Transcript Paternity Establishment Among Children reported to Child

LINKING RECORDS TO ADVANCE
CHILD PROTECTION:
A CALIFORNIA CASE STUDY
Emily Putnam-Hornstein, PhD
University of Southern California
Barbara Needell, PhD
University of California at Berkeley
3 rd Annual
State of
Health Care
Conference
BACKGROUND
California Child Welfare Indicators Project
 longstanding university/agency partnership
 longitudinal configuration of state’s child
protective services data
 technical assistance to California counties & state
 consultation services to other state child welfare
agencies
 publicly available website for tracking outcomes
and performance indicators (interactive queries)
 data available for research…
WHAT WE KNOW (NATIONAL)
 In 2011, more than 6 million children were referred
for possible maltreatment in the United States;
nearly 700,000 were substantiated as victims
 Estimated lifetime cost of child maltreatment is
$124 billion each year (Fang, et al., 2012)
 A growing body of research indicates that children
who experience abuse or neglect are at heightened
risk of adverse health outcomes, including:
 Obesity, cancer, strokes (Felitti, et al., 1998)
 Teen pregnancy (Noll & Shenk, 2013)
 Self-injurious behaviors (Rhodes, et al., 2013)
WHAT WE KNOW (CALIFORNIA)
Rates of CPS Involvement in California
30
20
10
0
Rate
40
50
(per 1,000 children)
2000
2001
2002
Referrals
2003
2004
2005
2006
Substantiations
2007
2008
2009
2010
2011
Entries to Foster Care
WHAT WE DO
CPS involvement
Birth
Maltreatment
Referral
Investigation
Services
A “SNAPSHOT” OF
MALTREATED CHILDREN
before
CPS Data
after
Children not Reported for
Maltreatment
MOVING AWAY FROM DATA SILOS…
birth data
child protective
service records
death data
before
CPS Data
after
Children not Reported for
Maltreatment
population-based
information
RECORD LINKAGES 101
File A
SSN
First Name
File B
deterministic match
Address
First Name
Middle Initial
Middle Name
Last Name
Date of Birth
SSN
probabilistic match
Last Name
Date of Birth
Zip Code
LINKED DATASET
cps records
514,000
LINKED
DATA
birth
cps contact
birth
no cps contact
birth records
4.3 million
EXPANDED INFORMATION
vital birth
records
child protective
service records
Child A
California
Birth
Cohort
Child B
Child C
Child D
Referral
by Age 5
population-based
information
LANGUAGE
 “Risk factor ”: a term used in epidemiology to
define a characteristic that is either directly or
indirectly associated with risk of disease or other
adverse health outcomes
 Stable / Fixed at birth (e.g., male gender is a risk factor for
injury)
 Time varying – developing through exposure to adversities
in the social or physical environment
 This information can be used to identify
individuals/groups/communities particularly vulnerable to
a given adverse outcome in order to strategically target
prevention and intervention programs and policies
BIRTH RECORD VARIABLES
sex
birth weight
prenatal care
birth
abnormality
maternal
birth place
race
•female
•male
•2500g+
•<2500g
•<=19
•20-24
•25-29
•30+
•1st trimester
•2nd trimester
•3rd trimester
•no care
•<high school
•high school
•some college
•college+
•present
•none
•US born
•non-US born
•Native American
•black
•Hispanic
•white
•Asian/Pacific Islander
maternal age
maternal
education
pregnancy
termination hx
named father
# of children in
the family
birth payment
method
•prior termination
•none reported
•missing
•named father
•one
•two
•three+
•public/med-cal
•other
SELECTED FINDINGS…
 14% of children in birth cohort were reported to CPS by
age 5
 Lower bound estimate…could not match 16% of CPS records
 Cumulative rate of CPS involvement 3x higher than single year
estimates suggest
 11 of 12 variables were significantly associated with CPS
contact
 Crude risk ratios >2 were observed for 7 variables
 Contact with CPS is hardly a rare event for certain
groups
 34% children without paternity established
 25% of children born to teen mothers
Percentage of Children Reported for Maltreatment by Age 5:
California's 2002 Birth Cohort, by paternity & birth payment
34%
21%
12%
missing paternity
paternity
9%
medi-cal coverage private insurance
Percentage of Children Reported for Maltreatment by Age 5:
California's 2002 Birth Cohort, by prenatal care
48.9
25.4
22.3
12.3
none
third trimester
second trimester
first trimester
Percentage of Children Reported for Maltreatment by Age 5:
California's 2002 Birth Cohort, by maternal age at birth
25.7
19.0
12.6
<20 yrs
20-24 yrs
25-29 yrs
9.3
30+ yrs
AN EPIDEMIOLOGIC RISK ASSESSMENT TOOL ?
( “ B A CK O F T H E E N VE LOP E ” CA L CU L ATIONS …)
 We classified as “high risk” any child with
three or more of the following (theoretically
modifiable) risk factors at birth:
 late prenatal care (after the first trimester)
 missing paternity
 <=high school degree
 3+ children in the family
 maternal age <=24 years
 Medi-Cal birth for a US-born mother
 Think of this as a means of “sorting” children –
looking for proxy indicators that give us
additional information about an infant’s
likelihood of referral
RISK ASSESSMENT TOOLS
ADMINISTERED AT BIRTH?
Full Birth Cohort
15%
Children Reported to CPS
50%
RECOGNIZING THE RISK ASSOCIATED WITH
THE PRESENCE OF MULTIPLE RISK FACTORS…
High Risk on Every Modifiable Risk Factor: 89% probability of CPS report
Low Risk on Every Modifiable Risk Factor: 3% probability of CPS report
CONCLUDING THOUGHTS…
 Data that are universally collected at birth can be used to
identify those children that are at greatest risk of later CPS
involvement
 Compared with the demographics of the birth cohort as a
whole, these young children are defined by the presence of
multiple risk factors
 A standardized assessment tool can never replace more
comprehensive assessments of a family’s strengths and risks,
but against an invariable backdrop of limited resources, the
ability to prioritize investigations and adjust levels of case
monitoring in order to meet the greater needs of a targeted
swath of at-risk children and families has the potential for
cost-savings to be realized, while also improving child wellbeing
RECORD LINKAGES
“Each person in the world creates a Book of Life. This Book starts
with birth and ends with death. Its pages are made up of the records
of the principal events in life. Record linkage is the name given to the
process of assembling the pages of this Book…” (Dunn, 1946)
University Partners
Government
Ongoing Collaboration
QUESTIONS?
[email protected]
[email protected]
http:// cssr.ber keley.edu/ ucb_ childwelfa re /
ACKNOWLEDGEMENTS
Thank you to our colleagues at the Center for
Social Services Research and the California
Department of Social Services
Ongoing support for research arising from the
California Performance Indicators Project and
related activities is generously provided by
CDSS, the Stuart Foundation, and Casey Family
Programs
Record linkages funded by the Harry Frank
Guggenheim Foundation, the Conrad N. Hilton
Foundation, and First 5 LA