The epidemiology of child maltreatment recurrences

Abstract

The primary aim of this dissertation was to elucidate the epidemiology of child maltreatment recurrences among families known to public child protective services (CPS). The specific objectives were: (1) To describe the pattern of recurrences over time; (2) To identify correlates of recurrence during and following CPS intervention; and (3) To describe the pattern of multiple recurrences. Subjects were a cohort of 1167 families who experienced a confirmed report of maltreatment and were followed for five years. Data on variables were collected from archival sources. To achieve objective 1, Life Tables were constructed at 30 day intervals to estimate the probability of recurrence during each interval. Survival functions of groups were then compared with the Wilcoxon (Gehan) statistic. To achieve objective 2, Kaplan Meier survival analyses were performed to compare the survival functions of potential variables and to test the Cox proportionality assumption of each variable. Models were then estimated with the Cox Proportional hazards model. To achieve objective 3, methods involved comparing the mean time until each recurrence between groups. Results suggest that risk of recurrence is greatest during the first thirty days following a report, that it is dependent on the type of maltreatment, and that it declines over time through the service period and remains relatively low for two years following the termination of services. Correlates of the time until first maltreatment recurrence while CPS was active were: child vulnerability, family stress, partner abuse, social support deficits and an interaction between family stress and social support deficits. Only one factor, age of the mother, predicted time until recurrence following services. Most recurrence families experienced only one recurrence. As the number of recurrences increased, the length of time between recurrences decreased. Future research should prospectively follow families over time to increase understanding about the specific treatment strategies and social supports most helpful to reducing risk of recurrence.