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Surveys suggest that between 4.3% and 11.5% of children living in the United States have a serious emotional disturbance (SED). SED is defined in the Federal Register, and federal block grants are allocated to states based on the prevalence of SED. Accurate measurement of SED is critical, yet surveys have used different methodologies and instrumentation to obtain prevalence estimates. Two expert panels were convened by the Substance Abuse and Mental Health Services Administration (SAMHSA) in the fall of 2014 to discuss the current state of the field in operationalizing and measuring SED. The aims of this article are to (a) provide an update on SED prevalence rates from survey research, (b) summarize key discussion points that emerged during the SAMHSA expert panel meetings, and (c) make specific recommendations for next steps in measuring the prevalence of SED. Issues addressed in this article are important not only for federal allocation of service dollars to meet the needs of children with SED, but also for broader mental health surveillance efforts within the context of large national research surveys.

This study examined predictors of child maltreatment re-reports and recurrence (substantiated re-reports) using two nationally representative data sets: the National Survey of Child and Adolescent Well-Being (NSCAW II) and the National Child Abuse and Neglect Data System (NCANDS). Maltreatment data from the survey and administrative data sources were merged for children who participated in NSCAW II and had an NCANDS record. Re-report and recurrence data were examined among the sample of 4715 with an NCANDS record and a subsample of 1873 who received a caseworker interview at the NSCAW II 18-months' follow-up because the child was in out-of-home care and/or the family had been involved with child welfare services since the baseline interview. Many of the regression and hazard estimates of the predictors of re-report and recurrence differed across the two samples due to endogenous selection bias that arises from conditioning on the "collider" variable of caseworker interviews which is itself partially an outcome of re-report and recurrence. Similar estimates, on the other hand, were obtained: Children with prior involvement with child protective services were more likely to have re-reports and recurrence than children without prior involvement. Children that the child welfare agency reported as receiving services at the time of investigation were also less likely to have re-reports and recurrence when compared with children not receiving services. The threats to the validity of inferences that are drawn from statistical models and samples that condition on collider variables are reviewed, and the use of administrative data to supplement survey information that is unavailable from caseworkers are discussed.

This study compared child-level estimates of child maltreatment re-report and recurrence in two national sets of data on child maltreatment: state administrative data submitted to the National Child Abuse and Neglect Data System (NCANDS) and caseworker interviews from the National Survey of Child and Adolescent Well-Being (NSCAW). Maltreatment data from NCANDS and NSCAW were merged for 2230 children that had intersecting information from both sets. The percentage of child cases with at least one re-report of abuse or neglect over the study period differed depending on the data set. The NCANDS re-report estimate was 32.3% (95% CI 26.5%, 38.6%) whereas the estimate based on NSCAW caseworker interviews was 22.9% (95% CI 17.6%, 29.2%). More than a quarter of the children with observations from the union of the two data sets had a re-report identified by one source but not the other (set difference). Most often, the set difference in re-reports appeared in NCANDS, but was not reported by an NSCAW caseworker. When the set difference from NCANDS was added to the re-reports by NSCAW caseworkers, the resulting union of re-reports increased the point estimate in the NSCAW-NCANDS intersection to 40.9% (95% CI 34.3%, 47.8%). Restricting the comparisons to only substantiated re-reports (recurrence) narrowed the differences in absolute terms but the set difference in recurrence rates was proportionally similar. Potential explanations for non-intersecting re-reports and recurrence between the two data sets were examined. FINDINGS illuminate methodological challenges that may arise when child maltreatment re-report and recurrence data from administrative and survey sources are merged, and the value of the union of state-level administrative data with national survey data for studies of safety and well-being of children reported for maltreatment.

This study examined the use of mental health and substance abuse services among adolescents in the child welfare system (CWS) who reported use of illicit substances. 1004 adolescents age 11–15 years at baseline were followed for 5–7 years, over five waves of data collection. Shortly after the investigation for maltreatment (baseline), 69.1% of youths using illicit substances received mental health and/or substance abuse outpatient specialty services. By the last follow-up, during the transition to adulthood, only 21.5% of young adults using illicit substances received outpatient specialty services. Youth who used illicit substances were more likely to receive outpatient and inpatient specialty services than non-users at the time of contact with the CWS (mostly baseline), but this difference faded over the follow-up period. By 5–7 years follow-up, there was no significant difference in specialty services receipt for illicit substances users versus non-users. Predictors of outpatient service use at most waves were having Medicaid, mental health needs, and having recently seen a school counselor or primary care physician. Among illicit substance users transitioning to adulthood, African American youths were less likely to receive outpatient specialty services than White youths. These findings reveal a need for more attention to illicit substances use among youth in the CWS, better cross agency integration, and special attention to the needs of transition-age youth to better connect them with services as they age out of the CWS.

This study examines depression among caregivers of young children involved in investigations of child maltreatment, in terms of 12-month prevalence of depression across 5 to 6 years. Data were from the National Survey of Child and Adolescent Well-Being, a national probability study of 5,501 children investigated for maltreatment. The study sample comprised 1,244 female caregivers (95.5% biological mothers) of children not placed out of home and younger than 5 years old. About a quarter of caregivers had, at any given point, a score indicating major depression in the previous 12 months; across all follow-ups, 46% of caregivers had a score indicating major depression at some point. Depression was associated with caregivers’ report of intimate-partner violence and fair or poor health status. Caregivers of maltreated children are at substantial risk for depression that does not diminish over the course of 5 years. Assessing and providing assistance for intimate-partner violence and health problems may help decrease depression prevalence.

This study examines the young adult outcomes of a nationally representative cohort of transition age youth who were involved with the Child Welfare System (CWS) during adolescence. We report on the demographic and psychosocial characteristics, risk of mental health problems, and developmental milestones related to young adult outcome among these transition age youth. We also examined the effect of risk for mental health problems on young adult outcomes, over and above other psychosocial risk factors. Many youth were living in poverty, getting married early and already parenting, involved with the criminal justice system and had high levels of mental health need. Being at risk for a mental health problem increased the likelihood of criminal justice system involvement for these youth. Youth transitioning to adulthood with a history of CWS involvement appear to be at risk for negative developmental outcomes. Our findings are consistent with previous findings and highlight the risks associated with the transition to adulthood for youth who were involved with the CWS in adolescence.

More than 2.4 million grandparents in the United States provide primary care for more than 4.5 million grandchildren, but little is known about how grandparents in the child welfare system (CWS) parent their grandchildren. Using a nationally representative sample of children reported for maltreatment to the CWS, the authors compared the parenting and home environments provided by grandmothers with those provided by nonkin foster caregivers. Grandmothers were older, less educated, less likely to be married, and more likely to be subsisting beneath the federal poverty level than foster caregivers. Grandmothers had significantly better parenting scores than foster caregivers, even when the child's age and the caregiver's race/ethnicity, education, and poverty level were taken into account. The home environment provided by grandmothers in the CWS was generally as good as the one provided by foster caregivers. These findings suggest that grandmothers are striving to give affection, be responsive, and—within their economic means—provide learning opportunities for the child. Findings also yield a profile of grandmothers' social and economic disadvantages, suggesting the need for increased support for grandmothers caring for children in the CWS.

This study examines mental health and special education needs and service use at school entry among children involved in maltreatment investigations as infants. Data are from the National Survey of Child and Adolescent Well-Being, a national probability study of 5,501 children investigated for maltreatment. The study sample comprised 959 children who were infants at baseline and 5 to 6 years old at the last follow-up. Half had behavioral or cognitive needs at entry to school. About a quarter received outpatient mental health or special education services. Logistic regression showed that compared to children residing with biological parents, adopted and foster children were more likely to receive mental health services, and children adopted or in kinship care were more likely to receive educational services. Increased monitoring of behavioral and cognitive needs of infants reported for maltreatment may facilitate their access to services and ease the transition to school.

The most common service provided to parents involved with Child Protective Services (CPS) is parenting training. Nevertheless, most of the programs currently in use with CPS families lack empirical research documenting the effect of parenting training. Moreover, studies of these programs lack observational data with independent reports about changes in parent–child behaviors. Using a nationally representative sample of families investigated by CPS, the authors assessed whether parenting training was related to changes in parenting practices 18 months after training, controlling for maternal, child, and family characteristics. Mothers who received parenting services were compared with mothers who did not receive services even though they had a similar need for services as determined by Propensity Score Matching. This study found some modest benefits in maternal responsiveness and total parenting scores for mothers of 3- to 5-year-old children when these mothers received parenting services, as compared with mothers that did not receive parenting services. However, these findings could not be confirmed with multivariate analysis. These results parallel previous findings that parent training obtained through the Child Welfare System lacks the requisite features to significantly change parenting practices, and they highlight the need for cohesive, national, evidence-based effective parenting training for families involved with CPS.

This study examines levels of developmental need in young children investigated by child protective services, estimates early intervention service use, and examines need and service use variations during the 5-6 years after investigation on the basis of maltreatment substantiation status. Data were from the National Survey of Child and Adolescent Well-Being, the first nationally representative study of children investigated for maltreatment. The sample comprised 1,845 children aged 0 to 36 months at baseline. Logistic regression with covariate adjustment was used to examine the relationship between having an Individualized Family Service Plan (IFSP; a proxy and marker of early intervention services through Part C of the Individuals With Disabilities Education Act) and substantiation status. A high prevalence of developmental problems was found among children with substantiated cases and children with unsubstantiated cases. Few children with developmental needs had an IFSP. Substantiation status and level of child welfare system involvement were significantly associated with having an IFSP.

This study examined the associations between intimate partner violence (IPV) and children's use of the emergency room (ER) for an illness or injury, and care of the child by a doctor or nurse for a serious injury, accident or poisoning. We hypothesized that a mother's mental health (depression, alcohol abuse and drug abuse) and a child's lack of supervision would mediate these associations. Data were from the National Survey of Children and Adolescent Well-Being (NSCAW), a national probability study of children investigated for abuse and neglect. The analysis was limited to 2929 female caregivers who were the biological, adoptive, or stepmothers of the children. Exposure of the mother to current severe intimate partner violence was positively associated with children's use of the ER. There was no association between maternal current or past exposure to IPV and children's injuries. Current moderate IPV, current severe IPV and past severe IPV were significantly and positively associated with maternal depression. Maternal depression was not associated with child's lack of supervision. However, maternal alcohol abuse and drug abuse were positively associated with child's lack of supervision. The relationship between IPV and children's use of the ER was mediated by maternal depression. Maternal depression and lack of supervision of the children were positively associated with children's injuries. Identification of maternal IPV and depression during children's ER visits can help guide services to prevent future use of the ER and injuries to children.

This study aimed to determine if identification of intimate partner violence (IPV) has improved by caseworkers that investigate reports of child maltreatment and if mothers who are victims of IPV are more likely to report receipt of services. The study data were drawn from the two cohorts of the National Survey of Child and Adolescent Well-Being (NSCAW I and II), the first in 1999-2000 with a sample of 5,501 children reported for maltreatment and the second in 2008-2009 with a sample of 5,872 children reported for maltreatment. The analyses focused on IPV victimization of 3,625 mothers in NSCAW I and 3,351 mothers in NSCAW II whose children remained in home after the maltreatment investigation. Multiple group logistic regression was used to compare NSCAW I and II. A significant decrease in mother-reported IPV victimization (28.9-24.7%) was observed, representing a 15% decline. There were no significant changes in caseworker identification of history of domestic violence or active domestic violence. In both cohorts, substance abuse by the secondary caregiver was associated with a lower likelihood for the caseworker to miss a history of active domestic violence, while substantiation reduced the likelihood that the caseworker will miss active domestic violence. There were no changes in caseworkers' service referral, or service receipt among victims. The next decade of efforts to reduce IPV and child maltreatment should focus simultaneously on increasing caseworkers' ability to identify IPV and on funding needed services for families impacted by IPV and child maltreatment. Language: en

This study describes the extent of caregiver instability (defined as a new placement for 1 week or longer in a different household and/or with a new caregiver) in a nationally representative sample of infants, followed for 5-7 years. Data were drawn from the National Survey of Child and Adolescent Well-Being (NSCAW), a longitudinal study of 5,501 children investigated for child maltreatment. The analysis sample was restricted to 1,196 infants. Overall, 85.6% of children who were infants at the time of the index maltreatment experienced at least one caregiver instability event during their first 2 years of life. Caregiver instability was associated with the child having a chronic health condition and the caregiver being older than 40 years of age at baseline. The levels of instability reported in this study from infancy to school entry are extremely high. Children with more risk factors were significantly more likely to experience caregiver instability than children with fewer risk factors. The repeated loss of a young child's primary caregiver or unavailable, neglectful care can be experienced as traumatic. Some evidence-based programs that are designed to work with young maltreated children can make a substantial positive difference in the lives of vulnerable infants. Language: en

Substantiation can have an important effect on what interventions are pursued for children investigated for maltreatment, but researchers lack knowledge about how the decision to substantiate is made. Using information from 4,515 children from a national probability study of children investigated for maltreatment, this study examined how caseworker judgments of harm, risk, and evidence predicted substantiation. The substantiation rate was 29.9%, but the majority of cases were substantiated when caseworkers reported at least moderate harm, at least moderate risk, and/or probably to clearly sufficient evidence. Each judgment variable significantly predicted substantiation in a multivariable model, with evidence the strongest predictor. Child gender and age were significant predictors beyond harm, risk, and evidence, suggesting that other judgments also influence substantiation. In 9 of 100 cases, reports were not substantiated despite moderate to severe harm. Thus, substantiation is generally based on judgments of harm, risk, and evidence but not exclusively. The findings underline previous researchers' conclusions that substantiation is a flawed measure of child maltreatment and suggest that policy and practice related to substantiation are due for a fresh appraisal by state child welfare service agencies.

OBJECTIVES: To determine the prevalence of intimate partner violence (defined as any physical violence during the last 12 months or previously) among mothers who maltreat their children, and to examine whether mothers' experiences of intimate partner violence (IPV) are associated with repeated reports (rereports) of children to Child Protective Services (CPS) during the following 18 months. METHODS: Data for the analyses were from the National Survey of Child and Adolescent Well-Being (NSCAW), a national probability study of children investigated for child maltreatment. The sample of 5,501 children (ages 0-14) was randomly selected from the families who entered the US child welfare system between October 1999 and December 2000. The analysis sample was restricted to 1,236 families in which caregivers were: (1) the alleged perpetrators of the child maltreatment at baseline (independently of substantiation status) and (2) the biological mothers (n=1,212 or 98.6%), adoptive mothers (n=17 or 1%), or stepmothers (n=7 or 0.3%) of children not placed in out-of-home care. RESULTS: Children of mothers physically abused by an intimate partner during the last 12 months or previously at the intake interview (44%) were twice as likely as children of mothers who had not experienced such violence to be rereported to CPS (29% vs. 14%, Odds Ratio=2.0, 95% Confidence Interval=1.1-3.4). Rereports occurred almost twice as quickly for children of mothers who experienced IPV compared to children of mothers who had not experienced IPV (Hazard Ratio=1.9, 95% Confidence Interval=1.1-3.0). CONCLUSIONS: The higher risk and speedier rereports of child maltreatment associated with intimate partner violence highlights the need for universal assessment and provision of services for IPV among families that are investigated by CPS. Language: en