Disadvantaged neighborhoods and the spatial overlap of substantiated and unsubstantiated child maltreatment referrals

Abstract

Background

Considerable debate exists on whether the substantiation decision is a reliable measure for rates of maltreatment. Studies have shown that risks among children victims of maltreatment versus children investigated but unsubstantiated are similar.

Objective

This paper aims to respond to two research questions: (1) Do most child maltreatment referrals, substantiated and unsubstantiated, come from the same neighborhoods? (2) Do substantiated and unsubstantiated referrals share the same neighborhood risk factors?

Participants and settings

We used geocoded data from substantiated (n = 1799) and unsubstantiated (n = 1638) child maltreatment referrals in Valencia, Spain (2004–2015). As the neighborhood proxy, we used 552 Census block groups. Neighborhood characteristics analyzed were: socioeconomic status, immigration concentration, residential instability, and public disorder and crime.

Methods

To study the geographical overlap of child maltreatment referrals, a Bayesian joint modeling approach was used. To analyze the influence of neighborhood-level characteristics on risk, we used a Bayesian random-effects modeling approach.

Results

For substantiated child maltreatment referrals, 90 % of the total between-area variation in risk is captured by the shared component, while for unsubstantiated child maltreatment referrals, the shared component was 88 %. The correlation between substantiated and unsubstantiated risks of child maltreatment referrals was .80. These risks were higher in neighborhoods with low levels of socioeconomic status, higher immigrant concentration, public disorder and crime.

Conclusions

Child maltreatment referrals, regardless of whether substantiated or unsubstantiated, overlap in the same disadvantaged neighborhoods. This suggests that in these neighborhoods, families are at a higher risk of being investigated by child protective services suggesting a potential reporting bias.

Introduction

Child maltreatment is a public health issue with detrimental consequences for victims. Children who are victims of maltreatment are more likely to have behavior problems including aggression (Cullerton-Sen et al., 2008), depression (Arata, Langhinrichsen-Rohling, Bowers, & O’Farrill-Swails, 2005), anxiety (Li, D’Arcy, & Meng, 2016), social and relational issues (Romano, Babchishin, Marquis, & Fréchette, 2014), and problems in school and academics (Romano et al., 2014). These challenges often translate into lasting issues that occur out into adulthood, with victims being more likely to struggle with issues of economic insecurity and unemployment (Currie & Widom, 2010), and justice system involvement (Mersky, Topitzes, & Reynolds, 2012). Although difficult to measure due to varying definitions and systems for dealing with the issue, child maltreatment is a significant problem across the globe. The World Health Organization (2019) estimates that one in four adults were physically abused as children and that 12 % of children are sexually abused each year. According to a Spanish official report, 47,493 minors had contact with the national child protection system in 2017, a rate of 5.7 per 1000 children across the country (Observatorio de la Infancia, 2018).

In Spain, child maltreatment concerns are reported to the child protection system and are then screened and investigated by trained child protection workers. After conducting a thorough investigation of the alleged child abuse or neglect, the child protection worker then decides whether there is sufficient proof to conclude that the maltreatment occurred. This decision is referred to as the “substantiation decision.” Allegations in which insufficient proof exists are deemed “unsubstantiated” meaning that there is no conclusion that the maltreatment occurred. When sufficient proof exists, the allegation is deemed “substantiated,” which indicates that the child protection worker has concluded that the maltreatment did occur.

Considerable debate exists within the child maltreatment field on whether the substantiation decision is a reliable metric for rates of maltreatment. Studies have shown that risks and outcomes among children who were deemed victims of maltreatment versus children who were investigated but unsubstantiated are similar (Gracia, 1995; Hussey et al., 2005).

Although existing research has examined the similarity of both types of referrals at the individual level, no research has examined whether the risk of substantiated and unsubstantiated child maltreatment also overlap in the same neighborhoods. Additionally, while some research has examined the neighborhood risks for substantiation (e.g., Freisthler, 2004; Freisthler, Midanik, & Gruenewald, 2004; Freisthler, Needell, & Gruenewald, 2005; Irwin, 2009), such studies have not examined the risk for investigations that were unsubstantiated. Studies examining neighborhood risks and investigated maltreatment (Maguire-Jack, 2014a) do not allow for comparisons between substantiated and unsubstantiated cases. Understanding whether substantiations and unsubstantiations occur within the same neighborhoods is important, because if both occur within the same neighborhoods, then neighborhood-level interventions targeting those areas may be a cost-effective approach to reduce child maltreatment and improve child outcomes. Further, receiving an investigation but having such allegations deemed unsubstantiated can be an intrusive and difficult experience for families. Given the findings that unsubstantiated cases have similar risks and outcomes of families with substantiated cases, understanding the neighborhood risk factors related to such outcomes is key for informing intervention efforts.

Demographic characteristics of neighborhoods, including neighborhood poverty, rates of residential instability, ethnic heterogeneity, and childcare burden (e.g., ratio of adults to children) are commonly studied under a social disorganization framework (Coulton, Korbin, & Su, 1999; Sampson, Raudenbush, & Earls, 1997; Shaw & McKay, 1942). Across studies with multiple measures of both economic disadvantage and child maltreatment, varying statistical methods, and diverse samples, researchers have repeatedly found a relationship between neighborhood poverty and child maltreatment (Gracia, López-Quílez, Marco, & Lila, 2017; Maguire-Jack, 2014b). The other factors are more tenuous and less understood, with some studies finding a relationship between residential instability and maltreatment (Irwin, 2009), ethnic heterogeneity and maltreatment (Gracia et al., 2017; Molnar, Buka, Brennan, Holton, & Earls, 2003), childcare burden and maltreatment (Coulton et al., 1999; Merritt, 2009), but others finding no such relationship. Crime and social disorder have also been linked to child maltreatment (Coulton et al., 1999; Gracia & Herrero, 2006; Morris, Marco, Maguire-Jack, Kouros, Im et al., 2019; Morris, Marco, Maguire-Jack, Kouros, Bailey et al., 2019). Studies examining the spatial distribution of child maltreatment have found that these risk factors tend to be concentrated in certain neighborhoods, where children and families experience a higher risk of child maltreatment (Gracia et al., 2017; Morris, Marco, Maguire-Jack, Kouros, Im et al., 2019, Morris, Marco, Maguire-Jack, Kouros, Bailey et al., 2019).

Although prior research has found a link between neighborhood conditions and substantiated maltreatment (Freisthler, 2004; Freisthler et al., 2004, 2005; Irwin, 2009), it remains unknown whether such neighborhood conditions are also related to unsubstantiated maltreatment referrals. Research has documented similarities in family-level risk factors for and outcomes of substantiated and unsubstantiated cases (Gracia, 1995; Hussey et al., 2005). However, it remains unknown whether there are common neighborhood-level risk factors for substantiated and unsubstantiated cases. Such information is critical for understanding whether examining neighborhood factors and child maltreatment reports (without specifying whether substantiated or not, such as in Maguire-Jack, 2014b) is appropriate, and is needed to inform the usefulness of neighborhood-level intervention efforts. The current study explores substantiated and unsubstantiated cases in the city of Valencia, Spain, with two specific aims. First, we sought to understand the spatial patterns of substantiated versus unsubstantiated cases of child maltreatment in Valencia. We hypothesized that both substantiated and unsubstantiated child maltreatment referrals would share the same spatial patterns. The second aim was to analyze and compare the neighborhood-level variables related to risk for substantiation and unsubstantiation. The same spatial models were performed for both substantiated and unsubstantiated cases of child maltreatment, in order to assess whether the same contextual variables are related to higher risk of child maltreatment referrals.