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BACKGROUND: Child protective services (CPS) reports are spatially concentrated in disadvantaged neighborhoods and Black children are more likely than White children to reside in these neighborhoods. Entrenched patterns of racial residential segregation reflect the lasting impact of historical redlining - a racist practice spearheaded by the federally sponsored Home Owners' Loan Corporation (HOLC) in the 1930s that assigned worst risk grades to minoritized neighborhoods. Research has established links between historically redlined areas and the present-day wellbeing of children and families; however, little is known about the relationship between historical redlining and CPS report rates in neighborhoods. OBJECTIVE: Using census tracts as a proxy for neighborhood, this study examines the relationship between historical redlining and the number of CPS reports within neighborhoods. PARTICIPANTS, SETTING, AND METHOD: This study combines data on HOLC risk grades and sociodemographic data from the American Community Survey with the aggregate number of CPS reports per census tract in Los Angeles County, CA (n = 1137). RESULTS: We used Bayesian conditionally autoregressive models to examine the relationship between historical redlining score (A = 1, B = 2, C = 3, D = 4) and the number of CPS reports within neighborhoods. In the unadjusted model, each unit increase in redlining score is associated with a 21.6 % higher number of CPS reports (95 % CI; 1.140, 1.228). In adjusted models that included concentrated disadvantage, each unit increase in redlining score is associated with a 7.3 % higher number of CPS reports (95 % CI; 1.021, 1.136). CONCLUSION: Housing policy reforms through a racial equity lens should be considered as a part of a national strategy to prevent child maltreatment.

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BACKGROUND: The "Hispanic Paradox" refers to a commonly noted tendency for Hispanic immigrants to have good health outcomes relative to risks faced. This paper demonstrates the presence of the Hispanic Paradox relative to child maltreatment, with a focus on how it appears to "fade" generationally. OBJECTIVES: To use national child maltreatment and census data to determine if the protective effects of the Hispanic Paradox are weaker ("fade") for counties with fewer foreign-born Hispanics. DESIGN: Census data, including the percentage of Hispanics in a county who were foreign-born, was used to predict child maltreatment rates as observed in the National Child Abuse and Neglect Data System. The analysis was done at a county level and included a number of covariates (e.g. Hispanic Median Income, Rural/Urban status…). PARTICIPANTS AND SETTING: We included national child maltreatment data at the county level. RESULTS: A negative binomial mixed effects model showed that for each point of increase in the percentage of the Hispanic foreign-born population of a county, the county Hispanic child maltreatment rate was expected to drop by 1 %. Variation in Hispanic national origin (i.e. Puerto Rico) was found to significantly moderate this relationship. CONCLUSION: Counties with higher percentages of foreign-born Hispanics have lower child maltreatment rates after controlling for other factors. This is consistent with emerging findings in the child mortality data and suggests that for child maltreatment, the Hispanic Paradox may fade generationally.

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BACKGROUND: Although children's right to participate in decisions that influence their lives is widely recognized, it is rarely present in the assessment and decision-making processes in child protective services (CPS). OBJECTIVE: The aim of this systematic review was to examine children's views and experiences of participating in CPS cases of child abuse and neglect and to identify the gap in scientific knowledge. METHODS: The systematic review follows the PRISMA statement and includes 13 peer-reviewed articles published in several academic journals from 2016 to 2023 reporting primary research with abused and neglected children registered in CPS. RESULTS: Thematic analysis identified five main themes: participation: assessment and decision-making, information and understanding, interaction and relationships, children vs parents, and experience of younger children. The findings show that although a few children reported instances of meaningful participation, overall, children's participation was often reduced to a tokenistic engagement, with limited influence on the decision-making processes. Children, especially younger children, receive insufficient information and struggle to understand the proceedings. Examples of prioritizing parents' views, needs, and rights rather than centering the children's perspectives are reported. CONCLUSIONS: The findings highlight a need for significant changes in how child participation is conceptualized and operationalized within CPS. Implications for practice, policy, and research are discussed to foster children's participation in CPS to contribute to the effective care and protection of children experiencing child abuse and neglect.

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BACKGROUND: Rates of child removal by child protective services (CPS) in Manitoba are the highest in Canada with a profoundly disproportionate impact on First Nations families. Despite infants constituting the highest proportion of children affected, no research has examined population-level rates of infant contact with CPS. OBJECTIVE: We examined the incidence of infant contact with different levels of CPS, including termination of parental rights (TPR), according to First Nations status. PARTICIPANTS: We identified 217,261 infants (47,416 First Nations; 169,845 non-First Nations) born between 1998 and 2014 in Manitoba, Canada and residing in the province until at least age 5. METHODS: We used linked administrative data to calculate population-level rates of contact with different levels of CPS by First Nations status, including an open file before age 1, out-of-home placement before age 1, and TPR before age 5. RESULTS: Overall 35.8 % of First Nations infants had an open file, 8.5 % experienced out-of-home placement, and 5.4 % experienced TPR. Among other infants, 8.5 % had an open file, 1.3 % experienced out-of-home placement and 0.7 % experienced TPR. The rate of early-stage contact increased the fastest among First Nations infants, with a rise of 22.4 % in our study period, compared to a rise of 1.7 % among all other infants. CONCLUSIONS: CPS contact was exceptionally high among First Nations infants compared to other infants, with early-stage contact accelerating most dramatically over time. Findings support calls to greatly reduce the disruption of system contact in the lives of First Nations families.

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Previous studies have determined that exposure to risk and adversities may impair children's cognitive abilities. In particular, children engaged with Child Protective Services (CPS) seem to be at greater risk for enhanced detrimental effects resulting from the cumulative risk factors to which they are exposed. However, little is known about children's future thinking when they face adverse circumstances, and it is not clear how the associations among episodic foresight abilities, episodic memory, and executive functions work with children under such circumstances. The current study describes the episodic foresight abilities of CPS-involved school-aged children, its association with other cognitive abilities, and how this association is affected by the exposure to cumulative risk and adversity factors. Episodic foresight, episodic memory, executive functions, and a composite of cumulative risk factors were analyzed in a sample of 95 school-aged children engaged with CPS in Portugal. Results suggest the detrimental effect of cumulative risk on the episodic foresight abilities of CPS-involved children. Episodic memory and cognitive flexibility were significant predictors of episodic foresight abilities, and cumulative risk exposure moderated the relation between episodic memory and episodic foresight. The current study provides a better understanding of the influences of multiple adversities on CPS-involved children's episodic foresight abilities and related cognitive outcomes.

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In a recent issue of Child Maltreatment (2023 vol. 28 (4)), an editorial by Palusci et al. and a commentary by Briggs et al. were published. These two publications express the American Professional Society on the Abuse of Children (APSAC) Board's and the Child Maltreatment editorial team's stance relative to Diversity, Equity, Inclusion and Justice (DEIJ). The current commentary expresses a range of concerns regarding how APSAC and Child Maltreatment plan to advance DEIJ through their editorial policies.

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In this special issue, innovative research teams expanded work on the effects of the COVID-19 pandemic and lockdowns on child maltreatment by assessing these effects on treatment and service delivery following maltreatment, on the professionals responsible for identification and treatment, and on the systems responsible for oversight and instruction. One theme that emerged across these studies concerned challenges faced by professionals as they attempted to evaluate families and provide service and support. Organizational leadership was crucial in helping these professionals navigate challenges in a positive and productive manner. A second theme concerned remote service delivery. Findings suggested that remote maltreatment assessments, treatment, and court procedures all worked to some degree. Thus, despite the massive social disruption caused by the pandemic and lockdowns, parents, professionals, and systems were able to adapt and address core needs of children and families. In future work, it may be important to consider how these findings and their implications vary depending on the type of maltreatment children experienced. Doing so would allow for more nuanced understanding of the consequences of significant national and global crises on child maltreatment and would enable clearer recommendations regarding how best to protect children and support families during such events.

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It is not known how school closure affected child maltreatment. We conducted a retrospective cohort, linear mixed-models study of 133 counties (comprising 8,582,479 children) in Virginia between 2018 and 2021. Exposure was the opening of schools at least 2 days a week. Outcomes were referrals and incidence of child maltreatment reported to the Department of Social Services. In 2020-2021, there were descriptively more referrals (in-person: 50.9 per 10,000 [95% CI: 47.9, 54.0]; virtual: 45.8 per 10,000 [95% CI: 40.7, 50.9]) and incidence (in-person: 3.7 per 10,000 [95% CI: 3.3, 4.2]; virtual: 2.9 per 10,000 [95% CI: 2.3, 3.5]) of child maltreatment in counties with in-person schooling, though these differences did not reach statistical significance. The referral rate variations (between pandemic and pre-pandemic eras) of counties with in-person schooling was significantly greater than rate changes in counties with virtual schooling during the summer period. There were no differences in incidence in any quarter. Higher poverty within a county was associated with both higher referrals and incidence. Our findings suggest that child maltreatment is driven primarily by underlying differences in counties (namely, poverty) rather than the type of schooling children receive.

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As the third case in the acute safeguarding essentials in modern-day paediatrics series, this article focuses on sexual relationships, consent and confidentiality. Using the scenario of a 15-year-old girl presenting to the emergency department with a positive pregnancy test, it begins with a guide to taking a psychosocial history in young people followed by discussion about some of the legality surrounding sexual relationships in adolescents, issues around consent and considerations for confidentiality in this age group.

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The purpose of this study is to investigate the mediating role of multisystemic strengths in the association between complex trauma (CT) exposure and placement stability among racialized youth using the Child and Adolescent Needs and Strength (CANS) assessment. Participants were 4022 Black and Latinx youth in the child welfare system in a midwestern state. Negative binomial regressions revealed a significant indirect effect of CT exposure on placement stability through interpersonal strengths (p < .01), coping skills (p < .001), optimism (p < .01), and talents/interests (p < .05). At the familial level, there was a significant indirect effect of CT exposure on placement stability through family strengths and relationship permanence (p < .001). At the community level, educational system supports, and community resources indirectly impacted the relationship between CT exposure and placement stability (p < .01). These findings suggest that early interventions aimed at identifying and developing multisystemic strengths in Black and Latinx youth in the child welfare system can help maximize placement stability.

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BACKGROUND: Facilities providing health- and social services for youth are commonly faced with the need for assessment and management of violent behavior. These providers often experience shortage of resources, compromising the feasibility of conducting comprehensive violence risk assessments. The Violence Risk Assessment Checklist for Youth aged 12-18 (V-RISK-Y) is a 12-item violence risk screening instrument developed to rapidly identify youth at high risk for violent behavior in situations requiring expedient evaluation of violence risk. The V-RISK-Y instrument was piloted in acute psychiatric units for youth, yielding positive results of predictive validity. The aim of the present study was to assess the interrater reliability of V-RISK-Y in child and adolescent psychiatric units and acute child protective services institutions. METHODS: A case vignette study design was utilized to assess interrater reliability of V-RISK-Y. Staff at youth facilities (N = 163) in Norway and Sweden scored V-RISK-Y for three vignettes, and interrater reliability was assessed with the intraclass correlation coefficient (ICC). RESULTS: Results indicate good interrater reliability for the sum score and Low-Moderate-High risk level appraisal across staff from the different facilities and professions. For single items, interrater reliability ranged from poor to excellent. CONCLUSIONS: This study is an important step in establishing the psychometric properties of V-RISK-Y. Findings support the structured professional judgment tradition the instrument is based on, with high agreement on the overall risk assessment. This study had a case vignette design, and the next step is to assess the reliability and validity of V-RISK-Y in naturalistic settings.

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AIM: People living with mental illness are more likely than the general population to experience adverse housing outcomes, including homelessness. The aim of the current study is to examine residential status when participants have their first contact with mental health services, and the correlates of residential status at that moment. METHODS: First-time mental health service users were recruited from seven clinical sites across Québec. Data on residential status at entry in the project, as well as demographic, clinical and social variables, were collected using self-report and interviewer-rated questionnaires. Participants were classified as 'Homeless', 'At risk of homelessness' and 'Stably Housed', and correlates of residential status were identified through multivariate logistic regression and unbiased recursive partitioning. RESULTS: Among the 478 participants, 206 (43.1%) were in stable housing, 171 (35.8%) were at risk of homelessness and 101 (21.1%) were classified as homeless. Placement in a youth protection facility was strongly associated with adverse housing outcomes, while having a high school diploma and more social support were associated with more stable housing situations. CONCLUSIONS: First-time mental health service users are likely to experience a range of adverse housing situations, indicating the potential for clinical sites to implement homelessness primary prevention strategies. Factors related to family, foster care and schooling seem to be particularly salient in understanding risk of homelessness in first-time mental health service users, calling for intersectoral action to prevent adverse psychosocial outcomes in this population.

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INTRODUCTION: As a part of the public health approach to child welfare, data about children placed in out-of-home care are needed to assess population trends, understand drivers of social and health inequities, and examine outcomes for children and families. We analyzed administrative data from Canada to describe the population of children in out-of-home care, and estimate and compare rates of out-of-home care by province/territory, year, sex/gender, age group and placement type. METHODS: We conducted a cross-sectional analysis of point-in-time data from all provinces and territories for the period 2013/2014 to 2021/2022. We used frequencies and percentages to describe the population of children (and youth up to age 21 years) in out-of-home care and estimated overall and stratified rates and rate ratios. RESULTS: An estimated 61 104 children in Canada were in out-of-home care on 31 March 2022. The national rate of out-of-home care was 8.24 children per 1000 population. Rate variations by province/territory were substantial and changed over time. Rates were highest among males and children aged 1 to 3 and 16 to 17 years. Foster homes were the most common type of placement, although kinship homes accounted for an increasing share. CONCLUSION: This analysis demonstrated that administrative data can be used to generate national indicators about children involved in the child welfare system. These data can be used for tracking progress towards health and social equity for children and youth in Canada.

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BACKGROUND: Prenatal substance use can have negative health consequences for both mother and child and may also increase the likelihood of child welfare involvement. The rate of newborns with substance exposure has increased dramatically. As of 2016, federal law requires notification of all infants to child welfare agencies so that a plan of safe care can be developed and referrals to services can be offered. OBJECTIVE: Child welfare agencies have not historically collected consistent, systematic data identifying substance exposed newborns. We utilized a unique strategy to identify substance exposed newborns with child welfare involvement. PARTICIPANTS & SETTING: We used data from the National Child Abuse & Detection System (NCANDS) which captures N = 3,189,034 unique child protective services investigations for children under the age of 1 between 2004 and 2017. METHODS: We calculated the incidence of substance exposed newborns investigated by child welfare agencies and compared with other administrative data on prenatal substance exposure. We also analyzed this rate by infant demographic characteristics (race/ethnicity, sex, rurality). RESULTS: Between 2004 and 2017, approximately 13 % of infants reported to child protective services were likely reported because of substance exposure at birth, and the rate of substance exposed newborns with child welfare involvement increased from 3.79 to 12.90 per 1000 births, an increase of 240 %, over this period. CONCLUSIONS: Understanding the extent of the substance use crisis for child welfare involvement is important for policymakers to support children and families.

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PURPOSE: Newborn removal by North America's child protective services (CPS) disproportionately impacts Indigenous and Black families, yet its implications for population health inequities are not well understood. To guide this as a domain for future research, we measured validity of birth hospitalization discharge codes categorizing newborns discharged to CPS. METHODS: Using data from 309,260 births in Manitoba, Canada, we compared data on newborns discharged to CPS from hospital discharge codes with the presumed gold standard of custody status from CPS case reports in overall population and separately by First Nations status (categorization used in Canada for Indigenous peoples who are members of a First Nation). RESULTS: Of 309,260 newborns, 4562 (1.48%) were in CPS custody at hospital discharge according to CPS case reports and 2678 (0.87%) were coded by hospitals as discharged to CPS. Sensitivity of discharge codes was low (47.8%), however codes were highly specific (99.8%) with a positive predictive value (PPV) of 81.4%, and a negative predictive value (NPV) of 99.2%. Sensitivity, PPV and specificity were equal for all newborns but NPV was lower for First Nations newborns. CONCLUSIONS: Canadian hospital discharge records underestimate newborn discharge to CPS, with no difference in misclassication based on First Nations status.

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BACKGROUND: Adverse childhood experiences can have immediate effects on a child's wellbeing and health and may also result in disorders and illness in adult life. General practitioners are in a good position to identify and support vulnerable children and parents and to collaborate with other agencies such as child welfare services. There is a need for better integration of relevant services. The aim of this study is to explore GPs' experiences of the collaboration process with child welfare services. METHOD: This is a qualitative grounded theory study, with data consisting of ten semi-structured interviews with general practitioners across Norway. RESULTS: The doctors' main concern was: 'There's a will, but not a way'. Three subordinate stages of the collaboration process were identified: (I) Familiar territory, with a whole-person approach to care by the doctor. (II) Unfamiliar territory, when child welfare becomes involved. Here, a one-way window of information and a closed door to dialogue perpetuate the doctors' lack of knowledge about child welfare services and uncertainty about what is happening to their patients. (III) Fragmented territory, where doctors experience lost opportunities to help and missing pieces in the patient's history. CONCLUSION: General practitioners are willing to contribute to a collaborative process with child welfare, but this is hampered by factors such as poor information flow and opportunities for dialogue, and limited knowledge of the partner. This implies lost opportunities for doctors to help families and contribute their knowledge and potential actions to a child welfare case. It can also impede whole-person care and lead to fragmentation of patient pathways. To counteract this, electronic two-way communication could enable a collaborative process and relationships that enhance coordination between the parties. Making space for all parties and their individual roles was considered important to create a positive collaborative environment.

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PROBLEM: This study was carried out to investigate the health-risk behaviors and peer pressure of adolescents aged 12-18 years in need of protection at child protective services. METHODS: The data of this cross-sectional study were collected using individual interviews with 85 adolescents living in child homes and child homes buildings complex between February 25 and May 31, 2019. The data were collected using the "Descriptive Information Form," the "Health-Risk Behaviors Questionnaire," and the "Peer Pressure Questionnaire." FINDINGS: The results of study in adolescents were 34.1% were in the risk group in terms of weight, and 41.2% had a psychiatric problem. Among the health-risk behaviors of adolescents; 56.5% did not pay attention to daily nutrition, 51.8% had fast food every day, 54.1% injury behaviors were doing dangerous sports, only 15.3% wore seat belts, 78.8% did not exercise three or more days per week, 38.8% watched television and computer three or more hours per day, 27.1% used painkillers without consulting a doctor, 24.7% applied the health recommendations they read on the internet, 20.0% of the adolescents reported that they went on a diet without consulting the healthcare personnel, and 14.1% voluntary vomited to lose or maintain their weight. And 21.2% of the adolescents were exposed to peer pressure. CONCLUSIONS: It was concluded that adolescents in need of protection at child protective services have health-risk behaviors and low-level peer pressure.

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