fatality.1 

It is truly unfortunate that the number of children in families that are involved in child welfare is not among the data required to be reported to the federal government by states. It is highly plausible that if these data were collected we would see a big difference.

If it is not the lack of research, why do supporters of child maltreatment prevention fail to include family planning and contraception in their suggestions? In part, Sarah Brown says of child advocates in general, it may be that they simply don’t think of it. But in large part, says Brown, it is because they fear getting in trouble and becoming mired in controversy about abortion or sex outside marriage. In addition to the issues raised by Brown, it is likely that others avoid this topic because of the shameful legacy of past attempts to control the population of minority groups.

But people who care about the future of African American children should not allow this racist history to prevent thinking clearly about what is best going forward. There are few if any policies that could be more helpful to the future of black children and the elimination of racial disproportionality in foster care placement than ensuring that black women have access to the most effective methods of contraception so that they can determine their own futures.

Family planning and contraception need to be included in the discussion about child maltreatment prevention. We have made great progress in teen pregnancy prevention. The teen birth rate has fallen dramatically from 59.9 per thousand in 1990 to 24.2 per thousand in 2014. While research suggests that reality TV shows and the last economic recession contributed to the decline in teenage pregnancy,  better information about preventing pregnancy and the availability of more effective methods have doubtless contributed to the drastic decline.

The Colorado Family Planning Initiative, initiated with the help of a private funder, improved access to highly effective methods of contraception by training public health providers, supporting family planning clinics and removing the barriers to obtaining Long Acting Reversible Contraceptives (LARC’s). As a result of this initiative, the state’s teen birth and abortion rates were cut in half in just five years, with big financial savings to the state. Because younger mothers are so much more likely to abuse or neglect their children, this initiative should yield lower maltreatment rates now and into the future.

Upstream USA, a nonprofit organization, hopes to expand the Colorado program nationwide, starting with Delaware. Delaware’s Contraceptive Access Now (CAN) is a partnership between Upstream and the State of Delaware to decrease the incidence of unintended pregnancy. CAN works to ensure that all women get same-day access to all methods of birth control, free or at a nominal cost. They are also working to eliminate administrative and reimbursement barriers so that women can access LARC’s immediately after giving birth, taking advantage of a crucial opportunity to provide this critically important service.

Imagine if these initiatives could be expanded nationwide, combined with a public information campaign to explain the benefits of planning, spacing and timing pregnancy for both children and their parents.

Few child welfare experts have noted the link between family planning and child welfare. One of the few is Judge Patricia Martin of Illinois, a member of the Commission to Eliminate Child Abuse and Neglect Fatalities (CECANF). Martin included teen pregnancy prevention, especially in high-poverty neighborhoods and among youth in foster care, as one of the recommendations in her dissenting report.

Family planning experts also rarely if ever mention the potential of their programs to reduce child maltreatment. The more immediate benefits of increased opportunities for women and reduction in taxpayer funding for cash assistance and other services are more than enough to justify spending on helping women plan their childbearing.

The link between child abuse prevention and family planning is clear. I hope that the word will spread and that child welfare advocates and family planning advocates can work together for increased resources to help young people plan their childbearing based on their readiness to be parents.