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Understanding allegations of childhood neglect using structured and unstructured administrative data

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Understanding allegations of childhood neglect using structured and unstructured administrative data

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UNDERSTANDING ALLEGATIONS OF CHILDHOOD NEGLECT
USING STRUCTURED AND UNSTRUCTURED ADMINSTRATIVE DATA

By
Lindsey Palmer, MSW

A Dissertation Presented to the
FACULTY OF THE USC GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(SOCIAL WORK)

August 2021

ii
Dedication

To each of my former clients. You have inspired me and I am sure that you continue to inspire
others.

iii
Acknowledgements

I would like to acknowledge and thank all the members of my dissertation committee.
During my doctoral studies I have had the privilege of working with not one but two outstanding
mentors. To Emily Putnam-Hornstein, thank you for the opportunity to follow your example.
Even as a master’s student I knew that there would be no one better to learn from. Your work
and what you have built in California speaks for itself and I could not be prouder to be your
mentee. Your patience and belief in me and of the work that I was capable of was invaluable and
I am forever grateful. To Jacquelyn McCroskey, thank for your guidance, unwavering support,
and investment in me as a future child welfare scholar. Your ability to wear many hats and your
dedication to Los Angeles County’s children and families is inspiring. I am very grateful to have
had the opportunity to watch and learn from you. Thank you to John Prindle (the methodology
guru) for your patience in allowing me to learn from you. To Rebecca Rebbe, thank you for
helping me through the planning process of this dissertation (and navigating career decisions),
your feedback has always been spot on and I truly appreciate the guidance. To Gayla Margolin,
thank you for providing a perspective from outside of the scope of child welfare, your feedback
contributed greatly to this dissertation.
This dissertation would not have been possible without the support of the researchers and
data scientists at the Children’s Data Network. I am in awe of what Emily and Jacquelyn have
built in an effort to better understand and serve California’s children. I am amazed at your ability
to find the most intelligent, hardworking and caring team members. Thank you to each CDN
team member for your encouragement and support. A special thank you to Andrea Lane Eastman
for teaching me all things Stata and coding, you gave me the kick start I needed and your support
throughout has been priceless.
iv
To Ankur, Yoewon and Joshua for countless study groups, happy-hours and dinners.
Thank you for taking this journey with me. To Joe, Jamie, Jessica, Ashley and Reed I am
humbled by your support and generosity throughout all these years.
To my mom, dad, Lacey, Cassie, Nik, Gabe, Elena, Elyse and Julian, thank you for the
countless hours playing with and loving Auggie while I worked, but especially thank you for
providing so many fun breaks from reality (trips to Tahoe, Hawaii and others) that allowed me to
relax and refresh during this process. I am so grateful to have all of you in my corner. To Joe,
Augustus, and Alexander for your never-ending support, love and encouragement. None of this
would be possible without any one of you.

v
TABLE OF CONTENTS

Dedication ....................................................................................................................................... ii
Acknowledgements ........................................................................................................................ iii
List of Tables ................................................................................................................................ vii
List of Figures .............................................................................................................................. viii
Abstract .......................................................................................................................................... ix
CHAPTER 1: Introduction and Rationale ...................................................................................... 1
Background ........................................................................................................ 3
Theoretical Framework .................................................................................... 11
References ........................................................................................................ 13
CHAPTER 2 (Study 1): Lifetime Prevalence and Risk of Exposure to Childhood Neglect: A
Linked Birth Cohort Study............................................................................................................ 20
Introduction ...................................................................................................... 20
Methods ............................................................................................................ 23
Results .............................................................................................................. 27
Discussion ........................................................................................................ 36
References ........................................................................................................ 40
CHAPTER 3 (Study 2): Population Level Examination of Reporter Concerns Associated with
Child Neglect ................................................................................................................................ 46
Introduction ...................................................................................................... 46
Methods ............................................................................................................ 49
Results .............................................................................................................. 54
Discussion ........................................................................................................ 60
References ........................................................................................................ 65
CHAPTER 4 (Study 3): Understanding Family Risk and Neglect Allegations: A Content
Analysis of CPS Investigations ..................................................................................................... 68
Introduction ...................................................................................................... 68
vi
Methods ............................................................................................................ 72
Results .............................................................................................................. 77
Discussion ........................................................................................................ 81
References ........................................................................................................ 89
CHAPTER 5: Conclusions, Implications and Future Directions.................................................. 95
Major Findings ................................................................................................. 95
Implications for Policy and Practice................................................................. 97
Implications for Research ............................................................................... 101
Conclusion ...................................................................................................... 102
References ...................................................................................................... 103
Appendices .................................................................................................................................. 105
Appendix A: Reporter Concern derived from SDM ...................................... 105
Appendix B: Content Analysis Process .......................................................... 106
Appendix C: Codebook for Identifying Key Risk Factors ............................. 108

vii
List of Tables
Table 2.1 Sociodemographic and birth characteristics of the 2000 CA birth cohort, by
maltreatment report group. California, United States, 2000-2018.................................................28
Table 2.2 Sociodemographic predictors for CPS report, by maltreatment report group. California,
United States, 2000-2018 ...............................................................................................................33
Table 2.3 Sociodemographic predictors for CPS report of abuse alone or abuse and neglect
among children reported to CPS. California, United States, 2000-2018 .......................................35
Table 3.1 Demographic characteristics, CPS history, and co-reported abuse allegations of
children investigated for allegations of neglect. California, United States, 2017..........................55
Table 3.2 Reporter concerns of children investigated for allegations of neglect, by substantiation
and placement status. California, United States, 2017...................................................................58
Table 3.3 Risk of substantiation and placement by reporter concern. California, United States,
2017-2019 ......................................................................................................................................59
Table 4.1 Frequency of each parental risk factor, overall and for investigations with allegations
of neglect. California, United States, 2017 ....................................................................................79
Table 4.2 Frequency of secondary risk factors, overall and by investigations for allegations of
neglect. California, United States, 2017 ........................................................................................80
Table 4.3 Percentage of investigations with concurrent parental risks ..........................................81

viii
List of Figures

Figure 2.1 Percentage of children in each maltreatment report group who were born with each
sociodemographic ..........................................................................................................................30
Figure 2.2 Percentage of children reported to CPS for each maltreatment group by number of risk
factors present ................................................................................................................................31
Figure 3.1 Percent of children substantiated and placed in foster care, for each neglect subtype .56

ix
Abstract

Child neglect is the most frequently reported and substantiated type of maltreatment in
the United States and accounts for a disproportionate amount of child protection system (CPS)
resources. Historically, neglect has been overlooked in place of research focused on childhood
physical and sexual abuse. Yet, as other forms of reported maltreatment have declined while
rates of neglect have not, a growing body of literature has sought to understand the risk factors
and outcomes of neglect. Efforts have often been hampered, however, by ambiguous definitions,
with opposing views on whether neglect should be defined from the vantage point of the child or
the caregiver. While child-centered definitions of neglect, including physical neglect, educational
neglect, medical neglect, psychological neglect, and others serve to better document the effects
of specific neglect-related maltreatment, it can often obscure the underlying threat or family
need. Meanwhile, the caregiver-centered definition focuses on the omission of care and often
places blame on the caregiver with little thought to contributory environmental factors. The
debate over how to conceptualize neglect is especially challenging within the parameters of CPS,
which operates on a victim-perpetrator continuum, making it difficult to overlook a caregiver’s
intention while also acknowledging the large overlap with poverty-driven risk factors. Further
complicating CPS’s classification of neglect are legal statutes and social application that vary by
jurisdiction. With vague empirical, legal, and social definitions of neglect it has become
increasingly clear that there is no unified understanding of how to identify and in turn address
childhood neglect.
The purpose of this dissertation is to gain a deeper understanding of the use of “child
neglect” as an official classification of child maltreatment by CPS by exploring formal
allegations and substantiations of childhood neglect. The objective is to generate knowledge that
x
will guide child protection policy and prevention efforts. This dissertation is organized as a
three-paper project that will triangulate various methodologies and differing data sources to
examine the dynamics of neglect.
Study 1: Linked Administrative Data
While the literature suggests that children who are reported to CPS differ from children
who are never reported, less is known about the sociodemographic markers of risk for exposure
to different types of maltreatment. Using linked CPS and birth records, Study 1 first identifies
the lifetime risk of CPS allegations of neglect, and second, explores whether risk factors for
neglect are meaningfully distinguished from abuse. Multinomial logistic regression models are
used to examine if children who are reported to CPS for allegations of neglect have distinct
sociodemographic risks from children who experience abuse allegations or a combination of
abuse and neglect allegations.
Study 2: Structured Data Analysis
Despite the disproportionate number of families who experience investigations for
allegations of neglect, little is understood about what specific concerns are being reported and
how these concerns may factor into the decision to substantiate or place a child in foster care.
Using CPS administrative records, including indicators from associated risk and safety
assessment tools, Study 2 focuses on identifying the specific concerns being documented at the
child abuse hotline when a family is reported for an allegation of neglect. Next it examines
which of these concerns may predict substantiation or placement into foster care. The frequency
of each reported concern is reported. A series of generalized linear models will be used to test the
association between reported concerns and the odds that neglect allegations are substantiated or
children are placed in foster care.
xi
Study 3: Unstructured Data Analysis
Building on Studies 1 and 2, Study 3 uses the unstructured administrative data to explore
the family context of neglect allegations. A content analysis of 500 randomly selected children
who were referred for alleged child maltreatment in 2017 is used to explore family- and parent-
level risks identified during the screening and investigations for allegations of neglect.
Unstructured data was accessed from the screener narrative (gathered at hotline call) and
investigative narrative (gathered during the investigation stage) accompanying each selected
record. Records will be coded based on the presence or absence of five risk factors: parental
substance use, domestic violence, parental mental health, concrete need, and custody issues. A
fifth category will be left open-ended to allow for the discovery of other frequently noted risk
factors identified within the narratives. After the unstructured narratives have been coded, overall
prevalence rates of identified risks are reported and differences between risks associated with
neglect versus abuse are explored.

1
CHAPTER 1
Introduction and Rationale
In 2018, the United States Child Protection System (CPS) received an estimated 4.4
million referrals of alleged child maltreatment. These referrals represented nearly 7.9 million
children across 52 U.S. states and territories (U.S. Department of Health and Human Services
[USDHHS], 2021). Child neglect was the most frequently reported and substantiated type of
maltreatment, accounting for approximately 75% of all substantiated allegations (USDHHS,
2021). While generally, there are four distinct maltreatment types (neglect, physical abuse,
sexual abuse, emotional abuse) there is a large degree of overlap between the differing types,
with approximately 15% of maltreatment victims having experienced two or more different types
of maltreatment. Given the overlap between abuse and neglect and since child abuse and neglect
are often treated as a unitary phenomenon, determining differences has been difficult.
Over $29 billion is spent each year to promote child safety through various CPS
processes and programs (Rosinsky & Connelly, 2016). With half of all allegations consisting of
neglect alone (without any other forms of abuse alleged), and three-quarters of all substantiations
including neglect, it stands to reason that a large proportion of CPS resources are being used to
address childhood neglect. Historically, however, the vast majority of research has focused on
other types of child maltreatment.
This dissertation seeks to extend the literature by unpacking “neglect” to better
understand its utility as a formal maltreatment classification used by child protection agencies.
The primary objective is to explore the prevalence, risk factors, and circumstances of allegations
of “neglect” and secondarily to examine whether neglect can be meaningfully distinguished from
abuse. This dissertation begins by examining the prevalence and sociodemographic markers of

2
risk for neglect and explores whether these risks can be meaningfully distinguished from abuse.
Next, it seeks to identify the concerns being reported when allegations of neglect are received by
CPS and examine which concerns are associated with substantiation or placement. Lastly, it
explores parental and family circumstances related to allegations of neglect and whether these
circumstances differ between neglect and abuse. With an eye towards prevention, this
dissertation seeks to understand the needs of children and families who present to CPS as
‘neglected’ and provide insight into the usefulness of this categorization.

3
Background
While the focus on child abuse was brought to the attention of the general public in the
early 1960s by Kempe’s (1962) “The Battered Child’s Syndrome,” neglect remained a relatively
hidden form of child maltreatment for another 20 years. In 1984, following a longitudinal study
which found neglected children experienced the poorest outcomes (Egeland et al., 1983),
Wolock and Horowitz (1984) published the groundbreaking paper “Child Maltreatment as a
Social Problem: The Neglect of Neglect.” Since the publication of that article, there has been a
steady increase in studies and interest around childhood neglect. To date there is a substantial
and growing body of research focused on identifying risk factors and outcomes associated with
child neglect. However, efforts to understand neglect continue to be hampered by the lack of a
universal definition, measurement, or theoretical base, as well as by the disagreement pertaining
to whether neglect should focus on the child or the caregiver.
Defining Neglect
Child-Centered Definition
In an attempt to encompass the heterogeneity of neglect and the complexity of interacting
factors which can lead to neglect, Dubowitz et al. (1993) proposed a broad definition of neglect
as occurring “when basic needs are not met regardless of cause.” This developmental approach
to understanding neglect makes clear that there is a shared responsibility across child, family and
societal levels for child well-being. Researchers have continued to refine this expansive
definition of neglect by proposing numerous subclassifications, including, physical neglect,
emotional neglect, medical neglect, mental health neglect, educational neglect (Erickson &
Egeland, 2002), psychological neglect, environmental neglect (Dubowitz, Pitts, and Black,

4
2004), cognitive neglect (Slack et al., 2003), care neglect (Knutson et al., 2005), and supervisory
neglect (Kaufman Kantor et al., 2004).
Caregiver-Centered Definition
While the child-centered definition has gradually grown in the academic literature, the
caregiver-centered definition has long been engrained in and continues to be the basis for most
legal child welfare statutes. The Child Abuse Prevention and Treatment Act (CAPTA) defines
child abuse and neglect as "any recent act or failure to act on the part of a parent or caregiver
that results in death, serious physical or emotional harm, sexual abuse, or exploitation, or an act
or failure to act that presents an imminent risk of serious harm" (Child Welfare Information
Gateway, 2019, pg. 1) Neil Gilbert (2012) has described the child welfare system in the U.S. as
having a child protection orientation which is based on “deviant behavior and dysfunctional
parenting” (pg. 533). This framework often results in an adversarial parent-state relationship due
to the system using coercive measures to address parental behaviors which have been defined by
the state as dysfunctional.
In general, child maltreatment is categorized into four types: sexual abuse, physical
abuse, emotional abuse, and neglect. Specific statutes for each type of child maltreatment,
including neglect, are left up to the states to define. While the three abuse categories (sexual,
physical, and emotional) tend to be clearer in their definition, in part due to requiring an act on
the part of the parent or caregiver that can clearly be operationalized (i.e. hitting a child, lewd
acts upon a child), neglect includes the omission of an act that knowingly or willfully harms,
leaving its meaning open to interpretation and its application inconsistent. Compared to many
other states, California has a broader civil definition of neglect, indicating that children need only
be ‘at risk’ of harm (Welf. & Inst. Code § 300, 1987; Pen. Code § 11165.2; Rebbe, 2018).

5
California sub-classifies neglect into two categories; general neglect (failure to provide food,
shelter, medical care or supervision where there was no physical harm) and severe neglect
(intentional failure to provide food, shelter, medical care, or supervision, such that health is
endangered). In addition, caretaker absence/incapacity and at risk due to sibling abuse often fall
under the umbrella of neglect (Child Welfare Information Gateway, 2019).
Ongoing Debate
Those who advocate for a child-centered definition of neglect suggest that the focus
should be on the needs of the child, highlighting the need that is not being met regardless of the
cause (Dubowitz et al., 1993). They contend that there is a large degree of agreement across
various sociodemographic and cultural groups on what constitutes ‘basic needs’ for a child,
which allows for some uniformity in understanding that neglect has occurred when these basic
needs are not being met. Additionally, proponents argue that unlike the narrow legal and civil
definitions, which place blame solely with the parent or caregiver, a child-centered definition
allows for the consideration of environmental and societal factors that are likely influencing a
caregiver’s ability to meet the child’s needs, and thereby compels a sense of shared responsibility
(Dubowitz et al., 1993). On the other hand, the narrower legal and child welfare definition of
neglect typically focuses on the action or lack of action of the caregiver in meeting a child’s
needs. This is a reflection of the current perpetrator-victim continuum within which CPS
operates, whereby the ultimate goal is to protect the child (victim) from harm caused, either
directly (abuse) or indirectly (neglect), by the caregiver (perpetrator). Within this context it is
difficult to ignore cause and motive as CPS needs to ensure legal authority to intervene on behalf
of the child. While the civil definition of neglect is narrower than the child-centered definition,
the characterization remains vague, especially for social workers trying to identify non-optimal

6
parenting versus maltreatment. To date, little is understood about how that determination is
made.
In a 2013 article, Golden, Samuels, and Southall argued that neglect should be
differentiated from what they called ‘deprivational abuse’ by defining derivational abuse as the
intentional and malicious omission of care for a child and neglect as an unintentional omission
that stems from various factors such as lack of education or finances. The authors reason that the
willful disregard for a child’s well-being is abusive, and by coupling neglect with abuse, we are
unintentionally attaching the stigma related to abusive behaviors onto neglect, even when the
root of the neglectful behaviors are outside of the caregivers’ control.
Risk Factors for Neglect
Neglect is a heterogeneous construct with complex and multidimensional risk factors,
spanning individual, parental, family, and neighborhood level factors. The literature has
identified several individual factors associated with an increased risk of childhood neglect
including mental and behavioral problems, physical health problems, younger age, perinatal
complications, and being non-white (Mulder et al., 2018). Parental factors include high stress,
high anger, low self-esteem (Cash & Wilke, 2003), low parental education, history of parental
mental health problems, fewer problem-solving skills (Coohey, 1998), and parental history of
abuse. Family level contributors include violence in the home (McGuigan & Pratt, 2001), large
family size, low social support, and poor parent-child relationships (Mulder et al., 2018; Stith et
al., 2009). Neighborhood and societal characteristics associated with neglect include living in
neighborhoods with high unemployment, limited access to informal social supports, and lack of
social cohesion (Maguire-Jack & Showalter, 2016; Maguire-Jack & Wang, 2016).

7
Perhaps one of the most profound factors associated with neglect is socioeconomic
disadvantage (Drake & Pandey, 1996; Sedlak et al., 2010). On a family level, children living in
low-income households are more likely to be referred to CPS for alleged child neglect (Sedlak et
al., 2010). Similarly, on a neighborhood level, children living in impoverished neighborhoods
have a higher likelihood of experiencing neglect (Drake & Pandey, 1996). It is estimated that
approximately 85% of families investigated for neglect have incomes below 200% of the poverty
line (Dolan et al., 2011). Socioeconomic factors have been found to be more strongly associated
with neglect than abuse (Berger, Font, Slack & Waldfogel, 2017; Drake & Johnson-Reid, 2013;
Drake & Pandey, 1996; Fein & Lee, 2003; Sedlak et al., 2010). Perhaps due to the enormous
overlap between poverty and neglect, some child welfare advocates argue that oftentimes,
poverty-related circumstances such as lack of food, clothing, and housing are conflated with
neglect and this has contributed to the high rates of child neglect reports among low-income
families (Dale, 2014). However, one recent study has pushed back on this belief by comparing
outcomes among impoverished children. Looking at differential outcomes among a population of
economically disadvantaged children, the study found that poor children who had been reported
to CPS for neglect had significantly worse outcomes compared to poor children with no CPS
history, suggesting poverty and neglect are distinct (Font & Maguire-Jack, 2020). Additionally,
some states have attempted to address the concern that neglect has become synonymous with
poverty by outlining criteria, including that socioeconomic status alone cannot be used to
substantiate neglect allegations (USHHS, 2018).
Despite the established link between poverty and child maltreatment, the role of poverty
among children reported for allegations of neglect is not well understood. Poverty and neglect
often share numerous risk factors, the temporal ordering of which is unclear. Maternal mental

8
health, intimate partner violence, and substance use have all been found to be associated with
both poverty and maltreatment (Chemtob et al., 2013; Vericker et al., 2010). Additionally, the
toxic stress related to poverty can affect a family’s ability to properly care for a child’s needs;
this is especially true if the family does not have a social network or strong community safety net
to rely upon (Berger, 2004).
Outcomes of Neglect
While the body of literature on the effects of physical abuse and sexual abuse is more
extensive, research over the past three decades has demonstrated that neglect can be as
detrimental to a child’s health and development as abuse (Gilbert et al., 2009; Stoltenborgh et al.,
2013). Neglect can have long lasting harmful effects on a child’s development and wellbeing
(Hildyard & Wolfe, 2002), with children experiencing numerous adverse effects including
language and communication delays (English et al., 2005), lower academic achievement
(Kendall-Tackett & Eckenrode, 1996), internalizing and externalizing behavioral problems
(Dubowitz, 2002); substance use (Hussey et al., 2006), low self-esteem (Kim & Cicchetti, 2006),
and suicide risk (Jardim et al., 2018). While it is often thought that abuse is more harmful to a
child’s development compared to neglect, recent research has challenged this assertion and
demonstrated that neglect can be equal to and at times more harmful than abuse (Font &
Maguire-Jack, 2020; Vachon et al., 2015).
California
With nearly 9 million children in the state, California’s CPS system handles the largest
number of calls nationwide (USDHHS, 2018). Each year nearly a half a million children are
reported to CPS as alleged victims of child maltreatment, this represents 45.0 per 1,000 children,
lower than the national per capita average which stands at 58.5 per 1,000 (Child Welfare

9
Indicators Project, 2020). Cumulatively, 29% of California’s children will be reported to CPS
during their lifetime and 12% will be substantiated (Putnam-Hornstein et al., 2021).
California CPS Process
CPS referrals
1
are handled by county CPS (with state oversight) and are charged with
responding to allegations of child maltreatment through screening, investigation, case
management, and support services. When an allegation is received at the CPS hotline, the initial
step is to gather information and determine whether the allegation meets the state statute of abuse
or neglect and needs to be investigated (often referred to as screened-in or screened-out). When
an allegation is screened in, an emergency response social worker will conduct an investigation,
assessing the circumstances of the allegation and evaluating the family’s environment, needs,
strengths, risks, and safety. In California, an instrument called the Structured Decision Making
(SDM) tool is used to aid decision making at both the initial decision-making stage (hotline) and
during the investigation. At the conclusion of the investigation a disposition is determined for
each allegation on the CPS report. Allegation dispositions can be unfounded (an allegation was
false, inherently improbable, accidental, or not child abuse or neglect), inconclusive (insufficient
evidence to determine whether or not abuse or neglect occurred), or substantiated (sufficient
evidence to determine that more likely than not, abuse or neglect occurred) (Martin, 2014).
An allegation is substantiated when there is a preponderance of evidence to determine
that the abuse or neglect is or has occurred (Provencher et al., 2014), but evidence suggests that
there may actually be little difference in risk and outcomes (i.e., recidivism, long term
consequences) between children whose reports are substantiated versus those who are not
(Hussey et al., 2006; Kohl, Jonson-Reid, & Drake, 2009; Kugler et al., 2019; Palmer et al.,

1
CPS referral refers to calls made to the CPS hotline alleging child maltreatment; CPS report refers to the referrals
that are screened-in for investigation.

10
2021). In California, certain substantiated allegations (e.g., physical abuse, sexual abuse,
emotional abuse, severe neglect) can also trigger a referral to the Department of Justice and the
perpetrator (mostly parents) being added to a centralized child maltreatment registry, which can
have long term consequences on a parent’s employment and economic stability (Henry et al.,
2020).
A social worker’s ability to identify neglect and the decision to substantiate is not well
understood. A limited number of studies have identified factors associated with a neglect report
being substantiated. Carter and Myers (2007) found that parental mental health and substance use
were the two most prominent indicators of the substantiation of physical neglect. Importantly,
after controlling for family-level variables, poverty-related indicators (unemployment, public
assistance) were not significant predictors of substantiation.

11
Theoretical Framework

Ecological Systems Theory
Ecological systems theory developed by Bronfenbrenner (1976) theorizes that an
individual’s development is influenced by a set of systems nested within one another, and that
one’s behavior can vary depending on their environment. Belsky (1993) expanded the ecological
framework by applying it to child maltreatment under the assumption that child maltreatment is a
social-psychological phenomenon, determined by individual (otogenic development), family
(microsystem), neighborhood (exosystem), and cultural (macrosystem) circumstances. The
interactions of these systems are important as they shape the context that either promotes or
inhibits child maltreatment. This framework does not solely place blame on the parent or
caregiver or ignore the role of one’s social environment; rather, it incorporates the influence of
both factors in a family’s ability to care for a child.
An ecological systems framework is used to identify and highlight the context in which
childhood neglect may present to child welfare agencies. This is done through the usage of
population-level linked data, with an awareness of both its potential—to broaden our
understanding—and its limitations—to include specific characteristics of one’s broader social
environment. However, it is not the goal of this study to outline a causal pathway by which
maltreatment occurs. Rather, it aims to illuminate specific factors that contribute to an allegation
and substantiation of neglect in order to continue building our empirical base for more robust
theory development.
The Public Health Model
While efforts to better understand the mechanisms by which neglect affects children are
ongoing, what is known is that neglect can have detrimental effects on a child’s wellbeing; this

12
in and of itself is enough to act (Zimmerman & Mercy, 2010). The public health model offers an
appropriate framework through which to understand childhood neglect as a public health
problem and to inform the discussion and conclusions of this dissertation. The public health
model has four main activities that build on one another; 1) surveillance to determine the
magnitude of the problem, 2) research to identify risk and protective factors, 3) the development
and testing of prevention strategies, and 4) the dissemination of empirically tested interventions
(Whitaker et al., 2005). This approach is an action-oriented model that addresses problems on a
large scale, with the aim of tying together research and practice by tapping into a community’s
vast network of governmental agencies, community-based organizations, faith-based
organizations, and academic institutions (Whitaker et al., 2005). As described above, there has
been a growing body of research examining the scope, risk factors, and outcomes associated with
neglect; however, several areas remain unclear. Defining the problem has been challenging due
to disagreement over how to operationalize neglect, despite this, it is well understood that the
scope of the problem is extensive (Stoltenborgh et al., 2013). There is also growing evidence of
risk and protective factors associated with childhood neglect. Most modifiable risks appear to be
related to a complex relationship between parental, familial, and environmental factors,
suggesting that the key to preventing childhood neglect may be in addressing the well-being of
the family as a whole.

13
References
Belsky, J. (1993). Etiology of child maltreatment: A developmental-ecological
analysis. Psychological bulletin, 114(3), 413.
Berger, L. M. (2004). Income, family structure, and child maltreatment risk. Children and Youth
Services Review, 26(8), 725-748.
Berger, L. M., Font, S. A., Slack, K. S., & Waldfogel, J. (2017). Income and child maltreatment
in unmarried families: Evidence from the earned income tax credit. Review of Economics
of the Household. Advance online publication.
Bronfenbrenner, U. (1976). The experimental ecology of education. Educational
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California Child Welfare Indicators Project (2020). CWWIP Report. Retrieved December 1,
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20
CHAPTER 2 (Study 1)
Lifetime Prevalence and Risk of Exposure to Childhood Neglect: A Linked Birth Cohort
Study
Introduction
Child maltreatment remains a major public health concern. Each year the child protection
system (CPS) receives over 4 million reports of alleged child maltreatment, involving 7.9 million
children (U.S. Department of Health and Human Services [USDHHS], 2021). Studies calculating
lifetime prevalence of CPS reports estimate that 37.4% of children in the United States are
investigated for alleged child maltreatment and 11.7% are substantiated as victims of child
maltreatment during their lifetime (Kim et al., 2017; Yi et al., 2020).
While children can be reported to CPS for allegations of physical abuse, sexual abuse,
and emotional abuse, the vast majority of children are reported for neglect. Neglect makes up
74.9% of all substantiated cases, either alone (61.0%) or in concert with abuse (39.0%)
(USDHHS, 2021). Estimating the risk of exposure to child neglect has been difficult given the
ambiguity in its definition and the variation in measurement. Current estimates vary greatly by
data source and measurement (i.e., self-report, CPS report [allegation versus substantiation])
(Stoltenborgh et al., 2013). Studies estimating lifetime risk of neglect exposure are largely
retrospective and rely on an individual’s ability to recall childhood events, with estimates
ranging from 15.1% (Vanderminden et al., 2019) to 80.1% (Stephenson et al., 2006). The large-
scale population-based studies that have used administrative data to examine lifetime risk have
focused on child maltreatment in general and not reported risk by individual maltreatment type
(Parrish et al., 2011; Putnam-Hornstein et al, 2021, Sabol et al., 2004; Yi et al., 2020), with one
exception. Kim et al. (2017) used synthetic cohort life tables to estimate lifetime prevalence of

21
neglect and found that 25.2% of children were reported to CPS due to concerns of neglect.
However, this study excluded children whose reports were not investigated. To date little is
known about the difference between children whose reports are investigated versus not
investigated. Not only is neglect highly prevalent, but researchers have found that neglect can
have lasting impacts on a child’s wellbeing that are equivalent to or even more serious than those
of abuse (Hildyard et al., 2002; Gauthier et al, 1996; National Scientific Council on the
Developing Child, 2012).
Given the large proportion of children experiencing neglect and the serious consequences
of exposure, understanding what may predict a child’s contact with CPS, specifically due to
allegations of neglect, is important in reducing a child’s risk and understanding its etiology.
However, like the difficulties in estimating prevalence, understanding sociodemographic markers
of risk for neglect is hampered by both overly ambiguous civil definitions and the large degree of
overlap between allegations of neglect and abuse. While the general civil understanding of
neglect is the failure of a parent or caregiver to provide for the needs of a child such that the
child’s wellbeing is threatened or harmed (Child Welfare Information Gateway, 2018), each state
defines what constitutes an omission of care or risk of harm. California, for example, splits
neglect into severe neglect, which must indicate actual harm, such as failure to thrive or
malnutrition, and general neglect, which only needs to have the threat of harm. Regardless of
whether neglect is defined using the standard of actual or threatened harm, neglect remains the
most reported and substantiated type of maltreatment nationwide (USDHHS, 2021), making it
imperative to better understand its risks and how they may differ from those of abuse.

22
Sociodemographic Risks for Maltreatment
While the literature suggests that children who are reported to CPS differ from children
who are never reported (Parrish et al., 2011; Putnam-Hornstein et al., 2011; Wu et al., 2004), less
is known about the sociodemographic markers of risk for exposure to different types of
maltreatment. Predictors of CPS involvement (using a single indicator of maltreatment) have
found associations between various sociodemographic characteristics and increased likelihood of
a child being reported to CPS for allegations of maltreatment. Factors such as maternal age (Lee
& Goerge, 1999), number of children in the family (Murphey & Braner, 2000; Parrish et al.,
2011), maternal education (Dubowitz et al., 2011), use of public health insurance (Wu et al.,
2004), and prenatal care receipt (Murphey & Braner, 2000; Putnam-Hornstein et al., 2011) have
all been found to be related to risk of CPS report.
Sociodemographic Risks for Neglect
Using surveys and official CPS records of neglect, Brown et al. (1998) found that large
family size, young maternal age, federal assistance (Aid to Families with Dependent Children
[AFDC]), and low maternal education were each associated with increased likelihood of both
self-reported neglect and CPS substantiated reports of neglect. After controlling for parental
mental health and parent child relationship, the strongest predictor of substantiated neglect was
AFDC assistance followed by maternal education. In an examination of sociodemographic risks
from birth records, Lee & Goerge (1999) found young maternal age (17 years and younger) and
community poverty were the greatest predictors of substantiated neglect reports. While this study
did use population-level data, it was only able to follow children for the first 5 years and
included only substantiated reports of neglect. Perhaps the most notable risk associated with
neglect has been poverty (Pelton, 1989; 2014). While the association between maltreatment in

23
general and poverty is also strong, there is growing evidence to suggest that neglect may be more
sensitive to family income levels and poverty than abuse (Berger et al., 2017; Drake & Pandey,
1996; Sedlak et al., 2010). Additionally, the lack of studies which have considered the degree of
overlap between neglect and abuse has made it difficult to understand if children reported for
allegations of neglect have unique risks compared to children reported for allegations of abuse.
Current Study and Hypothesis
Given the difficulty in estimating the occurrence of neglect, the dependence on cross-
sectional and retrospective survey designs to study risk factors, and the lack of information on
the differences between risk of neglect versus abuse, this population-based study uses linked
California birth and CPS records to ask the following questions: 1) What is the lifetime risk of
being reported to CPS for allegations of neglect?; 2) What are the sociodemographic and birth
characteristics that are associated with lifetime reports of neglect?; and 3) Do sociodemographic
markers of risk for neglect differ from those of abuse? Given the research on sociodemographic
risks of CPS reports, I hypothesize that children who are born to mothers with less education,
whose births are covered by public health insurance, who are born into larger families, who do
not have a father listed on the birth certificate, and whose mothers received late or no prenatal
care will be more likely to be reported to CPS for allegations of neglect. Additionally, given the
literature on the relationship between poverty and neglect, I hypothesize that the
sociodemographic markers related to economic disadvantage (paternity, education, public
assistance) will have a greater effect on children’s risk of neglect compared to abuse.
Methods
This prospective study explores lifetime prevalence and the differing sociodemographic
and birth characteristics (risk and protective factors) associated with children who fall into one of

24
four groups: (i) no maltreatment allegations; (ii) allegations of neglect alone; (iii) allegations of
abuse alone; and (iv) allegations of both abuse and neglect.
Data
This study uses California vital birth records and CPS records available through the
California Department of Social Services. Birth records from the 2000 birth cohort were
probabilistically linked to CPS records dated January 1, 2000 through December 31, 2018.
Linkage was conducted using open-source software ChoiceMaker (Version XXX), customized to
California data. First name, middle name, last name, date of birth, gender, parsed and geocoded
address, and social security number (when available) were used to identify matching records
from these two data sources. Records used for this analysis were linked on a non-networked
workstation. Following this linkage, an anonymized linkage key was generated to connect
individuals across birth and child protection records, and the de-identified dataset transferred to
the Children’s Data Network’s (CDN) secure server. Access to the CDN server is restricted to
approved researchers who are granted access to individual private project directories through a
VPN.
Study Population and Outcomes
Study population included all children born in 2000 (N=532,845). Children were
classified into one of four mutually exclusive groups: (i) no CPS reports; (ii) neglect alone (one
or more CPS reports for allegations of neglect, without any abuse allegations, from birth to age
18 years); (iii) abuse alone (one or more CPS reports for allegations of abuse, without neglect
allegations, from birth to age 18 years); and (iv) both neglect and abuse (at least one allegations
of neglect and at least one allegation of abuse reported to CPS from birth to age 18 years). Abuse
included any allegation of physical abuse, sexual abuse, or emotional abuse (Font & Maguire-

25
Jack, 2020). Neglect included any allegation of general neglect, severe neglect, caregiver
absence/incapacity, or child at risk due to sibling abuse. Children whose allegation type was
missing were excluded (n=408). The decision was made to include all children reported to CPS
regardless of system response. This is due to the growing body of research challenging
differences in outcomes based on allegation disposition (substantiated versus unsubstantiated)
(Hussey et al., 2005; Kohl, Jonson-Reid, & Drake, 2009; Kugler et al., 2019). These four groups
were our outcome of interest.
Sociodemographic Markers and Birth Characteristics
Seven independent variables derived from birth records were used to examine
sociodemographic characteristics, as well as risk and protective factors: 1) maternal
race/ethnicity (White, Black, Asian/Pacific Islander (US born), Asian (foreign born), Hispanic
(foreign born), Hispanic (US born), Native American); 2) maternal age at birth (<=19 years, 20-
24 years, 25-34 years, 35+ years); 3) maternal education (high school completion, no high school
completion); high school completion is defined as having a high school diploma or having
passed a high school equivalency test (GED); 4) birth payment is defined as payment method at
the time of birth (public insurance, private insurance). Public insurance included Medi-Cal and
Medicare. Mothers are covered by Medi-Cal insurance if they earn below 138% of the poverty
line (less than $26,500 annual income for a family of four) and covered by Medicare if they have
Social Security Disability Insurance (California Department of Health Care Services, 2021); 5)
prenatal care, defined as the trimester in which medical prenatal care began (first trimester,
second trimester, third trimester/none); 6) parity (first born, 1 or 2 prior births, 3 or 4 prior births,
5 or more prior births); 7) established paternity, defined as the presence of a named father on the
birth certificate (yes, no). Each of these birth characteristics was chosen based on a demonstrated

26
association with CPS reports (Dworsky, 2015; Parrish & Gessner, 2010; Murphey & Braner,
2000; Needell & Barth, 1998; Putnam-Hornstein & Needell, 2011; Wu, 2004).
An additional index variable was created to show overall number of sociodemographic
risks. Six risks were summed for a score of zero to six for each child: young maternal age (<=19
years), no maternal high school completion, no or late prenatal care (3
rd
trimester/none), public
health insurance, large family size (5 or more children), no established paternity. These six were
chosen based on their demonstrated association with economic status or poverty (Brooks-Gunn
& Duncan, 1997; King et al., unpublished; McDonald & Coburn, 1988; Zuravin, 1988)
Analysis
A series of chi-square tests were used to examine the birth and maternal characteristics of
the full cohort of children included in this study. A multinomial logistic regression model was
then used to examine predictors of maltreatment allegation classification (neglect alone, abuse
alone, both). Relative risk ratios with 95% confidence intervals are reported. In order to ensure
that the differences seen across the maltreatment categories are not due to the number of CPS
reports alone, an additional multinomial logistic regression model was run among the universe of
children with at least one maltreatment allegation. The second multinomial logistic regression
model examined the same predictors of maltreatment classification (neglect alone, abuse alone,
both) as model one, with the addition of the total number of lifetime CPS reports as a continuous
covariate. Relative risk ratios with 95% confidence intervals are reported. All analyses were
completed using Stata version 16.0 (StataCorp, College Station, TX).

27
Results
Descriptive Results
Of the 532,845 children born in 2000, 29.1% of children (N=154,720) were reported to
CPS from birth to age 18 years. Twenty-four percent of the children born in 2000 were reported
for alleged neglect (alone or in combination with abuse); 10.5% were reported for neglect alone
and 13.5% for both abuse and neglect.
Table 2.1 outlines the various sociodemographic and birth characteristics of the 2000
California birth cohort, highlighting the percentage of children who were reported to CPS for
neglect alone, abuse alone or both abuse and neglect. Children reported for neglect alone were
more likely to be born to young mothers (<=19 years), to mothers with no high school
completion, to mothers who received late or no prenatal care, without established paternity, and
with public health insurance coverage. Significant differences were observed for each variable
between maltreatment groups. All children reported to CPS (for neglect alone, abuse alone or
both) were more likely to be born to mothers that were younger, to mothers who did not
complete high school, to mothers who were Black, Native American, or Hispanic, born using
public health insurance, and born without established paternity. Children reported for abuse
alone differed from children reported for neglect alone in that children with only allegations of
neglect were more likely to be born to young mothers, mothers who did not complete high
school, mothers who started receiving prenatal care in the 3
rd
trimester or did not use prenatal
care, mothers who had given birth to larger number of babies, born using public health insurance,
and born without established paternity.

28
Table 2.1

Sociodemographic and birth characteristics of the 2000 CA birth cohort, by maltreatment report
group. California, United States, 2000-2018
Birth Cohort Neglect Alone Abuse Alone Abuse & Neglect
num col% num row% num row% Num row%
Total 532,845 100.0 55,867 10.5 26,959 5.1 71,894 13.5
Maternal Age at Birth
<=19 56,396 10.6 9,249 16.4 3,936 7.0 14,809 26.3
20-24 122,926 23.1 16,017 13.0 7,339 6.0 22,839 18.6
25-34 267,942 50.3 24,097 9.0 12,023 4.5 27,036 10.1
35+ 85,526 16.1 6,491 7.6 3,660 4.3 7,201 8.4
Maternal Race/Ethnicity
White 171,645 32.2 15,189 8.8 6,730 3.9 20,998 12.2
Black 33,803 6.3 5,785 17.1 2,183 6.5 8,944 26.5
Hispanic, US born 94,084 17.7 13,463 14.3 5,524 5.9 18,801 20.0
Hispanic, foreign born 168,085 31.5 17,585 10.5 9,755 5.8 19,272 11.5
Asian/PI, US born 9,478 1.8 663 7.0 432 4.6 755 8.0
Asian, foreign born 53,295 10.0 2,724 5.1 2,230 4.2 2,383 4.5
Native American 2,266 0.4 444 19.6 89 3.9 708 31.2
Maternal Education
High school completion 376,685 70.7 33,031 8.8 18,182 4.8 42,463 11.3
No high school 156,166 29.3 22,836 14.6 8,777 5.6 29,431 18.9
Birth Payment Method
Private 317,460 59.6 23,248 7.3 14,545 4.6 28,243 8.9
Public 215,385 40.4 32,619 15.1 12,414 5.8 43,651 20.3
Prenatal Care
1st Trimester 442,889 83.1 42,239 9.5 22,186 5.0 55,055 12.4
2nd Trimester 64,938 12.2 9,304 14.3 3,598 5.5 12,044 18.5
3rd Trimester, none 25,018 4.7 4,324 17.3 1,175 4.7 4,795 19.2
Parity
First born 207,246 38.9 17,224 8.3 11,706 5.6 24,942 12.0
1 or 2 prior births 262,063 49.2 27,304 10.4 12,556 4.8 33,904 12.9
3 or 4 prior births 52,239 9.8 8,673 16.6 2,305 4.4 10,221 19.6
5 or more 10,959 2.1 2,603 23.8 378 3.4 2,767 25.2
Second Parent
Established 495,145 92.92 48,482 9.8 24,932 5.0 61,657 12.5
Not established 37,700 7.08 7,385 19.6 2,027 5.4 10,237 27.2

While not tabled, differences were seen in the number of CPS reports and age of first
allegation across the three groups with a history of CPS contact. The mean number of reports for
both children who only experienced allegations of neglect and children who only experienced

29
allegations of abuse was approximately one report (neglect mean=1.8, SD=1.67; abuse
mean=1.3, SD=0.78). However, the average number of reports for children who were alleged
victims of abuse and neglect was 5.4 (SD=5.02). Similarly, the mean age at first report for
children with allegations of both abuse and neglect was 5 years (SD=4.69), whereas for children
with allegations of neglect alone this was 6 years (SD=5.24) and for children with allegations of
abuse the mean age was 9 years (SD=5.18). Additionally, for the children who experienced
allegations of both neglect and abuse during childhood, 55.7% were reported for neglect and one
type of abuse, 34.0% were reported for neglect and two types of abuse, and 10.3% were reported
for neglect and three types of abuse. For the plurality of children who experienced both abuse
and neglect allegations during their lifetime, their first CPS report was for allegations of neglect
alone (47.2%). One quarter (24.1%) of these children started with an initial report of abuse alone
and were later reported for neglect, and 28.7% started with a report containing allegations of
abuse and neglect.
Figure 2.1 illustrates the relationship between maltreatment group and the six
socioeconomically related factors (no established paternity, no high school completion, public
health insurance coverage, large family size, no or late prenatal care, and maternal age of 19 or
younger). While children who experienced each of these sociodemographic risk factors were
more likely to be reported to CPS, they appear to place a child at higher risk for reports of
neglect than for abuse. For example, 4.8% of children never reported to and 7.5% of children in
the abuse alone group did not have established paternity; these numbers are significantly lower
than the 13.2% of children in the neglect alone group or 14.2% of children in the neglect and
abuse group who did not have established paternity. Similarly, 33.5% of the children with no
CPS reports and 46.1% of children in the abuse alone group were born covered by public health

30
insurance, which again is significantly lower than the 58.4% of children in the neglect alone
group or 60.7% of children in the neglect and abuse group who were born covered by public
health insurance. In addition, a larger share of children reported for neglect alone (40.9%) or
both neglect and abuse (40.9%) were born to mothers with no high school diploma. Children in
the no CPS report group and the abuse alone group were less likely to be born to mothers with no
high school completion, following a similar trend as the other socioeconomically related factors
listed above.
Figure 2.1

Percentage of children in each maltreatment report group who were born with each
sociodemographic risk

Figure 2.2 demonstrates the percentage of children reported to CPS for each maltreatment
group by number of risk factors present. The likelihood that a child was reported for neglect
alone or abuse and neglect increased with each increase in the number of risks. However, this
same dose response trend is not seen for children reported for abuse alone, with a relatively
consistent number being reported regardless of the number of risks present. While not tabled,
children with no maltreatment allegations had a mean of 0.76 (SD=1.00) risks, children with
1.4%
3.9%
4.8%
7.5%
25.2%
33.5%
1.4%
4.4%
7.5%
14.6%
32.6%
46.1%
4.7%
7.7%
13.2%
16.6%
40.9%
58.4%
3.9%
6.7%
14.2%
20.6%
40.9%
60.7%
Large Family No or late prenatal
care
No Paternity Young Maternal
Age
No HS Completion Public Insurance
No Report Abuse Neglect Both

31
allegations of neglect alone had a mean of 1.41 risks (SD=1.15), children with allegations of
abuse alone had a mean of 1.06 risks (SD=1.08), and children with allegations of both had a
mean of 1.47 risks (SD=1.14). A one-way ANOVA was conducted to confirm differences in risk
means between maltreatment groups (p<.001).
Figure 2.2
Percentage of children reported to CPS for each maltreatment group by number of risk factors
present

Note. Although six risks were tallied, only five are reflected on this graph due to no child experiencing all six risks.

Multinomial Logistic Regression
Table 2.2 presents results of the multinomial logistic regression. Results were largely
consistent with those that emerged in bivariate analyses. Compared to children with no CPS
reports, children born to mothers 19 years and younger, Black or Native American mothers, and
mothers who did not complete high school, as well as children who had their births covered by
public health insurance and children without established paternity were at heightened risk of
being reported to CPS for reports of neglect alone, abuse alone, or both. Differences in the type
of maltreatment reported were seen across family size, prenatal care, and race and ethnicity.
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
0 1 2 3 4 5
Percentage Reported to CPS
Number of Risks
Neglect
Abuse
Both

32
Children born to US-born Hispanic mothers were slightly more likely to be reported for abuse
alone, neglect alone, and both compared to children born to White mothers. Also compared to
children with White mothers, children with foreign-born Hispanic mothers were less likely to be
reported for neglect alone or both but more likely to be reported for abuse alone. Children born
to both foreign-born and US-born Asian mothers were less likely be reported for neglect alone or
both, but no different than White mothers in risk of report for abuse alone. Children born to
mothers who began receiving prenatal care during the first trimester had lower odds of being
reported for neglect alone or both but were not significantly different in risk of report for abuse
alone compared to children born to mothers who either did not receive prenatal care or began
care in the third trimester. Again, there appears to be a graded relationship between neglect,
abuse, and both, with risk factors more strongly aligned with neglect alone or both than to abuse.
For example, children born using public health insurance were 1.33 times as likely to be reported
for abuse, 2.05 times as likely to be reported for neglect, and 2.28 times as likely to be reported
for both.

33
Table 2.2

Sociodemographic predictors for CPS report, by maltreatment report group. California, United
States, 2000-2018

Neglect Alone Abuse Alone Both
RRR 95% CI RRR 95% CI RRR 95% CI
Maternal Age at Birth
<=19 3.40* (3.26, 3.55) 1.94* (1.84, 2.05) 4.50* (4.33, 4.68)
20-24 2.26* (2.18, 2.34) 1.47* (1.41, 1.54) 2.77* (2.68, 2.86)
25-34 1.39* (1.35, 1.44) 1.04* (1.00, 1.08 1.40* (1.36, 1.44)
35+ ref ref Ref
Maternal Race/Ethnicity
White ref ref Ref
Black 1.72* (1.66, 1.79) 2.06* (1.95, 2.17) 1.82* (1.76, 1.88)
Hispanic, US-born 1.16* (1.13, 1.19) 1.47* (1.41, 1.53) 1.05* (1.03, 1.08)
Hispanic, foreign-born 0.54* (0.53, 0.56) 1.19* (1.14, 1.23) 0.40* (0.39, 0.41)
Asian/PI, US-born 0.66* (0.61, 0.72) 1.01 (0.91, 1.11) 0.51* (0.47, 0.56)
Asian, foreign-born 0.50* (0.48, 0.53) 0.95 (0.91, 1.00) 0.33* (0.31, 0.34)
Native American 2.07* (1.84, 2.32) 1.36* 1.09, 1.69) 2.24* (2.02, 2.49)
Maternal Education
High School Completion ref ref Ref
No High School Completion 1.39* (1.36, 1.42) 1.05* (1.03, 1.09) 1.44* (1.41, 1.47)
Birth Payment Method
Private ref ref Ref
Public 2.05* (2.00, 2.09) 1.33* (1.29, 1.37) 2.28* (2.24, 2.33)
Prenatal Care
1st Trimester ref ref Ref
2nd Trimester 1.19* (1.16, 1.22) 1.07* (1.03, 1.11) 1.14* (1.11, 1.17)
3rd Trimester, none 1.45* (1.38, 1.49) 0.95 (0.98, 1.04) 1.18* (1.14, 1.23)
Parity
First born ref ref Ref
1 or 2 prior births 1.77* (1.73, 1.81) 1.00 (0.98, 1.04) 1.66* (1.64, 1.71)
3 or 4 prior births 3.51* (3.40, 3.63) 1.12* (1.06, 1.18) 3.39* (3.29, 3.50)
5 or more 5.93* (5.61, 6.37) 1.07 (0.96, 1.19) 5.32* (5.04, 5.61)
Second Parent
Established ref ref Ref
Not established 1.82* (1.77, 1.88) 1.19* (1.13, 1.25) 1.82* (1.77, 1.88)
Note. 2000 Birth cohort followed through June 30, 2018.
Odds of CPS report derived from Multinomial logistic regression, where reference group is
children never reported to CPS. * Indicates p<.05

Table 2.3 shows results of the multinomial logistic regression model among the
subpopulation of children reported to CPS at least once during their lifetime (N=155,128).

34
Results confirm that even when controlling for number of lifetime CPS reports, the different
relationships observed between abuse and neglect remain. Young maternal age, no high school
completion, public health insurance, late or no prenatal care, larger family size, and no
established paternity were each associated with lower odds of a child being reported for abuse
compared to neglect. Interestingly, when accounting for the number of lifetime reports, children
who could be classified as being in the highest risk category of each independent variable (i.e.,
born to mothers with no maternal high school completion, no established paternity, larger
families, no prenatal care, young maternal age, and public health insurance coverage) were more
likely to be associated with reports of neglect alone compared to both. This may indicate that the
high risks associated with being reported for both abuse and neglect may be more closely tied to
the number of reports to CPS as opposed to the type of maltreatment report. Also noteworthy is
that there were racial and ethnic differences across maltreatment groups. Non-White children
were more likely to be reported for abuse alone or abuse and neglect compared to neglect alone,
with the exception of Native American children. Compared to children born to White mothers,
children born to Native American mothers were more likely to be reported for neglect alone but
less likely to be reported for abuse alone or abuse and neglect.

35
Table 2.3

Sociodemographic predictors for CPS report of abuse alone or abuse and
neglect among children reported to CPS. California, United States, 2000-2018

Abuse Alone Both
RRR 95% CI RRR 95% CI
Number of Reports 0.60* (0.59, 0.61) 1.84* (1.82, 1.86)
Maternal Age at Birth
<=19 0.61* (0.57, 0.65) 0.94* (0.88, 0.99)
20-24 0.69* (0.65, 0.73) 0.95* (0.91, 1.00)
25-34 0.78* (0.75, 0.82) 0.89* (0.85, 0.93)
35+ ref ref
Maternal Race/Ethnicity
White ref ref
Black 1.17* (1.10, 1.24) 1.12* (1.07, 1.18)
Hispanic, US-born 1.19* (1.14, 1.24) 1.13* (1.09, 1.17)
Hispanic, foreign-born 1.78* (1.71, 1.87) 1.41* (1.35, 1.46)
Asian/PI, US-born 1.51* (1.33, 1.72) 1.11 (0.98, 1.26)
Asian, foreign-born 1.66* (1.55, 1.77) 1.12* (1.05, 1.19)
Native American 0.69* (0.54, 0.87) 0.90 (0.77, 1.04)
Maternal Education
High School Completion ref ref
No High School Completion 0.79* (0.76, 0.83) 0.89* (1.30, 1.44)
Birth Payment Method
Private ref ref
Public 0.71* (0.68, 0.73) 0.87* (0.85, 0.90)
Prenatal Care
1st Trimester ref ref
2nd Trimester 0.92* (0.88, 0.96) 0.88* (0.75, 0.82)
3rd Trimester, none 0.67* (0.63, 0.73) 0.73* (0.69, 0.77)
Parity
First born ref ref
1 or 2 prior births 0.59* (0.57, 0.61) 0.78* (0.75, 0.80)
3 or 4 prior births 0.35* (0.33, 0.37) 0.62* (0.59, 0.65)
5 or more 0.21* (0.18, 0.23) 0.44* (0.40, 0.47)
Paternity
Established ref ref
Not established 0.69* (0.59, 0.61) 0.81* (0.78, 0.84)
Note. Children born in 2000 who were reported to CPS at least
once prior to June 30, 2018 (N=155,128).
Odds of CPS report derived from Multinomial logistic regression, where
reference group is children with reports of neglect alone.

36
Discussion
Findings from this study indicate that reports of child neglect are a common occurrence
among California children and youth. By age 18, nearly one in four children were reported for
child neglect. Overall, 82% of the children who came into contact with CPS during their
childhood had at least one allegation of neglect. While this is the first study to use birth and CPS
records to document lifetime risk of neglect, the significance is consistent with other reports
which document neglect to be the most frequently investigated and substantiated type of child
maltreatment (Kim et al., 2017; USDHHS, 2021).
Similar to previous studies that used linked birth and CPS records (Parrish et al., 2011;
Putnam-Hornstein et al., 2011; Wu et al., 2004), our findings suggest that specific birth
characteristics associated with socioeconomic disadvantage (no high school, public health
insurance, missing paternity, larger family size, young maternal age) are each risk factors of
future reports to CPS. However, our results also suggest that these specific factors may have a
greater impact on the risk of being reported for neglect compared to abuse. For example, children
born covered by public health insurance had 105% higher odds of being reported for allegations
of neglect alone, but only 33% higher odds of being reported for abuse alone when compared to
children who were never reported. Therefore, although children born with a greater number of
sociodemographic risks are being reported to CPS at higher rates than children without these
risks, the degree to which these factors affect risk varies by type of maltreatment being reported,
suggesting that neglect reports are more closely related to poverty-related factors, while abuse
allegations may be more weakly correlated with those same factors. More research needs to be
done to determine whether the link between socioeconomic disadvantage and neglect is causal.
Given the disproportionate number of children involved with CPS for allegations of neglect and

37
the overwhelming presence of poor children and children of color being reported to the child
welfare system (Berger & Waldfogel, 2011; USDHHS, 2020), a causal link between the two
might suggest that larger social policies aimed at improving the economic conditions amongst
the nation’s poorest families would alleviate some of the burden placed on the child welfare
system.
The finding denoting that children with the highest levels of socioeconomic disadvantage
are at greater risk of being reported for both abuse and neglect allegations highlights an
exceptionally vulnerable group of children. Differential results for children reported for neglect
alone or abuse alone and those reported for both appear to reflect increasing system contact, with
the first group (neglect or abuse alone) generally reported only once or twice during childhood
compared to children who experience many more allegations (including both abuse and neglect)
who have recurring or ongoing CPS involvement. Children reported for both appeared to be
reported at an earlier age, experience the highest number of risks, and have frequent CPS contact,
indicating that these families may have a more complex set of needs. Further research is needed
to understand allegations of both neglect and abuse to determine whether these reports accurately
measure risk of abuse and neglect or if neglect allegations often accompany abuse allegations
due to other environmental factors or one parent or guardian ‘ignoring’ the abuse perpetrated by
another.
In terms of race and ethnicity, we found that Black families were more likely to be
reported for neglect, abuse, or both. This is similar to the findings of others which have found
Black families to be at greater risk of CPS reports in general (Kim et al., 2017; Putnam-
Hornstein et al., 2011). The finding that children with US-born Hispanic mothers were more
likely to be reported to CPS for any maltreatment type but foreign-born Hispanic mothers were

38
less likely suggests that children of foreign-born Hispanic mothers may have access to social or
human resources not as available to children of US-born Hispanic mothers (Eastman et al.,
2016). However, it could also be an indication of the underreporting of undocumented parents
due to fears of deportation or other harm that may come from interaction with a government
system (Osterling & Han, 2011). Results also suggest that race and ethnicity not only play a role
in which families get reported but also in how they are reported. When economic indicators and
number of CPS reports were controlled for, children born to non-White mothers, with the
exception of children born to Native American mothers, were less likely to be reported for
neglect but more likely to be reported for abuse compared to White mothers. These findings
suggest that there are racial and ethnic differences in who is being reported for what type of
maltreatment above and beyond what can be explained by sociodemographic disadvantage. More
research is needed to understand the role of culture, discipline or bias in reporting differences.
While the use of population-level birth records provides numerous benefits, several
limitations must be acknowledged. Due to having birth and CPS records for the state of
California only, the inability to account for the children who may have been born in California
but moved out of state may lead to a slight overcount of children in the never reported group.
However, due to California’s low rate of migration (Internal Revenue Service, 2020), and the
likelihood of similar rates of migration between CPS and non-CPS groups, it is not anticipated
that this will significantly affect results. Similarly, since the analysis uses CA data, the ability to
generalize beyond the state is unknown.
Overall, results of this study suggest that children reported for neglect may be distinct
from children reported for abuse, implying that the needs of these children and the services that
may be needed are likely unique. An important goal for further research should be in determining

39
what specific individual, family, and environmental factors are associated with circumstances
that may lead to an allegation of neglect and differentiate between children who are truly unsafe
versus those at risk of negative outcomes due to economic and poverty-related factors. It is also
important to better understand the co-occurrence of neglect with other types of maltreatment,
given that these children appear to experience the highest levels of sociodemographic risk and
are more frequently reported to CPS. Understanding the distinct role of neglect versus abuse
among these families can impact our understanding of their specific treatment needs. With four
out every five children reported to CPS for neglect, researchers should consider examining
reports of maltreatment by subtype and co-occurrence or run the risk of unintentionally
evaluating predictors related mostly to neglect among socially disadvantaged families.

40
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46
CHAPTER 3 (Study 2)
Population Level Examination of Reporter Concerns Associated with Child Neglect

Introduction
Allegations of neglect make up a disproportionate number of all child maltreatment
substantiations (U.S. Department of Health and Human Services [USDHHS], 2021). In 1990,
less than half (49%) of children confirmed as victims of child maltreatment had substantiated
allegations of neglect; by 2017, nearly three-quarters (74.9%) of confirmed victims had
substantiated allegations of neglect. In 2019, approximately 61% of all child maltreatment
victims had a substantiated allegation consisting of neglect alone, indicating that the majority of
children with substantiated neglect allegations are in need of services related to “neglect”.
Defining Neglect
Neglect is an ambiguous and heterogeneous term that lacks a universal definition. There
has long been debate over whether neglect should be viewed through the lens of the child’s needs
or the parental omission in care (Rose & Meezan, 1993). In its broadest definition, child neglect
has been defined as unmet basic needs regardless of cause (Dubowitz et al., 1993). Advocates of
this child-centered perspective have argued that viewing neglect through the lens of child needs
removes some of the blame placed on parents and allows for a sense of shared responsibility.
Researchers have continued to refine this expansive definition of neglect by proposing numerous
subclassifications, including physical neglect, emotional neglect, medical neglect, mental health
neglect, educational neglect (Erickson & Egeland, 2002), psychological neglect, environmental
neglect (Dubowitz, Pitts, and Black, 2004), cognitive neglect (Slack et al., 2003), care neglect
(Knutson et al., 2005), and supervisory neglect (Kaufman Kantor et al., 2004). On the other
hand, the legal and civil definitions, such as those used by child protection systems (CPS), have

47
been oriented around a parent-centered definition, classifying neglect only when there is a failure
to act on the part of the parent. The general civil definition of neglect is the failure of a parent or
guardian to provide for a child’s needs, including food, shelter, clothing, medical care, or
supervision such that the child’s physical or psychological safety is endangered (Child Welfare
Information Gateway, 2019). Understanding the specific needs of children who come into
contact with CPS for neglect related allegations has been especially challenging due to numerous
circumstances being simplified into one general group. Additionally, there is a great deal of
variability across states in what is considered to be neglect (Rebbe, 2018). For example, 32% of
states do not consider threat of harm as sufficient grounds to meet the standard of neglect, only
24% of states include prenatal substance use as a form of neglect, and even fewer states (20%)
include a child’s exposure to substances in general in their definition of neglect. In line with the
findings from Rose and Meezan (1993), Rebbe found that there are several aspects that are
consistently included in most states’ definitions and are seen as the cornerstones of neglect:
inadequate food, clothing, shelter, medical care, or supervision, and abandonment. Despite the
inclusion of these specific elements in a state’s definition, the challenge of determining the
frequency with which they occur or their role in the decision to provide services remains. Due to
these elements being reported in only a few or even just a single category—neglect—it is
difficult to parse out or understand what is being reported when allegations of neglect are called
into the child abuse hotline.
Types of Neglect Reported to CPS
Researchers have attempted to report the frequency of specific child needs identified in
reports of neglect by manually coding neglect subtypes reported in a selection of CPS cases. For
example, Mennen et al. (2010) examined the case records of children who were 9 to 12 years of

48
age and had a newly opened child welfare case in Los Angeles County, finding that 72.5%
experienced supervisory neglect, 61.6% experienced environmental neglect, and 23.2%
experienced medical neglect. Dubowitz et al. (2005) looked at children aged 0 to 8 years and
determined that 81.3% had a CPS record of general neglect allegations and 9.8% had a record of
CPS contact due to caregiver absence. Using the Modified Maltreatment classification system to
identify specific child needs, the authors noted that 32.6% of children experienced lack of
supervision and 24.3% experienced environmental neglect, noting that failure to provide (lack of
food, clothing, shelter, hygiene, sanitation, or medical care) was the least frequently experienced
neglect type.
CPS Intervention Decisions
Even if not well understood, the vast majority of families who have substantiated
allegations of child maltreatment, have been substantiated for neglect. Studies examining CPS
outcomes following allegations of neglect, in general, have found that after controlling for race
and ethnicity, gender, and age, children reported for neglect were more likely than children
reported for other forms of maltreatment to have a case opened for services (Berrick et al., 1998;
Johnson-Reid, 2002), and have higher rates of foster care entry compared to children reported for
other reasons (Needell et al., 2003; Rivaux., 2008). The difficulty in identifying the specific
aspects (i.e., lack of food, clothing, shelter, supervision) of CPS allegations of neglect may
contribute to the decision to substantiate or remove a child from home, but the basis for doing so
is not well understood. Johnson-Reid et al. (2013) looked at investigative disposition by sub-type
and found that children reported for lack of basic needs, supervision, severe neglect, or
hygiene/sanitation were less likely to be substantiated compared to children reported for all other
reasons. Looking at neglect sub-types and the decision to place in foster care, Chiang (2019)

49
found that families reported for supervisory neglect, physical neglect, and prenatal substance use
were more likely to be placed in care compared to those reported for domestic violence-related
neglect.
Present Study
Given the overwhelming presence of neglect among children reported and substantiated
for maltreatment, understanding the specific concerns and conditions being reported, as well as
which of these informs the decision to substantiate or place in foster care, may be necessary in
order to identify child needs and provide tailored services. The objectives of this study are to (1)
identify the frequency of the specific concerns being reported at the child abuse hotline when an
allegation of neglect is received by CPS, and (2) to examine which of these specific concerns
may predict more significant levels of involvement with CPS (i.e., substantiation and placement).
Methods
Data
CPS records from the California Child Welfare Service Case Management System
(CWS/CMS) were used to document allegations and investigative outcomes. Reporter concerns
were recorded from the Structured Decision Making (SDM) hotline assessment tool. The SDM,
in use in California since 1998, was developed by the Children’s Research Center as a set of
assessment tools to help frontline CPS workers be more systematic in the determination of risk
of maltreatment for a child reported to the CPS hotline and assist with decisions on whether a
case should be opened and services offered post-investigation (Johnson, 2004). The two primary
goals of SDM assessments are to improve the decision-making capabilities of child welfare
workers and to improve outcomes for children and families (California State Auditor, 2000).
While the suite of SDM tools includes several different assessments used at various points of

50
contact, the SDM indicators used in this study are derived from the hotline assessment tool based
on information collected during the screening process (See Appendix B). This hotline assessment
tool was designed to assist hotline workers in identifying whether a reporter’s concerns meet the
statutory requirement to open an investigation (California Department of Social Services
[CDSS], 2021).
Both the SDM and CPS data came from the California Department of Social Services and
are available through a data sharing use agreement. Data merging and analyses have been
approved by the California Health and Human Services Committee for the Protection of Human
Subjects and the University of Southern California Institutional Review Board.
Study Population
CPS and SDM data were extracted for all maltreatment reports from January 1, 2017, to
December 31, 2019. Records were merged using unique report identifiers common to both data
systems. Nearly all (98.4%) of the 1,269,362 reports identified in the CPS data matched to a
corresponding SDM assessment. Reports were restricted to those that were screened in for an
investigation (N=715,612) and were restricted to include only reports where at least one
allegation of neglect was present. One focal child was randomly selected from each report if
there was more than one child identified on the report; similarly, if that child had more than one
report during the study time frame, one report was randomly selected. Reports that were made
during the prenatal period and reports made for children over the age of 18 years were excluded.
The final population consisted of 398,580 children.
Defining Allegations of Neglect
Compared to many other states, California has a broad civil definition of neglect,
indicating that children need only be ‘at risk’ of harm to be considered as neglected (Welf. &

51
Inst. Code § 300; Pen. Code § 11165.2, 1987; Rebbe, 2018). California sub-classifies neglect
into two categories; general neglect (failure to provide food, shelter, medical care, or supervision
where there was no physical harm) and severe neglect (intentional failure to provide food,
shelter, medical care, or supervision, such that health is endangered). In addition, caretaker
absence/incapacity and at risk due to sibling abuse often fall under the umbrella of neglect
(Child Welfare Information Gateway, 2019). Therefore, children who were reported for general
neglect, severe neglect, caretaker absence/incapacity, and at risk due to sibling abuse are
included in our population of children with neglect allegations.
Dependent Variables
Two binary variables were coded to capture the outcome of the investigation. The first,
substantiation, was defined as at least one confirmed allegation on the CPS report. An allegation
is confirmed or substantiated if there is sufficient evidence to determine that more likely than
not, abuse or neglect occurred (California Legislative Penal Code, 2012). The second variable,
placement, was defined as the child being placed in foster care within 60 days of the focal CPS
report.
Independent Variables
Independent variables were pulled from the SDM data and include 17 pre-defined
indicators that assist the hotline worker in determining whether or not a reporter’s concerns meet
the statutory requirement for neglect (CDSS, 2021) and one additional variable that identifies
whether children were exposed to domestic violence (Appendix A). In the SDM screener tool,
the variables listed below are referred to as ‘Reporter Concerns,’ therefore moving forward all 18
independent variables will be referred to as reporter concerns. Each reporter concern was coded
as a binary variable and represented the presence or absence of a reporter concern for any

52
member in the family. Variables included: (1) Malnutrition, defined as a child being diagnosed
as malnourished; (2) Failure to thrive, indicated when a child has been diagnosed by a qualified
health care professional or the professional has stated there are indicators of the child having
non-organic failure to thrive; (3) Endangered health and safety, defined as the caregiver’s willful
negligence in providing for basic needs (clothing, shelter, supervision, care, or medical care) of
the child such that has caused or is at imminent risk of causing serious injury; (4) Death of child
due to neglect, indicated following a death due to neglect or a death due to unexplained or
suspicious circumstances; (5) Inadequate food, indicated when the caregiver has not provided
sufficient food such that the child’s daily activities are impacted (the receipt of food stamps
alone is not considered a sufficient concern for inadequate food); (6) Inadequate clothing,
indicated when the caregiver has failed to provide adequate clothing or hygiene needs such that
the child’s daily activities are affected; (7) Inadequate or hazardous shelter, indicated when the
home is unsanitary or hazardous such that it has or could lead to injury to the child; (8)
Inadequate health or mental health care, indicated when the caregiver is not providing access to
medical care during a mild or moderate injury or illness or not providing proper care following a
serious injury or illness; (9) Caretaker absence or incapacity, defined as a caregiver being unable
(i.e., incarceration, hospitalization) or unwilling (i.e., deserted or abandoned the child, kicked the
child out of the home) and there is no other safe adult to care for the child; (10) Failure to
protect, indicated when a caregiver knowingly leaves a child in the care of someone known to
abuse children, does not intervene when there is knowledge of abuse or neglect, or caregiver is
aware of exploitation by a third party; (11) Involving child in criminal activity, indicated when
the caregiver is the cause of the child being involved in criminal activity; (12) Prior death due to
neglect or suspicious circumstances and there is a new child in the home; (13) Prior failed

53
reunification or severe neglect and there is a new child in the home; (14) Allowing child to use
alcohol or drugs, defined as a caregiver’s knowledge or offering of drugs or alcohol to the child;
(15) Prenatal substance use, indicated when there is a positive toxicology for the mother or child
or credible evidence of prenatal substance use and risk of continued use; and (16) Other high-risk
birth, indicated when no neglect has yet occurred but where the sole reason it has not occurred is
due to external supports (i.e. caregiver has severe cognitive limitations and would be unable to
care for the child’s basic needs). One additional reporter concern was included in this analysis
that is not by itself an indicator of neglect but rather emotional abuse: (17) Domestic violence,
defined as child’s exposure to domestic violence. This was included in the analysis given the
high degree of overlap between allegations of neglect and the presence of domestic violence in
the home (Rebbe et al., 2021).
Co-Variates
Demographic characteristics, CPS history, and co-reported allegations pulled from the CPS
records were used to control for child’s age at the time or report (under 1 year, 1-5 years, 6-10
years, 11-17 years), race and ethnicity (White, Black, Hispanic, Asian/Pacific Islander, and
Native American), CPS history (mutually exclusive categorical variable: no CPS history, prior
report, prior substantiation, or prior placement), co-reported sexual abuse, and co-reported
physical abuse.
Analysis
A series of multivariable generalized linear models were used to test the association
between each reporter concern and investigative outcomes. Each model included one
independent variable, all co-variates (controls), and the binary outcome. Overall, a series of 34
models were run to test the relationship between each of the 17 independent variables and

54
substantiation and each of the independent variables and placement. Multicollinearity was tested
to determine the degree of correlation between independent variables and no correlations greater
than 0.3 were detected (Supplementary table 3.1). While logistic regression models can be used
to examine the association between predictors and outcome, the association is often inflated for
nonrare outcomes (Zhang & Kai, 1998). Since the rate of substantiation is not uncommon
(between 17% and 68% across all predictor variables), generalized linear models specifying
Poisson distribution and link log were used. Results are presented as relative risk with 99%
confidence intervals. All analyses were completed using Stata 16.
Results
Characteristics of Children reported for Neglect
Table 3.1 presents the demographic characteristics, co-reported allegations, and CPS
histories of the children reported with allegations of neglect (N=398,580) in California in 2017.
A majority of children were age 10 or younger (64.2%), 23.2% were White, and 49.4% were
Hispanic. The majority of children had prior CPS history, with 36.9% having a prior
unsubstantiated report, 14.6% having a prior substantiated report, and 10.4% having a past
placement. Nearly one in four (23.8%) children had a co-reported allegation of physical abuse
and 8.1% had a co-reported allegation of sexual abuse.

55
Table 3.1.

Demographic characteristics, CPS history, and co-
reported abuse allegations of children investigated for
allegations of neglect. California, United States, 2017

All Children with
Neglect Allegations
N=398,580
num col%
All Children 398,580 100.0
Childs Age
Under 1 year 66,004 16.6
1-5 years 82,372 20.7
6-10 years 107,276 26.9
11-17 years 142,928 35.9
Race/Ethnicity
White 94,177 23.2
Black 51,373 12.9
Hispanic 197,014 49.4
Asian/Pacific Islander 15,334 3.9
Native American 3,333 0.8
CPS History
Prior reports 147,146 36.9
Prior substantiated reports 58,098 14.6
Prior foster care placements 41,380 10.4
Co-reported abuse allegation
Sexual abuse 32,237 8.1
Physical abuse 94,854 23.8

Investigative Outcomes based on CPS Classified Neglect
Using the official CPS classifications, among the children investigated for neglect, 84.0%
had allegations of general neglect, 4.2% had allegations of severe neglect, 5.1% had allegations
of caregiver absence or incapacity, and 24.2% had allegations of being at risk due to sibling
neglect or abuse. Figure 3.1 illustrates the percentage of children with substantiated allegations
among each sub-type of neglect, with children experiencing allegations of caretaker absence or
incapacity having the highest likelihood of substantiation, followed by those with allegations of

56
severe neglect, general neglect, and then at risk due to sibling neglect or abuse. These same
trends were seen for proportions of children placed into foster care.
Figure 3.1
Percent of children substantiated and placed in foster care, for each neglect subtype

Reporter Concerns
Table 3.2 describes the percentage of children who experienced each reporter concern
among those investigated, substantiated, and placed in care. The most frequently indicated
reporter concerns were inadequate supervision (33.0%), failure to protect (28.6%), and exposure
to domestic violence (16.8%). The least documented reporter concerns were threat due to prior
death due to neglect with a new child in the home (0.03%), diagnosed malnutrition (0.04%), and
7.7%
23.2%
33.9%
55.9%
0% 20% 40% 60% 80% 100%
Sibling abuse/neglect
General neglect
Severe neglect
Caretaker absence/incapacity
Substantiated Unsubstantiated
4.9%
9.1%
19.9%
45.6%
0% 20% 40% 60% 80% 100%
Sibling abuse/neglect
General neglect
Severe neglect
Caretaker absence/incapacity
Placement No Placement

57
non-organic failure to thrive (0.11%). These proportions were similar among children whose
allegations were substantiated and placed with three notable exceptions. Children with reporter
concerns of domestic violence made up a smaller proportion of children placed in foster
compared to their proportions among children investigated or substantiated, and children who
had a reporter concern for prenatal substance use or caregiver absence accounted for a larger
percentage of the children placed in foster care. Looking at inadequate food, clothing, shelter,
and mental or physical health together shows that 20.9% of families were investigated on the
basis of unmet concrete needs.
Two reporter concerns alone, lack of supervision and failure to protect, accounted for
over half of children investigated (54.1%), and over one-third of all children substantiated
(43.3%) or placed in foster care (39.6%). There was large overlap between children with reporter
concerns of failure to protect and co-reported abuse or domestic violence, 57.8% of children with
a reporter concern of failure to protect also had an indicator of domestic violence exposure or co-
reported allegation of physical or sexual abuse.

58
Table 3.2

Reporter concerns of children investigated for allegations of neglect, by substantiation and
placement status. California, United States, 2017
All Children Substantiation Placement
N=398,580 N=92,152 N=32,906
num col% num col% num col%
Inadequate supervision 131,304 32.94 23,469 25.47 9,492 27.19
Failure to protect 113,473 28.50 21,607 23.45 6,085 17.43
Domestic violence 66,946 16.80 23,999 26.04 4,947 14.17
Inadequate/hazardous shelter 36,771 9.23 8,080 8.77 3,853 11.04
Inadequate medical/mental health care 30,551 7.66 3,506 3.80 1,246 3.57
Caregiver absence/abandonment 18,731 4.70 8,746 9.49 6,252 17.91
Inadequate clothing/hygiene 17,120 4.31 2,313 2.51 1,133 3.25
Child's health/safety endangered 16,405 4.13 7,401 8.03 2,529 7.24
Prenatal substance use 16,376 4.11 10,559 11.46 6,720 19.25
Inadequate food 15,227 3.83 2,162 2.35 1,178 3.37
Allowing child to use alcohol or drugs 5,171 1.30 493 0.53 118 0.34
Prior failed reunification, new child 4,697 1.18 3,264 3.54 2,571 7.37
Other high-risk birth 2,791 0.70 1,532 1.66 1,099 3.15
Involving child in criminal activity 2,786 0.70 849 0.92 337 0.97
Death of child due to neglect 463 0.12 161 0.17 60 0.17
Non-organic failure to thrive 423 0.11 144 0.16 61 0.17
Diagnosed malnutrition 174 0.04 72 0.08 39 0.11
Prior death due to neglect, new child 133 0.03 69 0.07 51 0.15

Investigative Outcomes based on reporter concern
Table 3.3 shows the predicted probabilities of allegations being substantiated or children
placed in foster care by reporter concern. After controlling for demographic, CPS history, and
allegation factors, the relative risk of substantiation was highest for children whose reports
included a concern of caregiver absence or abandonment (IRR: 2.17, 99% CI: 2.11, 2.24),
followed by prenatal substance use (IRR: 2.05, 99% CI: 1.98, 2.11). The directionality of the
predictors of placement largely aligned with the predictors of substantiation, with the exception
of exposure to domestic violence. Allegations that children were exposed to domestic violence

59
were 1.67 times as likely to be substantiated (IRR: 1.67, 99% CI: 1.64, 1.71) but children were
less likely to be placed in care (IRR: 0.75, 99% CI: 0.72, 0.78) compared to children whose
investigations did not include a reporter concern for domestic violence. The greatest risk of
placement was observed for children with a reporter concern of absent caregiver or abandonment
(IRR: 4.30, 99% CI: 4.15, 4.47) and those with prenatal substance use (IRR: 3.10: 99% CI: 2.98,
3.24). Concerns indicating inadequate care (food, clothing, health and mental health care,
supervision) were less likely to be substantiated and placed.

Table 3.3

Risk of substantiation and placement by reporter concern. California, United States, 2017-
2019

Substantiation Placement
IRR 99% CI IRR 99% CI
Caregiver absence/abandonment 2.17 (2.11, 2.24)*** 4.30 (4.15, 4.47)***
Prenatal substance use 2.05 (1.98, 2.11)*** 3.10 (2.98, 3.24)***
Prior failed reunification, new child 1.82 (1.74, 1.91)*** 3.01 (2.85, 3.19)***
Child's health/safety endangered 1.81 (1.75, 1.87)*** 1.49 (1.41, 1.57)***
Domestic violence 1.67 (1.64, 1.71)*** 0.75 (0.72, 0.78)***
Prior death due to neglect, new child 1.48 (1.09, 2.02)** 2.21 (1.54, 3.17)***
Other high-risk birth 1.41 (1.32, 1.51)*** 2.02 (1.86, 2.19)***
Involving child in criminal activity 1.38 (1.26, 1.50)*** 1.47 (1.27, 1.69)***
Diagnosed malnutrition 1.35 (1.00, 1.83)* 1.58 (1.05, 2.39)*
Death of child due to neglect 1.15 (0.94, 1.41) 0.93 (0.67, 1.30)
Non-organic failure to thrive 1.09 (0.88, 1.35) 0.87 (0.63, 1.22)
Inadequate/hazardous shelter 0.92 (0.90, 0.95)*** 0.92 (0.89, 0.95)***
Failure to protect 0.81 (0.80, 0.83)*** 0.59 (0.57, 0.62)***
Inadequate supervision 0.68 (0.67, 0.70)*** 0.75 (0.72, 0.77)***
Inadequate food 0.62 (0.59, 0.66)*** 0.89 (0.83, 0.96)***
Inadequate clothing/hygiene 0.57 (0.54, 0.60)*** 0.73 (0.68, 0.79)***
Inadequate medical/mental health care 0.51 (0.49, 0.53)*** 0.49 (0.46, 0.53)***
Allowing child to use alcohol or drugs 0.49 (0.43, 0.55)*** 0.33 (0.26, 0.42)***
Note. IRR derived from a series of multivariable generalized linear models. *p<.05
**p<.01 ***p<.001
One multivariable model was run for each reporter concern, controlling for race/ethnicity,
age and prior CPS history.

60
Discussion
This study examined the frequency of reporter concerns and CPS’s response to such
concerns among children investigated for allegations of neglect. The objective was to document
the frequency of these reporter concerns and to examine which of these specific concerns were
associated with the decision to substantiate an allegation or place a child in foster care. Results
reinforce that general neglect is the most frequently reported type of maltreatment among the
four CPS classified sub-type categories (Dubowitz et al. 2005). However, this study generates
new insights as notable differences were seen across various reporter concerns.
Results demonstrated that among the families reported for concerns related to concrete
need (inadequate food, clothing, shelter, mental or health care), the allegations were less likely to
be substantiated and children were less likely to be removed and placed in out of home care. This
is particularly interesting given that the these are the “cornerstones” of the definitions of neglect
created after the passage of CAPTA in 1974 and used by the majority of states (Rose & Meezan,
1993: Rebbe, 2018). This may indicate that while poverty-related needs are often reported to
child protection hotlines, the concerns related to a lack of concrete needs may not be a key
determining factor in the investigative decision. While this is promising and would indicate that
the system process is working as it should by not overly intervening in families where the only
concern is that of concrete needs, it does not signify that the children in these families are any
less at risk of negative outcomes (Brooks-Gunn & Duncan, 1997). Given that the 20% of
families investigated in this study were reported for concerns related to concrete needs (and
likely represent the more severe cases of physical neglect), together with the fact that the vast
majority of children involved with CPS live in low-income households or impoverished

61
communities (Dolan et al., 2011; Drake & Pandey, 1996), suggests that these children and
families are in need of support and services.
Study findings also indicate that children are rarely reported based on an allegation of
caretaker absence or abandonment, yet when these reports occur, the children are at high risk for
substantiation and out-of-home placement. In fact, these children account for 17.9% of all
children placed in foster care. Intuitively this makes sense, as by definition, not having an
appropriate caretaker would represent imminent risk and a clear need to intervene on behalf of
the child. However, the underlying reason for the caretaker absence or inability to care for the
child remains unclear. From the data we are unable to determine if the caretaker is absent due to
hospitalization, incarceration, substance use, or other reasons, each of which would be important
to understand in plan prevention services. Similarly, prenatal substance use was indicated for
only 4.1% of children reported for neglect, but these children comprised 11.5% of children with
substantiated allegations and 19.3% of children placed. This finding indicates that there is a
strong need for services directed at pregnant mothers or women of childbearing age for substance
use prevention or intervention. Given that parental substance use is not reportable until the child
is born, these services will likely need to come from sources outside of the CPS system, such as
community-based mental health agencies, primary care doctors, or OBGYN providers. It is also
important to note that an indicator of prenatal substance use only includes allegations of
substance use while pregnant and does not indicate caregiver substance use generally. This
means that while prenatal substance use (either alone or in concert with other reporter concerns)
accounts for one in five foster placements, it is an underestimate of the total foster placements
that may be due to caregiver substance use.

62
The majority of children’s neglect reports were noted for a lack of supervision or failure
to protect. The high rates of lack of supervision among reported children largely aligns with
other research, with Chiang (2019) finding that 19.6% of neglect reports included lack of
supervision and Johnson-Reid et al. (2013) documenting that 38.9% of Black children and 35.1%
of White children were reported for supervisory neglect. Despite the frequency with which lack
of supervision or failure to protect were noted, it did not make a child more likely to have
substantiated allegations or placement in foster care. In fact, these children were less likely to be
substantiated or enter foster care compared to children with other reporter concerns. A
subsequent look at failure to protect determined that 57.7% of the children who had a reported
concern for failure to protect had a corresponding allegation of abuse or domestic violence,
indicating that well over half of all failure to protect allegations are likely allegations for failure
to protect children from sexual abuse, physical abuse, or domestic violence exposure. While the
risk of substantiation or placement was lower among children reported for failure to protect and
inadequate supervision, these two risks still represented 39.6% of all children placed in foster
care. Consequently, in order to reduce the number of children entering foster care it is imperative
that there is a better understanding of what places a child at risk of being reported for inadequate
supervision or failure to protect and what the specific needs of these families are.
The finding that children exposed to domestic violence are less likely to enter foster care
is similar to findings of other researchers. Rebbe et al. (2021) found that CPS reports containing
allegations of domestic violence with or without abuse allegations had between 0.17 and 0.45
times the odds of entering foster care compared to children who experienced neglect allegations
without an indication of domestic violence. Similarly, Chiang (2019) found that children
indicated for exposure to domestic violence had between 0.18 and 0.27 the odds of entering

63
foster care compared to children reported for other neglect subtypes. These findings may indicate
that these families are receiving services outside of the CPS system or that the risk from
domestic violence was in some way reduced (i.e., the perpetrator was incarcerated, or one parent
moved out), mitigating the need for placement. It is also important to note that in California,
domestic violence should be categorized within the emotional abuse maltreatment category
(CDSS, 2021; Henry, 2017), although it is unclear to what extent this happens across counties.
The estimate that 13.3% of children were reported for domestic violence should be interpreted as
13.3% of children reported for neglect were also reported for domestic violence.
Limitations
While this study has numerous strengths, including the use of population-level data to
examine specific reporter concerns of neglect, it is also important to note several limitations.
Data pertains to residents of California and therefore the generalizability of the findings is
unknown. Due to the nature of the SDM hotline tool, risk indicators were noted at the time CPS
was called and coded as binary indicators. This presents two challenges: one, it is possible that a
risk was not mentioned at the hotline but was later determined to be present, and two, the binary
nature of the tool does not allow for detailed or nuanced information regarding the specific
concerns. For example, it is unknown what the underlying causes or conditions are that might
endanger the health and safety of a child. Despite these limitations, the findings from this study
add to the scant literature on what specifically is being alleged when CPS reports of neglect are
received and how it influences substantiation or placement.
Conclusion

Results from this study provide an estimate of the differing reporter concerns being noted
when a child is investigated for neglect and which predict substantiation and placement. This is

64
important given the recent passage and implementation of the Family First Prevention Services
Act (FFPSA), which redirects federal funds to support keeping families intact and prevent
children from entering foster care. Given the overwhelming presence of failure to protect,
inadequate supervision, caregiver absence or abandonment, and prenatal substance use among
children with substantiated allegations and those placed in out of home care, results also indicate
a need to better understand the underlying needs beneath these risks. While generally helpful to
understand the specific child need that is not being met, the concerns (as classified) fall short of
helping us to understanding the underlying cause or condition that are at the root of those
concerns.

65
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Rebbe, R. (2018). What is neglect? State legal definitions in the United States. Child
maltreatment, 23(3), 303-315.
Rebbe, R., Eastman, A. L., Adhia, A., Foust, R., & Putnam-Hornstein, E. (2021). Co-Reporting
of Child Maltreatment and Intimate Partner Violence: The Likelihood of Substantiations
and Foster Care Placements. Child maltreatment, 10775595211007205.
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(2008). The Intersection of Race, Poverty, and Risk: Understanding the Decision to
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CHAPTER 4 (Study 3)
Understanding Family Risk and Neglect Allegations: A Content Analysis of CPS
Investigations
Introduction
The recent passage of the Families First Prevention Services Act (FFPSA), which aims to
increase family support, mainly by bolstering services aimed at improving parental and caregiver
conditions (mental health, parenting skills, substance use treatment), provides an opportunity to
address many of the needs of families reported to the child protection system (CPS) prior to entry
into foster care (Stoltzfus, 2018). With half of children being reported to the CPS for allegations
of neglect alone, and three-quarters of maltreatment victims with confirmed allegations of
neglect (U.S. Department of Health and Human Services [USDHHS], 2021), a deeper
understanding of what neglect really means is essential to the allocation of services.
To date little is understood about the circumstances or family context in which a family
comes to the attention of CPS for allegations of neglect. Studies that have attempted to
understand these allegations have been limited by a CPS classification system which largely
classifies neglect into a few, if not a single, category. While studies that have categorized CPS
allegations of neglect into sub-types (i.e., supervisory neglect, physical neglect, environmental
neglect) are important in determining the needs of these children who come into contact with
CPS, they do little in identifying the underlying condition, family or parental need that may have
led to the omission in care. For example, numerous studies have determined that supervisory
neglect is one of the most frequently reported types of neglect (Dubowitz et al., 2005; Mennen et
al., 2010), however, often little explanation is given as to what may constitute supervisory
neglect and why it may be happening. While FFPSA allows for an opportunity to provide

69
services to families to prevent foster care entry, our ability to do this largely relies on our
understanding of the needs of the child, the caregiver, and the family as a whole (Mulder et al.,
2018).
The research into parental factors that may contribute to the risk of neglect is growing. To
date several risk factors have been associated with an increased likelihood of CPS involvement
due to neglect.
Substance Use
It is estimated that anywhere between 34 to 80 percent of children involved with CPS
have at least one parent with a known substance use problem (Barnard and McKeganey,
2004, Forrester and Harwin, 2006, Murphy et al., 1991, Young et al., 2009). Parents with
documented substance use disorders are more likely be rated as high-risk to their children and
have more significant levels of CPS involvement compared to parents without documented
substance use disorders (Murphy et al., 1991). Families with chronic neglect are significantly
more likely to have certain risk factors, including drug use; a sample of families with chronic
neglect found that substance use disorders were present in 85 percent of families (Jones &
Logan-Greene, 2016). The presence of substance use within the home is associated with a social
worker’s decision to substantiate allegations and to place children in foster care, indicating the
importance placed on substance use as a risk factor for potential harm to the child (Freisthler et
al., 2017).
Parental Mental Health
Evidence has shown a link between caregiver mental health and child maltreatment.
Studies have estimated that anywhere from 7 to 24 percent of CPS-involved families are affected
by caregiver mental illness (Mulder et al., 2018; Sedlak et al., 2010). Not only are parents with

70
mental health disorders more likely to be reported to CPS, but these families are more likely to
experience repeated contact and have more significant levels of CPS involvement (Kohl et al.,
2011; Zuravin & DePanfilis, 1997). Parental mental illness has also been positively associated
with child neglect and increases a family’s odds of chronic neglect by 88 percent, with 76
percent of families with chronic neglect also experiencing mental health concerns (Mulder et al.,
2018; Loman, 2006; Logan-Greene & Jones, 2017; Jones & Logan-Greene, 2016).
Domestic Violence
It has been estimated that between 10 to 26 percent of CPS involved families are also
alleged to engage in domestic violence (Alaggia et al., 2013; Victor et al., 2019; Rebbe et al.,
2021). There is also evidence that children who are exposed to domestic violence are at
heightened risk of experiencing other types of abuse as well, most notably physical abuse (Victor
et al., 2019). Domestic violence has also been found to be significantly related to child neglect
(O’Donnell et al., 2008; McGuigan & Pratt, 2001). While in California domestic violence
exposure is most frequently classified as emotional abuse, there is a large overlap between
reports of domestic violence and neglect, with over half of CPS investigations involving
domestic violence allegations also including allegations of neglect (Rebbe, 2021). While this
overlap is not well understood, it may be due to the perception that allowing children to witness
domestic violence is in and of itself abusive, a concept that can disproportionately blame the
non-offending parent for the abusive behaviors of the partner (Hartley, 2004; Kantor & Little,
2003).
Concrete Needs
While there is no one definition for neglect, almost all definitions include inadequate
food, shelter, or clothing as a failure to meet the basic needs of the child (Coohey, 2003). The

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inability or unwillingness to adequately meet these physical needs of the child is noted in
approximately 4% of neglect reports for White families and 11% of neglect reports for Black
families (Johnson-Reid et al., 2013). The overlap in child neglect, and specifically inadequate
food, clothing and shelter, and poverty is well established (Drake & Pandey, 1996; Johnson-Reid
et al., 2013; Sedlak et al., 2010), however the reason for this correlation is not well understood.
Numerous states stipulate that poverty alone cannot be used to intervene or remove a child from
their home, however, some studies have challenged state adherence to this, suggesting that in
some states reasons such as lack of housing were key factors in family involvement with CPS
(Child Welfare Information Gateway, 2019; Eamon & Kopels, 2004; Shdaimah, 2009).
Current Study
This exploratory, mixed methods study uses both structured and unstructured data fields
from administrative CPS records to better characterize parental and family needs among families
investigated for child maltreatment. The objective is to identify parental risk factors which may
have led to an allegation of child maltreatment, and to determine whether risks differ between
investigations for allegations of neglect compared to those with allegations of abuse. The
objectives of the study are (1) to document the prevalence of five key parental risk factors
(substance use, mental health, domestic violence, custody issues, and concrete needs) as recorded
in unstructured child protection screener and investigative notes, (2) to identify other categories
that are frequently noted in the CPS records concerning family or parental risk, and (3) to
explore how these parental and family risk factors differ by type of maltreatment alleged.

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Methods
Data
Data were extracted from the California Child Welfare Services/Case Management
System (CWS/CMS) which falls under the authority of the California Department of Social
Services. Data were available through a university-agency data sharing agreement that has been
approved by both state and university institutional review boards. The CWS/CMS system is used
to track all case records for children and families involved with CPS and includes several
components: intake, client information, system delivery, case management, court processing,
caseload, resource management, placement information, program management and adoptions.
Each component allows a for a social worker to record information using structured (pre-defined
categories) and unstructured (notes, case narratives, photos) data.
Unstructured Data
Unstructured case records from two components were used for this content analysis: the
screener narrative and the investigative narrative accompanying each selected record. The
screener narrative is documented by a child protection worker at the CPS hotline. The document
summarizes the presenting problem and includes information regarding the alleged incident
(severity, frequency, description of injury), child characteristics (demographics, special
circumstances (i.e. behaviors, health issues)), caregiver characteristics (demographics, special
circumstances (substance use, criminal record, mental health)), family characteristics
(environment, support systems), and abuse characteristics (domestic violence, medical care
needed) (Luna, 2001). The investigative narrative is documented by a CPS social worker and
occurs during an emergency response investigation. This document typically includes interview
summaries from reporter, child, and perpetrator, as well as records social, cultural or physical

73
factors associated with the family, information on child’s developmental needs, child’s level of
risk, history of past CPS involvement, case disposition, and reasoning for case disposition.
Structured Data
The structured fields in the CWS/CMS data are used to formally code demographic
characteristics of children and to classify allegations into one of four maltreatment allegation
types: neglect, emotional abuse, physical abuse, and sexual abuse. Neglect is classified as any
child with an allegation of general neglect, severe neglect, caregiver absence or incapacity, and
child at risk due to sibling abuse or neglect (Child Welfare Information Gateway, 2019).
Study Population
Records were used to identify all children with an investigated CPS report from January
1, 2017 to December 31, 2017 (N=357,597). One randomly selected focal child was identified
for each report. If that child had been reported more than once during the study time period, a
randomly selected report was chosen. A representative statewide sample from this population
was then randomly selected (N=500), and their screener and investigative records were
abstracted from the CWS/CMS. Of the 500 randomly selected reports, 79 did not have a
corresponding investigative narrative and therefore were excluded from the analysis. These 79
reports came from 12 counties which do not systematically collect information in a screener
narrative form. In order to confirm equivalence between selected and unselected CPS reports, a
series of chi-square tests were conducted across several characteristics (age, sex, allegation, and
disposition).

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Analysis
Content Analysis
A thorough review of the written material was conducted, followed by a sequenced set of
steps to categorize passages into predefined classifications. This was an iterative process that
required many passes of the narration and modifications to the codebook. This highly systemized
process reduced the influence of biases or assumptions of the reviewer. While seemingly rigid in
its systematic process of reviewing the data, content analysis allowed the reviewer to retain a
degree of flexibility. For this study the eight steps of conducting a content analysis outlined by
White and Marsh (2006) were followed: establish research questions, identify data, determine
sampling method and sampling unit, draw sample, establish data collection unit and unit of
analysis, establish coding scheme (building a coding frame), code data, check for reliability of
coding and adjust coding process if necessary, analyze coded data, write-up results (Appendix
B). This process was used to code both the screener and investigative narrative based on the
presence or absence of five predetermined parental risk factors, leaving open the possibility of
additional categories to be identified. Risks could be present in either the screener or
investigative narrative to be counted. After the unstructured narratives were coded, prevalence
rates are reported, overall, and by maltreatment type.
Parental Risk Factors
The five initially selected parental risk factors were parental substance use, domestic
violence, concrete need, parental cognition, and parental mental health based on existing
empirical data demonstrating their association with childhood neglect (Mulder et al., 2018;
Murphy et al., 1991; Victor, 2019). The codebook used to classify each risk was developed by
the author using the framework outlined by McQueen (1998). The codebook was revised and

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expanded during the analysis process, categories and definitions were adjusted as researchers
moved through the narratives. After the first 100 narratives were reviewed, the decision by the
author and two other researchers was made to remove one category, parental cognition, due to
lack of information contained in the narratives to make this determination. One additional
category, custody issues, was added due to the frequency with which the research team perceived
the risk to be present. The final five classifications included in the codebook were parental
substance use, domestic violence, parental mental health, concrete need, and custody issues
(Appendix C).
Defining Parental Risk Factors
Substance use was defined as alcohol or drug use by one or more caregiver as identified
by a police report (i.e arrests for driving under the influence), a positive toxicology report,
caregiver currently receiving services for substance use/abuse, someone in the position to know
reports that the caregiver has an alcohol or drug problem (i.e. medical or mental health
professional, spouse, child, friends or family, neighbor), or caregiver self-reports. Examples of
incidents where substance use was marked include “Mother reports that father has been drinking
excessively. The father often drinks and uses coke” and “The mother admitted to using and
testing positive for benzodiazepines and methamphetamine.”
Caregiver mental health was defined as poor psychological functioning identified by a
record of one or more of the following: a mental health diagnosis, prescription of a psychotropic
medication, caregiver is currently or has been in a psychiatric hospital within the past 12 months,
or a teacher, babysitter, family member or household member reports mental health concerns.
Mental health diagnosis or concern were recorded for the mother, father, or guardian. Adults
noted with a mental health concern who lived in the home but who were not the child’s caregiver

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were not identified in this category. Examples of statements which indicated caregiver mental
health, “Mother had a meeting with her provider and during that appointment she presented as
delusional and erratic…the mother was diagnosed with Schizoaffective disorder” and “witness
reports that mother is suicidal and that she has made threats that all she has to do is not take one
of her medications and it would kill her.”
Domestic violence was defined as any incident which occurred in the past 12 months
where an attempt to cause or actual cause of injury to a household member, including physical,
emotional, sexual or financial injury. The category was marked if any of the following were
noted in the narrative: police were called to the home for incidence of domestic violence, the
parent/caregiver reported that there is domestic violence in the home, one parent or caregiver is
in the hospital or incarcerated due the domestic violence incident noted in the current allegation,
someone in the position to know reports domestic violence in the home (child’s teacher,
counselor, babysitter, neighbor, family member). Examples of when a domestic violence
indicator was selected, “It was reported that the father “took down” the mother to the ground
and chocked her. It was noted that the child was in the bedroom and witnessed the incident” and,
“Child reports that the boyfriend gets into physical fights with the mother all the time and
strangles her.”
Concrete need was identified if it was reported by the caller or if it was noted by the
investigating social worker that there is a lack of food, clothing, shelter or other household
necessities including running water or electricity. Examples include: “It was reported (the child)
and mother are homeless and (the child) called her father stating she hadn’t had food or water”
and “At the time of investigation mother did not have gas or hot water.”

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Custody issues was defined as any conflict or fear of conflict, verbal or physical, between
parents or caregivers who do not reside in the same household. Custody issues was counted if
any of the following were noted in the screener or investigative narrative: police were called to
assist during conflict between non-cohabitating parents, parent or caregiver reports conflict or
fear of conflict with other parent or caregiver, child reports conflict or custody issues between
non-cohabitating parents, someone in the position to know reported violence or conflict between
non-cohabitating parents or caregivers, one parent or the investigating social worker notes that
parents do not get along or communicate well. For example, “CSW assessed that the parents
have a lot of family conflict with one another, especially over disagreements related to raising
child.” Another example, “Father began throwing pebbles at the living room window and
awakened the mother…father stated that he wanted to see his daughter. The mother stated that it
was too early and told father to return at 1pm. Father then threw two large rocks which broke
the window…and threw another rock which went through the screen and hit the mother in the
cheek.”
Results
Of the 421 randomly selected investigations, 76.0% were investigations that included
allegations of neglect, 26.8% for included allegations of emotional abuse, 33.7% included
allegations of physical abuse, and 7.4% included allegations of sexual abuse. Forty percent of
investigations were for allegations of neglect alone and 36.1% were for allegations of neglect
and at least one type of abuse (sexual, physical, emotional).
Parental Risk Factors
Table 4.1 outlines the frequency of parental risk factors identified in either the screener or
investigative narrative, overall and by those focused on investigations for allegations of neglect.

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Overall, 34.0% of all investigations included an allegation of substance use by one or both
parents or caregivers, 23.3% included allegations of domestic violence, 15.9% included a
concern for the parent or caregiver’s mental health, 13.1% included an indication of custody
issues, and 9.3% included an allegation of lack of attention to concrete need. Similar to the
overall proportions, for investigations of allegations of neglect parental substance use was the
most frequently identified risk factor (38.1%), followed by domestic violence (19.06%), custody
issues (16.25%), parental mental health (15.9%), and concrete need (11.88%). When tallied,
53.4% of all allegations and 54.1% of all investigations for allegations of neglect included one or
more of the following risks: parental substance use, domestic violence and parental mental health
concerns.
As noted above, investigations involving allegations of neglect indicated the presence of
substance use by a parent or caregiver in 38.1% of investigations. However, parental substance
use was more likely to be identified in investigations for allegations of neglect compared to
abuse. Where the presence of substance use among investigation for allegations of neglect was
nearly double that seen for sexual abuse (19.4%) and physical abuse (20.3%). Domestic violence
was most frequently identified in investigations for emotional abuse (62.8% of emotional abuse
investigations included an allegation of domestic violence). While concrete need numbers by
abuse type cannot be reported due to small cell sizes, this risk was predominately seen in
investigations which included allegations of neglect and was rarely (less than 10% of
investigations) identified in investigations for allegations of abuse. While concerns about
parental mental health accounted for larger percentages of emotional abuse allegations than
neglect allegations, it is important to note that due to the disproportionate number of
investigations for allegations of neglect the vast majority of families who had an indicator of

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parental mental health concerns were investigated for allegations of neglect. For example, of the
67 families identified with a parental mental health concern, 52 or 77.61% were investigated for
allegations of neglect, compared to 29 (43.3%) who were investigated for allegations of
emotional abuse.
Table 4.1

Frequency of each parental risk factor, overall and for investigations with
allegations of neglect. California, United States, 2017
All Allegations Neglect
num col% num col% row%
Total 421 100.00 320 76.01 76.01
Substance use 143 33.97 122 38.13 85.31
Domestic violence 98 23.28 61 19.06 62.24
Mental health 67 15.91 52 16.25 77.61
Custody issue 55 13.10 42 13.13 76.36
Concrete need 39 9.26 38 11.88 97.44

Secondary Risk Factors
Any risk factor that was indicated in more than 5% of investigations was also
documented. In 14.8% of investigations, parental or caregiver failure to protect the child from
abuse or domestic violence was indicated. In 10.5% of investigations, it was noted that the child
had a physical, developmental, or mental health diagnosis. In 5% of investigations, it was noted
that the child’s behaviors were a concern. Behaviors included: running away from home,
physical altercations with peers or siblings, child arrested or child using drugs or alcohol. And, in
6.2% of investigations it was noted that at least one parent had a history of CPS involvement as a
minor.

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Table 4.2

Frequency of secondary risk factors, overall and by investigations for
allegations of neglect. California, United States, 2017
All Allegations Neglect
num col num col%
Failed to protect from abuse or DV 62 14.76 59 18.44
Child mental/physical health problem 44 10.48 31 9.69
Child behaviors 21 4.99 18 5.63
History of CPS (parent as minor) 26 6.18 18 5.63

Other Risk Factors
Overall, 78.9% of investigations indicating at least one of the five parental risks or one of
the secondary risks. However, in 21.1% of investigations none of these indicators was identified.
Examples of ‘other’ risk factors that were identified among those with no other indicator present
were incidents such as: grandparent or other non-custodial household member has a severe
mental illness or substance use problem, physical or verbal altercations or conflict between
members in different households (i.e. “mother and uncle got in physical fight” or “parents do
not get along with neighbors and neighbor keeps reporting family to CPS”), parent or caregiver
no longer wishes to care for child (i.e. mother gave birth and informed hospital staff that she
does not want baby, grandmother states that she is “too old” to continue to care for
grandchildren), and parent or caregiver was not supervising child when child hurt themselves
(i.e. “child fell off the bed when father was not present in the room”).
Overlap in risks
Figure 4.1 outlines the count and percentage of investigations with concurrent parental
risks present. There was a large degree of overlap between substance use and all other risks. For
example, 48% of investigations where concerns of parental mental health were identified also

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included indicators of parental substance use. Similarly, 54% of investigations which identified
concrete need also identified substance use.
Table 4.3

Percentage of investigations with concurrent parental risks

Substance
Use
Domestic
Violence
Mental
Health
Custody
Issues
Concrete
Need
Substance Use 100% 26% 22% 16% 15%
Domestic
Violence 38% 100% 21% 12% "--"
Mental Health 48% 31% 100% 19% "--"
Custody Issues 42% 22% 24% 100% "--"
Concrete Need 54% "--" "--" "--" 100%

Note. "-" indicates cell size less than 11 and have been suppressed per
California Health and Human Services (CHHS) deidentification guidelines

Discussion
It is well understood that families with needs related to substance use, domestic violence
and mental health are more likely to have deeper and more consistent levels of involvement with
CPS (Barth, 2009). It is less understood, however, how these needs are captured by the CPS
system and what the relationship is between these “complex needs” and the type of maltreatment
classified. The objective of this study was to explore the parental and family needs documented
in investigations of child maltreatment and determine if these needs differed for families reported
for allegations of neglect compared to abuse.
In alignment with the literature at large, our findings indicated that substance use,
domestic violence and mental health are the most common parental risk factors among CPS
involved families, and aligns with the calls for mental health, substance use and domestic
violence services for families investigated by CPS (Barth, 2009; Child Welfare Information

82
Gateway, 2020, 2021). However, several other prominent risks were identified among CPS
families, as well as differences in parental risks for neglect versus abuse.
Over half of all investigations included parental concerns of substance use, mental health
or domestic violence. Substance use was the most common among families investigated for child
maltreatment, particularly among families investigated for neglect. An estimated one in eight or
12.5% of children nationwide live in a household where one or both parents have a substance use
disorder (Lapari et al, 2017). Results of this study suggest that one in three families investigated
by CPS are alleged to have parental substance use problems in the home. Prevalence is higher
among families investigated for allegations of neglect suggesting that many of the outcomes
associated with parental substance use are being captured as neglect (i.e. lack of food, housing or
supervision due to substance use).
Our study found only 15.9% of investigations overall and 16.3% of investigations for
neglect included an indication of the presence of parental mental health concern during the
screening or investigation. This is significantly less than other studies which estimate
approximately one in four caregivers investigated for alleged maltreatment have a mental health
concern (Burgess & Borowsky, 2010). This discrepancy is likely due to the differences in
methods, whereas other estimates included direct assessments of mental illness through
interviews and surveys with parents, this exploratory study depended on the disclosure of
diagnosis or report of mental health concerns to a CPS worker by a person observing the parent
or the parent themselves. This likely indicates that the mental illness captured in the investigative
process were the more severe cases, where symptoms were observable, hospitalization was
necessary, or where the parent was willing to disclose to the worker. This is supported by the

83
accounts described in the screener and investigative narrative. For example, “mother was
involuntarily hospitalized for the evaluation and treatment of her psychiatric condition.”
Looking at these risks as a function of what is being classified as neglect, we see that the
vast majority of families with indicators of substance use, mental health, custody issues, and
concrete need, or other risks such as child health, mental health or behavioral concerns are being
investigated as neglect (either alone or in concert with abuse). For example, 77.6% of the time
that parental mental health concern was present the family was being investigated for allegations
of neglect. Similarly, 85.7% of the times that a child behavior was identified as a risk the family
was being investigated for allegations of neglect. This suggests that the effects of many of these
risks are more likely to be classified as neglect compared to abuse. For example, the parent’s
mental health concern led to the inability of the parent to properly supervise the child (neglect),
versus the parents’ mental health concern caused serious emotional distress to the child (abuse).
Alternatively, these factors could be more frequently noted in investigations for allegations of
neglect due to actual versus threatened harm. Frequently in the records substance use was present
without any indication that the child had experienced physical or emotional harm due to the
substance use, therefore, it may be that it is easier to “fit” this family into the neglect category
where the threat of harm is sufficient criteria to intervene.
Similar to other studies, including study two of this dissertation, the family’s need for
concrete support to meet basic needs was among the risk least often identified in either overall
investigations or investigations for allegations of neglect (Dubowitz et al., 2005; Vanderminden
et al., 2019). A deeper look at the data found that concrete need was the only risk category noted
in less than 3% of all investigations, indicating that only a small fraction of the families
investigated are investigated for concrete needs alone. The majority of investigations during

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which concrete needs were identified as a risk co-occurred with other risks, most notably
substance use. This may indicate that a great deal of the allegations related to failure to meet the
basic needs of the child among CPS involved families are associated with parental substance use.
Since both poverty and substance use are intertwined, with substance use acting as both a risk
factor for and an outcome related to poverty (Conners et al., 2004; Knight et al., 1999; Leventhal
& Brooks-Gunn, 2000), the directionality is unclear. In other words, it is unknown whether the
parental substance use has led to the parents’ inability to meet the basic needs of the children or
if the family was living in poverty prior to the substance use. The authors of a 2008 systematic
review of substance use treatment among mothers involved with CPS suggested five components
that would increase treatment success, with one of them being concrete support and assistance.
Given that so many CPS involved families are low-income, providing services such a
transportation, childcare, and access, significantly decreased the amount of time families were
involved with CPS (Osterling & Austin, 2008). Additionally, it is well established that the vast
majority of children involved with CPS are from low-income families. Given early evidence that
poor children who are alleged victims of neglect fair worse in later developmental outcomes
compared with poor children with no such allegations (Font & Maguire-Jack, 2020), our results
could also indicate that the child protection system is capturing a subset of poor children who are
at particularly heightened risk due to multiple risks in addition to concrete needs. According to
Maslow’s (1943) hierarchy of needs, these basic or physiological needs must first be addressed if
we hope to see meaningful change. However, the CPS system historically has not been designed
nor situated within the community to address these concrete needs. Addressing such a complex
set of needs (concrete, substance use, mental health, domestic violence) will require a

85
collaborative community-based approach where the family can be treated as a whole starting
with meeting basic needs.
The fact that failure on the part of the parent or caregiver to protect the child from abuse
or domestic violence showed up in nearly one in five investigations for allegations of neglect is
not surprising. Study two of this dissertation found that failure to protect is present in 28.5% of
neglect investigations, however, what is unique to study 3 is that we chose to only focus on
failure to protect when it was in relation to the non-offending parent not intervening or being
perceived by the reporter or case worker to not sufficiently intervene when abuse or domestic
violence was occurring in the home. A subsequent look at the data found that one out of five
investigations which included domestic violence also included failure to protect by the non-
offending parent, and 20.4% of investigations for allegations of physical abuse included failure
to protect. Interestingly, in 48.4% of investigations for sexual abuse allegations, failure to protect
by the non-offending parent was noted in the narrative, suggesting a non-offending parent is
more frequently considered to be “non-protective” in instances of sexual abuse compared to
domestic violence or physical abuse. It is unclear to what degree this is due to the non-offending
parent not believing the child or the perception of the social worker that the parent did not do
enough to protect that child from harm. The high frequency with which you see failure to protect
in neglect investigations may partially explain some of the overlap between investigations that
include both allegations of neglect and abuse. In one out of every ten investigations for
allegations of neglect, the only parental risk factor identified was failure to protect the child from
the abuse or domestic violence. The degree to which a non-offending parent is responsible for
the abuse of a partner is debatable, with many domestic violence advocates arguing that

86
penalizing the non-offending parent minimizes the trauma of the survivor and ignores the
obstacles that they face in accessing services (Alaggia et al., 2007).
Another notable finding from this study was that 13% of all investigations identified
custody issues as being a concern. These included both incidences of violence between two non-
partnered parents, as well as other circumstances related to a high conflict separation or custody
arrangements, such as incidences where parents were continuously reporting each other for
alleged abuse against the other. Chronic, high conflict fighting between parents can have
detrimental and long-lasting effects on children (Ahrons, 2007), with an estimated 20 to 25%
experiencing serious psychological or social problems (Hetherington & Kelly, 2002). Due to the
consequences of these situations, it makes sense that CPS should investigate circumstances
related to high conflict custody issues, however, the circumstances by which many of these cases
are brought to the attention of CPS appear to be murky and unclear, often including
circumstances where it is difficult to decipher whether one parent is fabricating allegations or
not. While more research is needed in exploring the context and circumstances of families who
come into contact with CPS due to custody issues, given the detrimental effects of such
situation’s, services should be offered to these families (Barnwell, 2016).
Limitations
Although this study has many strengths, including the use of a novel data source, and the
randomized selection process, several limitations exist. While the randomized selection provides
the ability to generalize results within the state of California, it is unknown to what degree these
results can be generalized outside of California. Similarly, the laws, policies and procedures
around what constitutes child maltreatment (i.e. domestic violence, parental substance use) varies
by state (Child Welfare Information Gateway, 2019) also limiting our ability to generalize

87
outside of California. Additionally, this study is limited to the information captured by the social
worker in written CPS records occurring within counties that may have differing practices and
cultures. While it is plausible that cross counties differences may arise, chi-square tests did not
detect any differences in age, race, allegation types, or disposition decisions between
investigations included and not included.
Administrative records provide an accessible and cost-effective source of data for
researching child maltreatment, but most analyses have been confined to information collected in
structured fields. This study provided an opportunity to better understand the information already
being collected by tapping into the unstructured data fields rarely used in maltreatment research.
This information adds to our knowledge by providing context to allegations of ‘neglect’ by
documenting parental behaviors and family risk factors critical to understanding the underlying
factors associated with neglect. With the recent passage of the FFPSA which redirects CPS
dollars to focus on prevention, including services aimed at helping the parent or caregiver,
understanding these underlying risks that have led to an allegation of neglect can aid
administrators in planning and directing funds to the kinds of services needed by families coming
to the attention of CPS. Importantly, FFPSA funds are only designated for families at imminent
risk of foster care. The majority of families reported to CPS will not experience substantiated
allegations (and therefore may not be eligible for these services). However, results of this study
demonstrate that the vast majority of families investigated by CPS are experiencing one or more
of these serious risk factors, meaning that these families (with or without substantiated
allegations) are in need of mental health, domestic violence, substance use and other services.
Not providing or connecting these families with such services could forecast more serious
problems down the line including more frequent and significant levels of contact with CPS, and

88
increased chances of children moving from one system to the next (i.e. from CPS to juvenile
justice).

89
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CHAPTER 5
Conclusions, Implications and Future Directions
Major Findings

This dissertation sought to extend the literature by unpacking “neglect” to better
understand CPS allegations of neglect by triangulating differing methodologies and datasets.
Structured as a three-paper project, the dissertation aimed to explore the prevalence, risk factors,
and the circumstances of allegations of neglect from the perspective of the child, the family and
the child protection system (CPS). Secondarily, it sought to examine whether sociodemographic
and parental risks associated with neglect are distinct from abuse. Key findings from each
chapter are discussed below:
Chapter two (study 1) used linked birth and CPS records to examine the prevalence of
neglect allegations and sociodemographic risk factors among a cohort of children born in
California in 2000. Children were identified using birth records and then prospectively followed
using CPS records through the age of 18. Results showed that nearly one in four (24.0%)
California children born in 2000 had a record of at least one CPS report for allegations of
neglect. One in ten children had experienced reports of neglect alone (without any allegations of
abuse) and 13.5% had experienced allegations of both abuse and neglect during their childhood.
Several sociodemographic and birth factors were identified as increasing the risk of reports for
allegations of neglect. Children born to mothers 19 years and younger, mothers who did not
complete high school, mothers who received late (3
rd
trimester or later) or no prenatal care,
children born with public health coverage, children who were not first born, and children who
did not have established paternity at birth were more likely to be reported for both neglect alone
and co-occurring neglect and abuse. Interestingly, when examining differences between children

96
with reports of neglect versus abuse, there appeared to be a graded relationship to each
sociodemographic risk. While children who experienced each of these sociodemographic risk
factors were more likely to be reported to CPS for any reason, they appear to place a child at
higher risk for experiencing reports of neglect than for abuse. Additionally, when risks were
tallied, there was a positive dose-response relationship, with the likelihood that the chances of a
report of neglect increased with each increase in the number of risks. However, this same dose
response trend is not seen for children reported for abuse alone, with a relatively consistent
number being reported regardless of the number of risks present. These results are important as
they both document the commonality of reports for allegations of neglect and suggest that
neglect allegations may be more closely tied to poverty related factors compared to abuse. It also
demonstrated that children reported for allegations of abuse and neglect may be a particularly
vulnerable population whom extra attention should be paid, especially given that more than one
in ten California children fall into this category.
Chapter three (study 2) used CPS administrative records, including indicators from
associated child abuse hotline assessment tools, to examine children reported to CPS in 2017
through 2019. This study focused on identifying the child concerns being reported for allegations
of neglect and examined which concerns predict substantiation. Results showed that the most
frequently reported concerns were for inadequate supervision and failure to protect. While
families experiencing these risks were less likely to be substantiated or placed in foster care, the
two risks alone still accounted for nearly 40% of all children placed in foster care. Families
reported for inadequate care (lack of food, shelter, clothing or health care) were the least likely to
be substantiated or placed in care. This is particularly interesting given that the these are the

97
foundations of the definitions of neglect created just after the passage of CAPTA in 1974 and
used by states to determine what constitutes neglect.
Chapter four (study 3) used the unstructured data fields from CPS records to explore the
family and parental risk factors identified in investigations for allegations of neglect. Using the
screener narrative (collected at the child abuse hotline) and the investigative narrative (recorded
during an investigation) to conduct a content analysis, this study identified five frequently
recognized parental risks and four less frequently reported child or family level risks. Substance
use was found to be the most frequently identified parental risk present in all maltreatment
investigations but was seen twice as frequently in investigations for allegations of neglect
compared to investigations for allegations of physical or sexual abuse. Not only was substance
use the most frequently documented parental risk, it also frequently co-occurred with other risks.
Similar to study two, results of study three indicate that reports based on family inability to meet
concrete needs were not common, and reports where the only risk was based on concrete needs
were even more rare (<4%), with most families reported with a lack of food, clothing or shelter
also had co-occurring parental risks, most notably substance use.
Implications for Policy and Practice
Several important implications emerged from this work:
First, allegations of neglect are a common occurrence for California children. While this
is a large number of children, it is also likely that it is an underestimate of the true prevalence of
child neglect, as typically CPS is only called in the more severe instances of child neglect. Given
this high prevalence and grave threat that neglect poses to a child’s lifelong health and well-
being, understanding how to reduce the occurrence of neglect should be a major public health
concern. Using the public health approach provides an opportunity to address neglect across a

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prevention continuum, taking into account known risk factors for neglect. Primary prevention
efforts, including universal maternal and child health services, aimed at increasing child and
family wellbeing from birth are imperative in decreasing incidents of neglect. Given the
enormous overlap between poverty and neglect, public welfare programs which support meeting
families’ concrete needs could reduce child neglect cases by supporting basic needs so families
can address the secondary but critically important factors that may have brought them to the
attention of CPS, such as substance use or mental health issues. Families identified as being at
heightened risk of contact with CPS, including the children identified in this and other studies
(i.e. children born to young mothers, mothers with no high school diploma, born into low-income
families, and no established paternity), could be directed into secondary prevention programs
such as the Nurse Family Partnership, which has been shown to decrease the risk of child abuse
and neglect (Olds et al., 1997). Increased access to specialized interventions such as those
focused on substance use disorder, domestic violence and parental mental health issues could
also be an important aspect of prevention, reducing entry into and long-term involvement with
the child welfare system, especially programs which take into account the well-being of the
children within the family (O’Donnell et al., 2007). Even with a robust array of primary and
secondary prevention programs, there will likely always be a need for tertiary efforts, such as
those with which CPS is currently engaged. Tertiary prevention includes quickly assessing risk
and making a determination on the best ways to intervene to protect the child, whether it is in-
home monitoring or out of home placement. While all of these families could likely benefit from
intensive intervention, many, if not most, of these families will not be referred to specialized
services (Palmer et al., 2020). Increasing access to services across all three levels will be

99
necessary to decrease the frequency with which children are reported to CPS for allegations of
neglect.
Second, while all families associated with CPS have heightened rates of
sociodemographic and family risks, neglect appears to be more directly influenced by these
factors. However, reports identifying a lack of food, shelter or clothing, were infrequent, and
significantly less likely to be substantiated or result in removal. This is particularly interesting
given that these are the foundations of the definitions of neglect created by most states after the
passage of CAPTA (Rebbe, 2019; Rose & Meezan, 1993). This disconnect between how neglect
is defined and what is actually being captured through allegations of neglect may be confusing to
parents who find themselves confronted with the presence of CPS in their lives due to “neglect.”
While studies have suggested that there is a general consensus across cultures on what may
constitute basic needs (Polansky et al., 1987; Polansky & Williams, 1978), there is less of an
understanding of what is considered protective care or appropriate supervision. When allegations
have little to do with omissions in providing for a child’s basic needs, is it fair to assume that the
parent should have known what CPS deems to be the proper level of protection or supervision?
Clarifying the definition or perhaps separating the different types of neglect, as well as
promoting a broad public understanding of neglect could help clarify when a report for neglect is
necessary, help parents understand their responsibilities, and draw attention to the conditions that
may contribute to what is considered “neglectful” parenting.
Additionally, allegations of parental inability to meet the concrete need of their children
rarely occurred alone, almost always co-occurring with other risks, most notably with substance
use. While there remains debate over whether neglect is “simply poverty” or how the CPS
system is being used in impoverished communities, results of this dissertation suggest that while

100
economically disadvantaged families are more likely to be reported to CPS, most have an
indication of risk in addition to economic need. While this does not negate the fact that most
families reported to CPS, especially those reported for allegations of neglect, are low-income, it
does suggest that the families who receive CPS intervention (i.e. investigation, substantiation,
placement) may be a particularly vulnerable subset who are at particular risk due to the presence
of multiple risk factors.
Third, there is a clear need for services for families investigated by CPS. Each of the
three studies in this dissertation outlined heightened risk among families reported and
investigated for child maltreatment. These families are more likely to be socioeconomically
disadvantaged compared to the general population, and they have more child, parent and family
risk factors present in the home. These findings support calls for services to be offered to all
children and families who come to the attention of CPS, not just to those at imminent risk of
foster care. Providing services, the first, or each time a family comes into contact with CPS could
help to reduce the risk of worsening problems and decrease subsequent involvement with CPS.
This is particularly true for families reported for allegations of neglect. With a large number of
these families presenting to CPS with concerns of parental substance use, domestic violence,
mental health concerns, and custody issues, and given CPS’s mandate to protect children from
imminent danger, CPS may not be well situated to address these concerns alone. Rather building
a community’s capacity to engage, assess and serve these families would help to increase child
and family well-being and prevent future CPS involvement. The current system of waiting until a
child has been confirmed as a victim of abuse or neglect is too late, CPS must broaden its
approach to protecting children by constructing a prevention continuum, serving families from
the hotline all the way through reunification.

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Implications for Research

Findings from these studies helps to clarify what is being reported when CPS receives or
investigates allegations of neglect. However, these results also highlight several factors that
remain unknown. First, there are two categories that were frequently identified among families
with neglect allegations that are not well understood: failure to protect and custody issues. A
clearer understanding is needed about when a non-offending parent’s lack of action in protecting
a child from domestic violence or abuse is or should be defined as neglect. While it is understood
that a child who is not believed when disclosing sexual abuse can have a harmful impact on the
child’s emotional health (Lovett, 2004) much less is known about the effects of a non-offending
parents’ failure to intervene in cases of physical or psychological abuse.
Second, results provided some evidence that the official CPS category of general neglect
may be used as a “catch all bucket” to classify allegations that do not appear to fit neatly into any
other category. While 20% of neglect allegations did not have any of the primary or secondary
risks identified, there were at least 20 different situations or risks that occurred among that 20%
that were classified under neglect but did not occur frequently enough to be classified as its own
risk. For example, “mother allows adolescent daughter’s boyfriend to stay the night” or “child
wrote a school paper about killing other people.” Additionally, the majority of neglect
investigations appeared to be for “threats” of harm as opposed to actual harm (as evidenced by
the numbers of general neglect vs severe neglect and by the distinction between when an
allegation of parental mental health was deemed neglectful vs emotional abuse). Further research
is needed to evaluate this assumption.
Third, while it is well understood, and findings from this dissertation again underscored,
that substance use, mental health and domestic violence are endemic within the CPS system, it is

102
unclear how successful the system has been at addressing these issues. A 2020 report looking at
CPS service referrals determined that less than half of families who had a family maintenance
case opened were referred for community-based services. Whether the lack of referrals is due to
availability, case worker awareness, or other factors is unknown. However, what is clear is that
these families, having a substantiated allegation and a case opened, are in need of services.
Future research should focus on the lack of connection to services among CPS involved families.
Conclusion

This dissertation provided insight into the complexity of neglect by identifying specific
sociodemographic, child, parental and family risks associated with allegations of neglect. While
the literature on neglect has grown exponentially since Wolock and Horowitz (1984) proclaimed
that neglect was being neglected, there is still confusion as to what classifies neglect and who is
responsible, which has hampered our ability to truly understand the associated risks, responses,
and outcomes. Given the variation in how neglect is defined, screened, investigated and what
specific needs and risks are being captured in allegations of neglect, in addition to the lack of
alignment in system response, discerning what should be done to address neglect remains
unclear. Regardless, it is my hope that this work will contribute to the ongoing conversation on
neglect and encourage a deeper look at how neglect is being used and addressed by the child
welfare system.

103
References

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O'Donnell, M., Scott, D., & Stanley, F. (2008). Child abuse and neglect—is it time for a public
health approach?. Australian and New Zealand journal of public health, 32(4), 325-330.
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Palmer, L., McCroskey, M., Lane Eastman, A., Rebbe, R., Guo, L. & Foust, R. (2020). Los
Angeles County family-centered services: Using administrative data to understand the
landscape of community-based child welfare supports.
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Polansky, N. A., Chalmers, M. A., Buttenwieser, E., & Williams, D. (1978). Assessing
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Work, 23(5), 397-401.
Rebbe, R. (2018). What is neglect? State legal definitions in the United States. Child
maltreatment, 23(3), 303-315.
Rose, S. J., & Meezan, W. (1993). Defining child neglect: Evolution, influences, and
issues. Social Service Review, 67(2), 279-293.

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Wolock, I., & Horowitz, B. (1984). Child maltreatment as a social problem: the neglect of
neglect. American Journal of Orthopsychiatry, 54(4), 530.

105
Appendices

Appendix A

Reporter Concern derived from SDM

VARIABLE DEFINITION VALUE
Diagnosed Malnutrition
Diagnosed malnutrition
yes,no
Non-organic failure to thrive
Non-organic failure to thrive
yes,no
Child's health/safety is endangered
Child's health/safety is endangered
yes,no
Death of child due to neglect
Unexplained and/or suspicious death of a child and
there are other children in the home
yes,no
Inadequate food
Inadequate food
yes,no
Inadequate clothing
Inadequate clothing
yes,no
Inadequate shelter
Inadequate/hazardous shelter
yes,no
Inadequate supervision
Inadequate supervision
yes,no
Inadequate medical/mental health care
Inadequate medical/mental health care
yes,no
Caregiver absence
Child has no parent or guardian capable of providing
appropriate care
yes,no
Failure to protect
Failure to protect
yes,no
Involving child in criminal activity
Involving child in criminal activity
yes,no
Prior failed reunification, new child
Prior failed reunification or severe neglect, and new
child in household
yes,no
Allowing child to use alcohol or other drugs
Allowing child to use alcohol or other drugs
yes,no
Prior death due to neglect, new child
Prior death of a child due to neglect AND there is a
new child, of any age, in the home yes,no
Prenatal substance use
Prenatal substance abuse
yes,no
Other high-risk birth
Other high-risk birth
yes,no
Domestic violence
Child exposed to domestic violence yes,no

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Appendix B

Content Analysis Process

1) Deciding on a research question: This study has 2 primary research questions where
content analysis will be used:
a) What is the prevalence of five key parental risk factors (substance use, mental health,
domestic violence, custody issues, and concrete need) as recorded in unstructured child
protection screener and investigative notes?
b) What other information can be gleaned from CPS records concerning the nature of a
neglect allegation?

2) Identifying appropriate data: Unstructured case records pulled from the CWS/CMS system
CPS records will be used for this analysis

3) Determining sampling method and sampling unit: To obtain a representative sample of
investigated CPS reports, investigated CPS reports will be randomly selected from the
entire population of CPS reports.

4) Draw a sample: 500 randomly sampled reports were identified. Case records were pulled
from CWS/CMS for the selected individuals. Chi2 tests were conducted to ensure no
differences between selected and unselected reports (age, sex, allegation, disposition, and
county).

5) Establish data collection unit and unit of analysis. Two documents from the CPS case
records will be examined; the screener narrative and the investigative narrative (Central
California Training Academy, n.d,).
• Screener narrative is documented by a child protection worker at the CPS hotline. The
document summarizes the presenting problem and includes information regarding the
alleged incident (severity, frequency, description of injury), child characteristics
(demographics, special circumstances (e.g. behaviors, health issues)), caregiver
characteristics (demographics, special circumstances (substance use, criminal record,
mental health)), family characteristics (environment, support systems), and abuse
characteristics (domestic violence, medical care needed)
• Investigative narrative is documented by a CPS social worker and occurs during an
emergency response investigation, this document typically includes interview
summaries from reporter, child, and perpetrator, a social, cultural or physical factors
associated with the family, information on child’s developmental needs, child’s level of
risk, history of past CPS reports and involvement, reasoning for case disposition.

6) Building a coding frame. Codebook was developed using Codebook Development for
Team Based Qualitative Analysis (McQueen, 1998). Categories were chosen based on
existing empirical data demonstrating the association between the four key risk factors and
childhood neglect. This codebook will be revised and expanded, adding or adjusting
categories and definitions as researchers move through the narratives. See appendix C

107
7) Code Data. First, five reports representing each of the key parental risk factors will be
independently coded by 2 researchers to test the codebook developed in step 5. Second,
five reports which do not meet the criteria for any of the five parental risk factors will be
evaluated and discussed by both researchers, additional categories will be added if
necessary, additional reports will be reviewed until saturation has occurred. During this
step the codebook will be revised and refined as needed and additional reports will selected
and coded to ensure agreement on the appropriate classifications and definitions. Nvivo
will used to categorize and code the screener and investigative narratives.

8) Check for reliability of coding and adjust coding process. This step is to ensure
consistency between coders. Material is formally segmented by the inherent structure of
the screener and investigative narrative form. Two researchers will independently code 10
screener and investigative narratives. Validation efforts will include two coders reaching
an inter-rater agreement of 0.75.

9) Analyze coded data.

10) Presenting and interpreting the findings.

108
Appendix C

Codebook for Identifying Key Risk Factors

Risk Factor Definition When to use When not to use Example
Substance Use
Substance use by
one or more
caregivers in the
home
(1) One or both parents receiving services or were referred
for drug or alcohol abuse treatment
(2) Had a child who tested positive for drugs at birth
(3) The parent self-reported having a problem with drugs or
alcohol
(4) Someone in a position to know (child, neighbor, teacher,
helping professional) reported that the parent had a
substance abuse problem
(5) Police record (DUI, possession of controlled substance)
If substance use
charge/arrest is only
indicator and it was
more than 1 year prior
to report
Police records search
indicated past SU
arrests and/or charges
(within 1 year of
report)
Domestic
Violence
Attempting to cause
or causing bodily
injury to a family or
household member
or placing a family
member by threat of
force in fear of
imminent physical
harm
(Childwelfare.gov)
(1) Police were called to the home for domestic violence
(2) One parent or caregiver has a restraining order against
the other parent/caregiver
(3) The parent self-reported domestic violence in the home
(4) One parent or caregiver currently in a shelter or hospital
due to domestic violence
(5) Someone in a position to know reported domestic
violence issues in the home
When the domestic
violence occurred
more than 12 months
ago AND the
caregivers no longer
live together
Mother reported that
father became angry
and shoved her against
a wall
Mental Health
Poor psychological
or emotional well-
being
(1) One or both parents received services or were referred
for mental health treatment (including psychiatric
hospitalization)
(2) The parent self-reported having a mental health diagnosis
(3) A mental health or health provider reported concerns of
mental health issues
(4) A family member reports that the parent or caregiver has
a mental illness
(5) The parent or caregiver is taking a prescribed
psychotropic medication
When mental health is
not related to a direct
caregiver (living with
part or full time)
Paternal grandmother
reports that father is
acting erratically and
"not making sense"
Concrete Need
Family does not
have resources to
provide for the basic
needs of the child
(1) Insufficient food, shelter or clothing
(2) Home does not have electricity or running water
(3) Family cannot afford appropriate childcare
Home is uncleanly
where mental health or
substance use is
present
Teacher reports that
child comes to school
hungry daily and states
that he does not have
any food at home
Custody Issues
Conflict between
non-cohabitating
parents (or
caregivers)
(1) Police were called to assist during conflict
(2) Parent/caregiver self-reported conflict with other parent
(3) Child reports custody issues/conflict
(4) Someone in a position to know reported
violence/conflict/custody issues between caregivers/parents
When parents are
living together, still
married or otherwise
together romantically
Child reports that
parents will often
verbally or physically
fight during child
custody exchanges
Other
Other risk factors
that are not
mentioned above
When the reviewer feels that the circumstances provides
important context to the neglect allegation. Examples
include:
- child acting out and parents unable to address behaviors
- child has a known physical, developmental, behavioral or
emotional problem
- parent arrested and no one else to provide for child

Parent reports teenage
daughter runs away
overnight and does not
respond to appropriate
consequences
*Codebook Development for Team Based Qualitative Analysis (McQueen, 1998)

Abstract (if available)

Abstract Child neglect is the most frequently reported and substantiated type of maltreatment in the United States and accounts for a disproportionate amount of child protection system (CPS) resources. Historically, neglect has been overlooked in place of research focused on childhood physical and sexual abuse. Yet, as other forms of reported maltreatment have declined while rates of neglect have not, a growing body of literature has sought to understand the risk factors and outcomes of neglect. Efforts have often been hampered, however, by ambiguous definitions, with opposing views on whether neglect should be defined from the vantage point of the child or the caregiver. While child-centered definitions of neglect, including physical neglect, educational neglect, medical neglect, psychological neglect, and others serve to better document the effects of specific neglect-related maltreatment, it can often obscure the underlying threat or family need. Meanwhile, the caregiver-centered definition focuses on the omission of care and often places blame on the caregiver with little thought to contributory environmental factors. The debate over how to conceptualize neglect is especially challenging within the parameters of CPS, which operates on a victim-perpetrator continuum, making it difficult to overlook a caregiver’s intention while also acknowledging the large overlap with poverty-driven risk factors. Further complicating CPS’s classification of neglect are legal statutes and social application that vary by jurisdiction. With vague empirical, legal, and social definitions of neglect it has become increasingly clear that there is no unified understanding of how to identify and in turn address childhood neglect. ? The purpose of this dissertation is to gain a deeper understanding of the use of “child neglect” as an official classification of child maltreatment by CPS by exploring formal allegations and substantiations of childhood neglect. The objective is to generate knowledge that will guide child protection policy and prevention efforts. This dissertation is organized as a three-paper project that will triangulate various methodologies and differing data sources to examine the dynamics of neglect. ? Study 1: Linked Administrative Data ? While the literature suggests that children who are reported to CPS differ from children who are never reported, less is known about the sociodemographic markers of risk for exposure to different types of maltreatment. Using linked CPS and birth records, Study 1 first identifies the lifetime risk of CPS allegations of neglect, and second, explores whether risk factors for neglect are meaningfully distinguished from abuse. Multinomial logistic regression models are used to examine if children who are reported to CPS for allegations of neglect have distinct sociodemographic risks from children who experience abuse allegations or a combination of abuse and neglect allegations. ? Study 2: Structured Data Analysis ? Despite the disproportionate number of families who experience investigations for allegations of neglect, little is understood about what specific concerns are being reported and how these concerns may factor into the decision to substantiate or place a child in foster care. Using CPS administrative records, including indicators from associated risk and safety assessment tools, Study 2 focuses on identifying the specific concerns being documented at the child abuse hotline when a family is reported for an allegation of neglect. Next it examines which of these concerns may predict substantiation or placement into foster care. The frequency of each reported concern is reported. A series of generalized linear models will be used to test the association between reported concerns and the odds that neglect allegations are substantiated or children are placed in foster care. ? Study 3: Unstructured Data Analysis ? Building on Studies 1 and 2, Study 3 uses the unstructured administrative data to explore the family context of neglect allegations. A content analysis of 500 randomly selected children who were referred for alleged child maltreatment in 2017 is used to explore family- and parent-level risks identified during the screening and investigations for allegations of neglect. Unstructured data was accessed from the screener narrative (gathered at hotline call) and investigative narrative (gathered during the investigation stage) accompanying each selected record. Records will be coded based on the presence or absence of five risk factors: parental substance use, domestic violence, parental mental health, concrete need, and custody issues. A fifth category will be left open-ended to allow for the discovery of other frequently noted risk factors identified within the narratives. After the unstructured narratives have been coded, overall prevalence rates of identified risks are reported and differences between risks associated with neglect versus abuse are explored.

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Asset Metadata

Creator Palmer, Lindsey (author)

Core Title Understanding allegations of childhood neglect using structured and unstructured administrative data

School Suzanne Dworak-Peck School of Social Work

Degree Doctor of Philosophy

Degree Program Social Work

Degree Conferral Date 2021-08

Publication Date 07/19/2021

Defense Date 05/20/2021

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag child maltreatment,child protective services,OAI-PMH Harvest

Format application/pdf (imt)

Language English

Advisor Mc Croskey, Jacquelyn (committee chair), Margolin, Gayla (committee member), Prindle, John (committee member), Putnam-Hornstein, Emily (committee member), Rebbe, Rebecca (committee member)

Creator Email lnpalmer@icloud.com,lnpalmer@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC15611961

Unique identifier UC15611961

Legacy Identifier etd-PalmerLind-9796

Document Type Dissertation

Format application/pdf (imt)

Rights Palmer, Lindsey

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

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