Faculty of Social and Behavioural Sciences
Graduate School of Childhood Development and Education
Hi, here we are again!
The role of parental and case characteristics
in recurrent involvement of child welfare
services and police after Home-Start
parenting support
Research Master Educational Sciences Thesis 1, February 2014
Rosanne op den Kelder
Abstract
Recurrent maltreatment is an indication of persistent parenting problems and can be harmful to children. There are several risk and protective factors that influence the likelihood of recurrent involvement of child welfare services or police. The aim of the current study is to describe characteristics of families with reports of recurrent maltreatment while
simultaneously evaluating which specific parental and case characteristics are the most
influential. Reports include both concerns of child maltreatment or parenting problems in four databases of child welfare services and police after Home-Start parenting support.
One-hundred-eleven families from three evaluation studies of the effectiveness of Home-Start were checked for recurrence in four databases; Youth Care Agency, Advice and Reporting Centres for Child Abuse and Neglect, Child Protection Board and police. Repeated event history analysis was used to study recurrence and the timing of reports related to child maltreatment or parenting problems child welfare services or police databases. Recurrence rates of respectively 61%, 53%, and 26% for study 1, 2, and 3 were found. Kaplan-Meier results showed that there were no significant differences between conditions in survival curves. Cox proportional hazards showed that prior child welfare services and police involvement and higher levels of parenting stress at baseline were significant predictors of time to recurrence. Results suggested that there were no differences across conditions for time to recurrent child welfare services and police involvement. However, the theoretical model of change of Home-Start was partly supported, because parenting stress levels were found to be a predictor. Increasing research on parenting support programs will aid in the identification of predictors of recurrent maltreatment, which might reduce the amount of chronically
maltreated children in the Netherlands.
Keywords: Child Maltreatment, Recurrence, Child Welfare Services, Police, Home-Start, Parenting Support
Introduction
Child maltreatment inflicted by a child’s caretakers is considered severely disruptive to children’s developmental process (Hermanns & ter Meulen, 2007). Parental failure to provide a healthy, safe and nourishing environment that fosters optimal child development can lead to a wide range of negative outcomes throughout a child’s life (Cicchetti & Toth, 2005). Abundant evidence has shown that maltreated children are more likely to experience both mental and physical health problems, exhibit delinquent and aggressive behavior, and obtain lower academic outcomes than non-maltreated children (Cicchetti & Toth, 2005; Prinz, Sanders, Shapiro, Whitaker, & Lutzeker, 2009). These issues are exacerbated in children who experience recurrent maltreatment. Moreover, recurrent maltreatment negatively impacts levels of posttraumatic stress and depression, compared to children who experience episodic abuse or neglect (English, Graham, Litrownik, Everson, & Bandiwala, 2005). Furthermore, the impact of child maltreatment is not isolated to the child, but can broadly impact societies as well (Cicchetti & Toth, 2005; Gilbert et al., 2009; Gonzales & MacMillan, 2008). For example, maltreated children experience more to be unemployed in later life, which has large effects on economic productivity (Gilbert et al., 2009). In sum, recurrent child maltreatment has a broad variety of short and long term detriments for both individuals and broader society, whichmakes prevention of child maltreatment important.
Recurrent child maltreatment is at the forefront of both child development research and protective policies because it indicates unresolved and persistent parenting problems or harm to children (Zhang, Fuller, & Nieto, 2013). For instance,it was found that 30% of investigated events are re-reported to child welfare services within three years from the initial event (Connel, Begeron, Katz, Saunders, & Tebes, 2007), and recurrence rates can be as high as 22% in a 2-year period (Fluke, Shusterman, Hollishead, & Yuan, 2008). Risk for this recurrence is highest within the first six months after the initial report to child welfare
services (Bae, Solomon, & Gelles, 2009; Fluke, Shusterman, Hollinshead, & Yuan, 2008; Jonson-Reid, Emery, Drake, & Stahlschmidt, 2010). Despite some inconsistencies in results, a majority of recurrent maltreatment research has found the subsequent main factors to be associated with recurrence (Zhang, Fuller, & Nieto, 2013). Firstly, case characteristics such as the specific type of maltreatment at initial event affected the probability of a recurrent event (Hélie & Bouchard, 2010). However, no consensus as to which specific maltreatment characteristics influenced the risk for recurrence the most was found in previous research. Secondly, parental factors, for example single parenthood, (Bae, Solomon, & Gelles, 2009) and maternal and paternal health problems (Kahn & Schwalbe, 2010) has shown to affect the likelihood of recurrence. Thirdly, family factors such as poverty, child-caregiver
relationships, prior involvement of child welfare services, and number of children in the household are considered risk factors for recurrent involvement. Lastly, familial factors such as receiving financial aid and parental higher education serve as protective factors in recurrent child maltreatment (Drake, Jonson-Reid, & Sapokaite, 2006).
As such, the international governments have prioritized protection against all forms of physical and psychological abuse and neglect while in care of their legal guardian by signing the United Nations Convention of the Rights of the Child (article 19 of the United Nations Convention on the Rights of the Child, U.N., General Assembly, 1989). Despite this legal declaration, child maltreatment is still prevalent in the Netherlands with an estimated 34 cases per 1000 children in 2010 (Alink et al., 2011). Dutch law currently characterizes child
maltreatment based on four main criteria; (1) any form of threatening or violent interaction between minor and parents or other persons on whom the minor is dependent, (2) the
interaction is either physical, psychological or sexual in nature, (3) the interaction is actively or passively forced upon the minor, and (4) the interaction results in harm, or threat of harm to the child regardless of parental intent (Law on Youth Care, article 1, sub m). In short,
despite the fact that most parents do not intend to mistreat their children and protective laws are in place, many children still are abused or neglected under the Dutch child maltreatment clause.
In the Netherlands, there are several organizations that advocate, support and protect children against maltreatment. Central to this cause is The Youth Care Agency (in Dutch: Bureau Jeugdzorg) which is the primary care center for youth under 18 years with
developmental problems. Legally, the Youth Care Agency is responsible for assessment, probation and protective regulations for youth, while working in conjunction with the Advice and Reporting Centers for Child Abuse and Neglect (in Dutch: Advies en Meldpunt
Kindermishandeling). The Youth Care Agency can only be contacted by the child’s legal guardian and child care professionals, whereas the Advice and Reporting Centers can be contacted by a concerned family members for advice or a referral. After a referral, a
mandatory investigation into parenting practices and home life takes place. Post investigation several different protocols are taken depending on the case: arranging access to specialized care, providing protection, and referring cases to the police, the Child Protection Board (in Dutch: Raad voor de Kinderbescherming) and/or prosecutor (Staal, Hermanns, Schrijvers, & van Stel, 2013). The Child Protection Board is only contacted, when the Youth Care Agency and parents cannot resolve the issue independently and/or the environment is potentially unsafe or harmful to the child. When compulsory care is warranted after investigation, the Child Protection Board can request a court order to authorize a youth protective regulation. For example, appointing a new legal guardian or out-of-home placement for the child. In partnership with these child welfare services, the National Program Domestic Violence and Police Task (in Dutch: Landelijk Programma Huiselijk Geweld en Politie Taak) also provide childcare services. Established in 2004, this program provides supplemental support to the Dutch police corps to reinforce their policy on domestic violence (Goedee & Rijkers, 2010).
In conclusion, many organizations provide resources and support for children who are at-risk or currently experiencing an unsafe home environment. The combination of these
organizations, representing the Dutch government, is responsible for protecting children against violence.
Several parenting support programs aim to prevent child maltreatment and parenting problems. Home-Start is one of the home-visiting programs that aim to improve parenting behavior and to have long-term benefits for children’s development and well-being through social support that is given inside the home. As a result, this positive change should prevent daily problems from developing into more severe parenting problems or child maltreatment Hermanns, 2008). However, empirical evidence for the prevention of child maltreatment after parenting support remains relatively weak and inconsistent, because a lot of challenges in methodology, data collection, and data access have to be faced. For
example, organizational policies and technical problems cause problems in adequate data access, which might confound the results of scientific research (Howard & Brooks-Gunn, 2009).
Hélie and Bouchard (2010) argued that there are too many discrepancies and limited knowledge about risk and protective factors for recurrence. For instance, in the Netherlands, currently there are no studies about recurrent maltreatment events in databases of child welfare services and police. In addition, most recurrence research does not integrate the psychosocial information of families with administrative databases. As the current study is part of the ongoing evaluation on the effectiveness of Home-Start in the Netherlands, it was possible to make this connection. In other words, this study can have a large contribution in reducing the knowledge gap of recurrence and the psychosocial characteristic influencers. The aim of this study is to first gain insight about recurrence after Home-Start parenting support by describing characteristics of families with recurrent or single events at child welfare
services or police databases. Secondly, recurrence rates and timing of recurrence are
investigated in order to understand a possible influence of Home-Start on the development of recurrence patterns in families after an initial report to child welfare services or police. Lastly, the influence of maternal baseline outcome measures parenting competence, parenting stress, maternal psychopathology, and maternal depression –based on the theoretical model of change of Home-Start- and prior involvement of child welfare services on recurrent child welfare services and police involvement are investigated.
Method
Participants
The current sample of 111 participants originated from 953 participants of three evaluation studies on the effectiveness of Home-Start (Asscher, Hermanns, 2008; Hermanns, Asscher, Zijlstra, Hoffenaar, & Dekovi 2013; Smallegange, 2013 (in
preparation)). These 111 participants were selected, because their families were reported to child welfare services or police at least once. The evaluation studies compared Home-Start to different groups in different research designs. Study 1 compared Home-Start to a control group who experienced similar parenting problems in a quasi-experimental research design. Study 2 used care as usual as a comparison group in a cluster randomized trial. Lastly, study 3 was a randomized control trial that made a comparison between Home-Start plus a parenting management training and Home-Start. In addition, non-respondents of the three studies were also included in this sample, because it was hypothesized that there would be a high amount of reported events within these groups. In study 1, the non-response group originated from the control group. Non-respondents of study 2 came from the Home-Start group, while non-respondents of study 3 originated from both Home-Start only and Home-Start plus parenting management training.
Procedure
Baseline outcome measures and demographic information of before mentioned evaluation studies were combined with official administration data of child welfare services and police. All participants were checked for events concerning child maltreatment or
parenting problems in databases of the Youth Care Agency, Advice and Reporting Centers of Child Abuse and Neglect, Child Protection Board, or National Program Domestic Violence and Police Task. Prior to data collection at CWS and police databases, research variables were defined in collaboration with child welfare services’ boards and legal departments. Data was collected in the period 2011-2013. In contrast to the Child Protection Board and police that were nationally coordinated, Advice and Reporting Centers and Youth Care Agency were regionally coordinated. Therefore only databases of six regional offices were consulted.
Ethics. Parents signed an informed consent form confirming their participation and
allowing the use of gathered data for supplemental research purposes. However, no specific consent was given to link gathered information to official registrations at child welfare services and police databases. Therefore, approval for both the evaluation studies and the supplemental data collection was obtained from the Ethics Committee of the Department of Child Development and Education of the University of Amsterdam. This request was granted because the unlikely probability to cause any harm to (non-)respondent families caused by data collection at child welfare services or police databases. As a result, the present study was registered as 2012-POWL-2356. In addition, the national boards of and Child Protection Board, National Program Domestic Violence and Police Task, the Ministry of Justice and Security, and the regional boards of the Advice and Reporting Centers for Child Abuse and Neglect and the Youth Care Agency permitted data collection. Finally, before consulting child welfare services and police databases, a contract was signed by the researcher to conform to privacy legislations.
Measures/instruments
For each analysis, different variables were used. For example, in order to detect differences between families with single or recurrent events there was focused on
demographic variables. To investigate recurrence rates and timing of recurrence only time variables and conditions of each study separately were used in analysis. Time to recurrence was measured using time lapse in months between initial and first recurrent report, first recurrent report and second recurrent report, second recurrent report and third recurrent report, and etcetera.
Demographic characteristics. Number of children in the household (1,2,3 or more),
income (low, middle, and high), other active forms of support (yes/no), more than 3 life events experienced (yes/no), parental age (in years), educational level (primary education, lower education, intermediate education, higher education), nationality (Dutch, Western, Non-Western) paid employment (yes/no), single parenthood (yes/no), number of sources of support, and presence of chronic health problems (yes/no) were included as background variables for descriptive analyses.
Case characteristics. Case characteristics of the initial event were included for
descriptive analyses as well. Reports of child welfare services and police were coded for date of event, contactor type (child in the family, parent or other adult in the family, third parties in the private environment of the family, professionals, others, unknown), database type (Youth Care Agency, Advice and Reporting Centers, Child Protection Board, and police), substantiation of parenting problems or maltreatment (yes/no), subsequent action (yes/no), and prior involvement of child welfare services or police (yes/no). The definitions of the type of problems that were related to child maltreatment or parenting problems are presented in Appendix 1. Events that were not related to child maltreatment or parenting problems, such as
theft, neighbor quarrel, nuisance, or indications for child psychopathology, were excluded from analysis.
Baseline outcome measures. Lastly, for Cox proportional hazards all participants
were taken together and variables in Home-Start’s theoretical model of change were used as covariates. These variables included parental well-being in terms of parental psychopathology and parenting stress. Parental psychopathology was measured using the Brief Symptom Inventory (BSI). This questionnaire of 53 items was used to get an overview of parental psychopathological symptoms and its intensity. The experienced burden of symptoms over the last week was rated on a five point scale (not at all - extremely). The BSI has shown to be reliable and valid after extensive research (Derogatis, 1993, as cited by Kellet, Beail,
Newman, & Frankish, 2003). Parenting stress was measured using a Dutch translation of the Parental Daily Hassles (PDH) questionnaire. This questionnaire was used to assess the frequency and intensity of events that can be a hassle to parents. For example, items as “Being nagged, whined at, complained to” and “The kids won’t listen or do what they are asked without being nagged” were rated on a 4 point frequency scale (1 = rarely, 2 =
sometimes, 3 = a lot, 4 = constantly) and a scale from 1 to 5 for intensity of the events (1= no hassle, 5= a big hassle). Both frequency and intensity have adequate internal consistency with Cronbach’s alphas of respectively .81 and .89 (Crnic & Booth, 1991). Second, parenting competence was measured using the Nijmeegse Ouderlijke Stress Index. This questionnaire is constructed of 13 subscales. One of these subscales is parenting competence, which was used to assess parenting competence in the current study. Finally, the child’s well-being was measured using internalizing and externalizing problem broad-band scales of the Child Behavior Check List for ages 1.5 – 5. This questionnaire is rated on a three-point Likert scale (0=not true, 1= somewhat or sometimes true, 2= very true) and is completed by parents and assesses different emotional and behavioral problems in young children. A one-week
adequate test-retest reliability for both scales was found, ranging from .82 to .95 (Achenbach, 1991, as cited by Dehon & Scheeringa, 2006).
Analyses
Event history analysis. Event history analysis was used in order to examine the time
duration between recurrence of an event (Mills, 2011; Tabachnick & Fidell, 2012). Firstly, Kaplan-Meier estimates were used to investigate median survival times for each condition. For each study, survival times were calculated independent of the others. Second, a right-censored model of Cox proportional hazards was used to examine the influence of covariates on the recurrence of events. In order to be able to perform Cox proportional hazards there cannot be missing data. Therefore, Estimation Maximization imputation was used for missing data, because the data was missing completely at random ( 2 (27) = 25.9055, p = .412). Moreover, three univariate outliers were truncated prior to data-analysis, because Cox proportional hazards is very sensitive for outliers. Lastly, assumptions for Cox proportional hazards, such as proportionality of hazards, were met.
Results
Firstly, demographic information about the 111 reported families are displayed in Table 1. One-way subject analysis of variance was used to determine differences in
background variables across conditions. Post-hoc tests were used if variables were compared for more than two conditions. In study 1, a significant difference between Home-Start and control group were found on single parenthood, and number of resources of support (both F (1,14) = 7.272, p = .017). In study 2 significant differences were found between Home-Start and care-as-usual in active other forms of support (F (1,23) = 8.849, p = .007) and more than 3 major life events (F (1,23) = 5.688, p = .026). In study 3, no significant differences in
background variables were found. Furthermore, no significant differences were found between single or multiple reported families on any background variables and case characteristics.
Secondly, when examining the overall sample there are important differences to note concerning reported child maltreatment or severe parenting problems. At first, approximately 50% of initial events were reported to police in comparison with 40% of reported to the Youth Care Agency. Only 10% of events concerning child maltreatment and severe parenting
problems were initially reported to Advice and Reporting Centers and the Child Protection Board. Furthermore, almost 50% of initial reported events were regarding pedagogical neglect or severe parenting problems and 20% of initial reported events concerned domestic violence. The latter two percentages remained consistent over time throughout the recurrent reported events different studies for recurrent reported events. However, the proportion of physical maltreatment reports increased considerably after third recurrent events. Of initial reported events, 63% were substantiated and in 55% of the cases, a subsequent action was initiated. Recurrence rates and mean number of reports separated by study and intervention type are displayed in Table 2. Recurrence rates of study 1 and 2 seemed to be higher, compared to recurrence rates of study 3. In addition, the mean number of reports was slightly lower for study 3 compared to study 1 and study 2. However, an analysis of variance showed no significant differences between conditions and mean number of reports for any of the three studies.
Table 1
Demographic Information of Participants
Study 1 Study 2 Study 3
Home-Start (n = 11) Control (n = 5) Non-response (n = 5) p Home-Start (n = 23) Care-as-usual (n = 7) Non-response (n = 15) p Home-Start + Triple P (n = 10) Home-Start (n = 14) Non- response (n = 15) p Parental age in years (SD) 30.80 (5.83) 36.00 (7.58) 33.80 (3.89) .268 30.95 (.677) 34.90 (5.18) 30.57 (7.27) .350 29.70 (5.91) 32.67 (8.15) 30.7 (6.29) .411 Ethnical background(%) .763 .789 .388 Dutch 10 (90.9) 5 (100) 4 (80.0) 13 (72.2) 5 (71.4) 7 (63.6) 3 (60.0) 3 (37.5) 9 (69.2) Western - - 1 (20.0) - 1 (14.3) - - - - Non-Western 1 (9.1) - - 5 (27.8) 1 (14.3) 4 (36.4) 2 (40.0) 5 (62.5) 4 (30.8) Educational level (%) .045 .914 .160 Very low education - - - 4 (22.2) 2 (40.0) 4 (33.3) 2 (40.0) - - Lower education 4 (44.4) 2 (40.0) - 4 (22.2) 1 (20.0) 3 (25.0) - - - Intermediate education 4 (55.6) 1 (20.0) 2 (40.0) 8 (44.4) 1 (20.0) 1 (8.3) 3 (60.0) 4 (100.0) Higher education - 2 (40.0) 3 (60.0) 2 (11.1) 1 (20.0) 4 (33.3) - - 1 (100.0) Paid employment 2 (18.2) 0(0.0) - .341 4 (23.5) 3 (60.0) - .136 1 (25.8) 1 (25.0) - .779
Table 1 continued
Study 1 Study 2 Study 3
Home-Start (n = 11) Control (n = 5) Non-response (n = 5) p Home-Start (n = 23) Care-as-usual (n = 7) Non-response (n = 15) p Home-Start + Triple P (n = 10) Home-Start (n = 14) Non- response (n = 15) p Single parenthood (%) 6 (54.5) 0 (0.0) 0 (0.0) .017 6 (30.0) 2 (40.0) 4 (26.7) .863 0 (0.0) 0 (0.0) 6 (28.6) .130 Income (%) .219 .219 .130 Low 6 (54.5) - - 5 (31.3) 3 (60.0) - - - - Middle 4 (36.4) 4 (100.0) - 9 (56.3) 2 (40.0) - 6 (100.0) 4 (100.0) - High 1 (9.1) - - 2 (12.5) - - - - - Number of children (%) .969 .732 .214 1 2 (18.2) 1 (20.0) - 4 (22.2) 1 (16.7) - 1 (16.7) - - 2 6 (54.5) 2 (40.0) - 7 (38.9) 4 (66.7) - 3 (50.0) 1 (25.0) - 3 or more 3 (27.3) 2 (40.0) - 7 (38.9) 1 (16.7) - 2 (33.3) 3 (75.0) - Prior involvement (%) 0 (0.0) 0 (0.0) 0(0.0) - 4 (17.4) 0 (0.0) 1 (6.7) .368 3 (30.0) 4 (28.6) 8 (38.1) .826 Active forms other support (%) 3 (37.5) 1 (20.0) - .546 15 (83.3) 2 (28.6) - .007 2 (50.0) 3 (75.0) - .537 Chronic health problems (%) 3 (27.3) 2 (40.0) - .639 4 (22.2) 0 (0.0) - .223 3 (50.0) 2 (50.0) - 1.00 Major life events >3 (%) 5 (45.5) 2 (40.0) - .851 13 (68.4) 1 (16.7) - .026 3 (50.0) 2 (50.0) - 1.00 Number of support resources (SD) 4.70 (1.79) 7.00 (.707) - .017 6.38 (2.14) 9.2 (4.45) - .078 6.3 (2.15) 5.9 (2.04) - .655
Note. Valid percentages are displayed.
Table 2
Reported Families Distinguished by Single or Multiple Reports
Reported at least once Recurrent reports Mean Number of Reports (SD) Study 1 Home-Start 11 (16.9%) 7 (63.6%) 1.400 (0.894) Control 5 (5.1%) 2 (40.0%) 2.273 (1.679) Non-response 5 (4.3%) 4 (80.0%) 1.800 (0.447) Total 21 (7.5%) 13 (61.9%) 1.952 (1.322) Study 2 Home-Start 23 (21.7%) 11 (47.8%) 2.286 (1.976) Care-as-usual 7 (5.4%) 3 (42.9%) 1.826 (1.193) Non-response 15 (10.9%) 10 (66.7%) 2.333 (1.397) Total 45 (12.1%) 24 (53.3%) 2.067 (1.389) Study 3 Home-Start +Triple P 10 (14.9%) 5 (50.0%) 1.714 (1.139) Home-Start 14 (20.9%) 5 (35.7%) 1.700 (0.823) Non-response 22 (14.1%) 2 (9.1%) 1.238 (0.539) Total 46 (15.9%) 12 (4.1%) 1.489 (0.843) Overall total 111 (11.9%) 49 (43.8%) 1.811 (1.202)
Thirdly, Kaplan-Meier estimates were calculated in order to examine the median survival estimates in months after the initial event. Meaning, the earliest time at which half of the families experienced a recurrent event. The Hazards functions of each condition are displayed in Figure 1 for each study. For study 1, Home-Start and the non-response group had median survival times of 37 and 39 months respectively, with lower confidence bounds of 10 and 34 months. No median survival time could be calculated for the control group. In
addition, no significant differences between groups were found ( 2 (2) = 2.0, p = .371). Median survival times for study 2 also showed no significant differences between groups ( 2 (2) = 1.1, p = .574). Median survival times for Home-Start, care as usual, and non-response group were 25, 25, and 19 months with lower confidence limits of 15, 6, and 8 months.
Similarly, for study 3, no significant differences between groups were found ( 2 (2) = 4.4, p = .112). Median survival times for the Home-Start + Triple P group and Home-Start were found
to be 34 and 22 with lower confidence limits of 22 and 7. However, median survival times for the non-response could not be calculated, because there were too few recurrent events. It should be noted that it was not possible to calculate upper confidence limits of the median survival time because the confidence interval did not intersect with a survival probability of .5, therefore only the lower bounds of the confidence intervals were reported.
Figure 1. Kaplan-Meier Survival Curves of Time to Recurrent Involvement of Child Welfare Services or Police
Fourthly, in Table 4, results of Cox Proportional Hazards are presented. In this
analysis, all participants across the 3 studies were combined to investigate possible predictors of recurrence. Non-respondents were not included in analysis because baseline outcome measures were not available. Therefore, this analysis was based on 70 families. However, as it was an analysis of recurrent events, treating each reported incident as an individual case created a long data file. From these 70 families, a total sample of 130 cases with 61 recurrent events was created. The Cox proportional hazards was stratified by condition, because results of Kaplan-Meier indicated no significant differences and the predictive value of this covariate was expected to be very small. Inclusion of covariates was based on the theoretical model of change by Home-Start. This theory suggests that social support given inside the home affects parental being and, in turn, improve parenting practices. As a result, children’s well-being improves too.
Results of the Cox proportional hazards showed that the model explained approximately 9% of the variance in time duration until recurrence. The Wald test was significant ( 2 (7) = 17.48, p = .015), meaning that the regression coefficients were
significantly different from zero. However, the non-significant likelihood ratio test ( 2 (7) = 12.42, p = .088 ) indicated that there was no dependence of observations within families. Due to substantive reasons, the dependence within families was still taken into account in the analysis. Hazard ratios with their 95% confidence limits are displayed in Table 3. From this table, two regression coefficients were significant. Firstly, the hazard of recurrence for families that experienced prior child welfare services or police involvement is around 226% of the hazard compared to families that were not reported to these services before the end of the intervention. Secondly, the hazard of recurrence for families with higher levels of daily hassles at the baseline is approximately 160% of the hazard compared to families that reported lower levels of daily hassles at baseline.
Table 3
Cox Proportional Hazards: Factors Associated with Recurrent Child Welfare Services or Police Involvement Without Non-response Group
Risk Ratio p Risk Ratio 95% CI
Variable Lower Upper
Maternal psychopathology 0.598 0.281 0.230 1.531
Maternal depression 1.472 0.342 0.664 3.265
Parenting competence 1.391 0.126 0.912 2.124
Parenting stress 1.595 0.091 0.928 2.742
Externalizing problem behavior child 0.990 0.701 0.941 1.042 Internalizing problem behavior child 1.041 0.268 0.970 1.118 Prior child welfare service or police involvement 2.264 0.019 1.148 4.472 Note. CI = confidence interval.
Discussion Conclusions
Firstly, the reported recurrence rates of 61%, 53%, and 25% for respectively study 1,2, and 3 are higher compared to previous research. For example, Connel, Bergeron, Katz,
Saunderse, and Tebes (2007) found a recurrence rate of 30% for a follow-up interval of three years. The higher recurrence rate might be due to the at-risk sample of the current study. In addition, the lower recurrence rate of study 3 might be a result of the stronger right censoring due to a shorter follow-up interval. Secondly, a majority of events were reported to police and Youth Care Agency. This was expected because in the Dutch child welfare system, these organizations are the primary contact for consultation when parenting problems are reported. Unexpectedly, there were no significant differences between background variables between families with single and multiple reports of recurrence.
Secondly, Kaplan-Meier results indicated that there were no significant differences in survival times across conditions in the three studies. Meaning that time to recurrence was the
same across conditions in all evaluation studies. This could be explained by the fact that the comparison was conducted separate for each study, which decreased the sample size, thus decreasing the power to detect significant differences. On the other hand, medial survival times of the studies are much larger compared to previous research, A possible explanation is the fact the Kaplan-Meier estimates were based on the first, second, third, fourth, and fifth recurrent event in contrast to the findings of Bae, Solomon, and Gelles (2009) that used only singular recurrent events.
Thirdly, Cox proportional hazards showed that the theoretical model of change explained 9% of the variance in time to recurrence. Furthermore, time to recurrence was partly predicted by Home-Start’s theoretical model of change. A higher level of parenting stress reported at baseline was a significant predictor. This implies that when interventions such as Home-Start are able to decrease the level of parenting stress, families will have a lower hazard for time to recurrence compared to families with higher levels of parenting stress.
Limitations
An important limitation of the current study is the dependency on official registrations about concerns of child maltreatment or parenting problems. Firstly, official rates of alleged or substantiated child maltreatment represent only a small portion of all maltreatment cases because not all abusive or neglectful parenting practices are reported or investigated by child welfare services or police. Secondly, it is possible that not all reports are included in child welfare services or police databases due to technical issues. For example, the police database was nationally reorganized in 2009 and a majority of prior events were not integrated into the new system. As a result, police contacts before 2009 could not be retrieved from the database and it was not possible to differentiate between absence of reports and absence of child maltreatment or parenting problems. However, as this was the first research to report on
recurrence in the Netherlands, using the current administrative system was the sole option. As the current study relied on officially documented reports, a second limitation is the relatively low incidence rate of reports among all groups which resulted in some statistical issues. For example, it was more difficult to detect possible effects of covariates (Reynolds, Mathieson, & Topitzes, 2009; Howards & Brooks-Gunn, 2009) with low incidence rates. However, as indicated by Alink, et al. (2011), the prevalence of child maltreatment and severe parenting problems that was found in the current study -111 families out of 953- is higher in compared to the prevalence of child maltreatment that was estimated in the Netherlands in 2010. Therefore, it is recommended to replicate this study with a larger sample size in order to have more power to detect predictors for recurrent maltreatment. It is further recommended that recurrence research in terms of effectiveness of parenting support programs, includes longer follow-up periods and use time-varying covariates. This would provide valuable insights into the factors that influence recurrence, and in turn, influence the effectiveness of parenting support programs.
Practical implications
Generally, more recurrence research is needed in order to provide families with appropriate interventions or support after initial reported events. In addition, functioning and efficiency of early childhood interventions and child welfare services could be evaluated using recurrence research. Replication of this study is strongly recommended, as this was the first recurrence research in the Netherlands. Increasing recurrence research on parenting support programs will aid in the identification of predictors of recurrent maltreatment, which might reduce the amount of chronically maltreated children in the Netherlands.
Acknowledgements
The author would like to thank the Child Protection Board, Advice and Reporting Centers for Child Abuse and Neglect, the Youth Care Agency and the National Program Domestic Violence and Police Task for facilitating data collection.
References
Alink, L., Pannebakker, F., Euser, S., Bakermans-Kranenburg, M., Vogels, T., & van
IJzendoorn, R. (2013). Kindermishandeling in Nederland Anno 2010. Tijdschrift voor gezondheidswetenschappen, 91(7), 396-404. Retrieved from:
http://link.springer.com/article/10.1007/s12508-013-0137-x#
Asscher, J. J., Hermanns, J., & Dekovic, M. (2008). Effectiveness of the home-start parenting support program: Behavioral outcomes for parents and children. Infant Mental Health Journal, 29, 95-113. doi: 10.1002/imhj.20171
Bae, H. O., Solomon, P. L., & Gelles, R. J. (2009). Multiple child maltreatment recurrence relative to single recurrence and no recurrence. Children and Youth Services Review, 31, 617-624. doi: 10.1002/imhj.20171
Bae, H. O., Solomon, P. L., & Gelles, R. J. (2009). Multiple child maltreatment recurrence relative to single recurrence and no recurrence. Children and Youth Services Review, 31, 617-624. doi: 10.1016/j.childyouth.2008.11.005
Cicchetti, D., & Toth, S. L. (2005). Child maltreatment. Annual Review of Clinical Psychology, 1, 409-438. doi:10.1146/annurev.clinpsy.1.102803.144029
Connell, C. M., Bergeron, N., Katz, K. H., Saunders, L., & Tebes, J. K. (2007). Re-referral to child protective services: The influence of child, family, and case characteristics on risk status. Child Abuse & Neglect, 31, 573-588. doi: 10.1016/j.chiabu.2006.12.004 Crnic, K.A., & Booth, C.L. (1991). Mothers’and fathers’ perceptions of daily hassles of
parenting across early childhood. Journal of Marriage and the Family,53(4), 1042-1050. Retrieved from: www.jstor.orga/stable/353007
Dehon, C., & Scheeringa, M. S. (2006). Screening for preschool posttraumatic stress disorder with the Child Behavior Checklist. Journal of Pediatric Psychology, 31(4), 431-435. doi: 10.1093/jpepsy/jsj006
Drake, B., Jonson-Reid, M., & Sapokaite, L. (2006). Rereporting of child maltreatment: Does participation in other public sector services moderate the likelihood of a second maltreatment report? Child Abuse & Neglect, 30, 1201-1226. doi:
10.1016/j.chiabu.2006.05.008
English, D. J., Graham, J. C., Litrownik, A. J., Everson, M., & Bangdiwala, S. I. (2005). Defining maltreatment chronicity: Are there differences in child outcomes?. Child abuse & neglect, 29, 575-595. doi: 10.1016/j.chiabu.2004.08.009
Fluke, J. D., Shusterman, G. R., Hollinshead, D. M., & Yuan, Y. Y. T. (2008). Longitudinal analysis of repeated child abuse reporting and victimization: Multistate analysis of associated factors. Child Maltreatment, 13, 76-88. doi: 10.1177/1077559507311517 Gilbert, R., Widom, C. S., Browne, K., Fergusson, D., Webb, E., & Janson, S. (2009). Burden
and consequences of child maltreatment in high-income countries. The lancet, 373, 68-81. doi: 10.1016/S0140-6736(08)61706-7
Goedee., J. & Rijkers, A. (2010). Zorgsignalen van de politie: Over het werkproces
‘vroegsignaleren en doorverwijzen’ tussen politie en bureau jeugdzorg (Centrum voor Jeugd en Gezin Report). Retrieved from Nederlands Instituut van Psychologen
website: http://www.psynip.nl/themas-ledennet/sector-jeugd/documenten-centra-jeugd/handreiking-zorgsignalen-van-de-politie.pdf
Gonzalez, A., & MacMillan, H. L. (2008). Preventing child maltreatment: An evidence-based update. Journal of postgraduate medicine, 54, 280. doi: 10.4103/0022-3859.43512
Long-term Changes in Parenting and Child Behaviour after the Home-Start Family Support Program. Children and Youth Services Review, 35, 678-684. doi:
10.1016/j.childyouth.2013.01.017
Hermanns, J., & ter Meulen, M. (2007). Het bestrijden van kindermishandeling: het Regio RAAK experiment. (Nederlands Jeugdinstituut Report). Retrieved from Nederlands Instituut van Psychologen website: http://www.psynip.nl/themas-ledennet/nip-algemeen/meldcode-huiselijk-geweld/nji-wat-werkt-bij-kindermishandeling.pdf Howard, K. S., & Brooks-Gunn, J. (2009). The role of home-visiting programs in preventing
child abuse and neglect. The Future of Children, 19(2), 119-146. Retrieved from: http://www.jstor.org/stable/27795050.
Jonson-Reid, M., Emery, C. R., Drake, B., & Stahlschmidt, M. J. (2010). Understanding chronically reported families. Child maltreatment, 15, 271-281. doi:
10.1177/1077559510380738
Kahn, J. M., & Schwalbe, C. (2010). The timing to and risk factors associated with child welfare system recidivism at two decision-making points. Children and Youth Services Review, 32, 1035-1044. doi: 10.1016/j.childyouth.2010.04.011
Kellett, S., Beail, N., Newman, D. W., & Frankish, P. (2003). Utility of the Brief Symptom Inventory in the assessment of psychological distress. Journal of Applied Research in Intellectual Disabilities, 16, 127-134. doi: 10.1046/j.1468-3148.2003.00152.x
Mills, M. (2011). Introducing survival and event history analysis. London: Sage Publications. Prinz, R. J., Sanders, M. R., Shapiro, C. J., Whitaker, D. J., & Lutzker, J. R. (2009).
Population-based prevention of child maltreatment: The US Triple P system population trial. Prevention Science, 10, 1-12. doi: 10.1007/s11121-009-0123-3 Staal, I. I., Hermanns, J., Schrijvers, A. J., & van Stel, H. F. (2013). Risk assessment of
parents' concerns at 18 months in preventive child health care predicted child abuse and neglect. Child Abuse and Neglect. Retrieved from:
http://www.sciencedirect.com/science/journal/aip/01452134
Tabachnick, B. G., & Fidell, L. S. (2012). Using Multivariate Statistics: International Edition. Pearson Education.
United Nations (UN) General Assembly. (1989). Adoption of a convention on the rights of the child. New York: Author.
Zhang, S., Fuller, T., & Nieto, M. (2013). Didn’t we just see you? Time to recurrence among frequently encountered families in CPS. Children and Youth Services Review,35, 883-889. doi: 10.1016/j.childyouth.2013.02.014
Appendix A
Categorization of problems in child welfare services databases and police databases.
Type of problem Definition
Physical abuse “Involves the infliction of bodily injury on a child by non- accidental means” (Cicchetti & Toth, 2005, p. 410)
Physical neglect Insufficient care for physical well-being and / or safety of a child
Emotional abuse (violence) “Involves persistent and extreme thwarting of a child’s basic emotional needs” (Cicchetti & Toth, 2005, p.410) Affective neglect (emotional) A child’s emotional needs are severely or persistently
ignored
Sexual abuse “Involves sexual contact or attempted contact between a child and a caregiver or other adult for purposes of the caregiver’s sexual gratification or financial gain”(Cicchetti & Toth, 2005, p.410)
Domestic violence A child is exposed to domestic violence or one of the parents is the victim of domestic violence whereby the child is not a direct victim.
Munchausen by proxy Parents present their children to doctors with non-objective disease symptoms. Optionally, parents have induced these disease symptoms to their children.
Pedagogical neglect and severe parenting incompetency
Parents set to few boundaries, spoil their children, provide too little structure or there is a problematic parenting situation where parents do not feel competent and there is not enough support from the family’s network.
Other All other forms of abuse that could not be categorized such as simple assault.
Drugs/alcohol (ab)use parents Use of drugs or alcohol by the person responsible for the care and supervision of the child
Aggressive behavior Aggressive or threatening behavior towards animals, people or objects outside the home setting
Relational problems Divorce and visitation issues, stalking, fights without consequences between family members, and flights for (ex) partners
Support for executing youth protective action
Police assistance for CPB or YCA in the execution of youth protective regulations or custody matters Other police involvement Disappearance of under aged persons
