Vulnerability within families headed by teen and young adult mothers investigated by child welfare services in Canada - HPCDP: Volume 35-8/9, October/November 2015

Volume 35 · Number 8/9 · October/November 2015

Young mothers were more likely than those aged 22 or older to have risk factors, including alcohol and drug abuse, cognitive impairment, and having few social supports, noted by the investigating child welfare worker (Table 2). Teen mothers were more likely than young adult mothers to have these risk factors noted. Mothers in all three groups were equally likely to be assessed as having mental health issues and being victims of domestic violence. Mothers aged 22 or older were more likely to be reported as having physical health issues. Young mothers were more likely to have had a history of foster care or living in a group home (31% among teen mothers and 23% among young adult mothers) compared with 10% for mothers aged 22 or older. Having multiple risk factors was more common among young mothers; 3 or more risk factors were noted among 30% of teen mothers and 29% of young adult mothers compared with 23% of mothers aged 22 or older.

In families where a secondary caregiver lived in the home (Table 3), this was most often the biological father (61% for teen mothers, 69% for young adult mothers and 77% for mothers aged 22 or older). The grandmother was the second most common secondary caregiver for teen-mother families (25%) and a stepfather/partner of the mother in families with a young adult mother (13%) and families with a mother aged 22 or older (17%). Secondary caregivers in families with a young mother were more likely to have risk factors noted by the child welfare worker including alcohol and drug abuse, cognitive impairment, having few social supports and/or having a history of living in foster care/group home. In all cases, secondary caregivers in teen-mother families were more likely than those in families with a young adult mother to have these risk factors noted. Secondary caregivers were equally likely in all family types to be reported as having mental and physical health issues. More than one-quarter (27%) of secondary caregivers in teen-mother families had 3 or more risk factors reported, compared with 23% for secondary caregivers in families with a young adult mother and 14% in families with a mother 22 years or older.

Children in families with a teen mother were more likely to be subjects of risk investigations than those in families with a mother aged 22 or older (31% vs. 17%; Table 4). Substantiation of risk investigations was equally likely among the three family types. Although children in teen-mother families were less likely to be subjects of maltreatment investigations compared with children in families with a mother aged 22 or older, maltreatment was equally likely to be substantiated. Children in families with a teen or young adult mother were more likely to be investigated for neglect while children in families with a mother aged 22 or older were more likely to be investigated for physical and sexual abuse. The same relationship was observed when the analysis was restricted to families where the child was two years old or younger (data not shown).

Emotional maltreatment investigations were more common among families with a young adult mother compared with children with mothers aged 22 or older (18% vs. 15%). Exposure to intimate partner violence was less likely to be investigated among children with a teen mother (20%) than children with a mother aged 22 or older (29%), while this type of investigation was more likely for children with a young adult mother (33%). The same relationship was observed when the analysis was restricted to families in which there was a biological father or mother's intimate partner living in the home (data not shown). For all five individual maltreatment types, substantiation of investigated maltreatment was equally likely to occur for children in the three groups of families (Table 4).

Among families where the youngest child was substantiated for maltreatment, a child welfare worker was more likely to refer those with a young mother (teen or young adult) than those with a mother aged 22 or older for use of a parent support group and in-home family or parent counselling (Table 5). Referrals for welfare or social assistance were more common for teen-mother families, and medical and dental services for families with a young adult mother. Referrals for domestic violence services were less likely for families with a teen mother. The same pattern (approximately equal domestic violence referrals for young adult mother and comparison mother families; fewer for teen mother families) was seen when the analysis was restricted to families in which there was a biological father or mother's intimate partner living in the home (data not shown). Family members in all three groups were equally likely to be referred for drug or alcohol counselling, food bank or shelter services, and psychiatric/psychological services.

Among families with a young mother where alcohol or drug abuse were noted for either the mother or the secondary caregiver, less than one-third were referred for drug or alcohol counselling (26% for teen-mother families, 29% for families with a young adult mother, 31% for families with mother aged 22+). Among families with young mothers where mental health issues were noted for either the mother or the secondary caregiver, less than one-quarter were referred for psychiatric/psychological services (19% for teen-mother families, 24% for families with a young adult mother, 23% for families with mother aged 22+) (data not shown).

As part of the investigation, children in families with a teen mother were more likely to be physically examined by a physician or nurse than children in the comparison group. Out-of-home placement of the child during the investigation was more common among families with a young mother (teen or young adult) than in families with a mother aged 22 or older (29% and 27% vs. 17%). Families with a teen mother were less likely to have police involved in an adult domestic violence investigation, and this relationship was maintained when the analysis was restricted to families in which a biological father or mother's intimate partner was living in the home (data not shown). All three groups were equally likely to have police involvement in a child maltreatment investigation.

Discussion

The members of families investigated by child welfare services are at high risk of experiencing violence, mental health and substance abuse issues, and other difficulties. In this pooled sample of high-risk Canadian families identified in 2003 or 2008, we analyzed, by mother's age, risk-related variables in the following domains: household, child and family characteristics; mothers' and secondary caregivers' risk factors; services referred and used. Within all domains, an age gradient was evident, with families with the youngest mothers most at risk. However, there was no clear evidence of a mother's age gradient with regard to types of substantiated maltreatment, and the relationship between mother's age and intimate partner violence was complex.

Unlike other samples, in which younger couples are more inclined to report violence than are older couples,^{Footnote 14Footnote 15} the youngest mothers in this child welfare sample were not more likely to have been victims of domestic violence. We suggest that this finding was not due to the presence or absence of an intimate partner but rather because another adult was present in the home, most common situation in the teen-mother families. Although the potential for violence in teen-mother intimate partnerships may be high, the presence of another adult may reduce the expression of violence between intimate partners.

The age gradient for one risk factor for mothers was particularly strong: 10% of mothers aged 22 years and older had a noted or suspected history of living in foster care or a group home; this was the case for more than 20% of 19- to 21-year-old mothers and for more than 30% of mothers younger than age 18 years. A significant but weaker age gradient was seen for secondary caregivers. Time spent in foster care or a group home suggests a childhood history of maltreatment. The links between a history of maltreatment and early parenthood have been previously explored.^{Footnote 16-18}  Using data from a longitudinal sample of 1000 American adolescents observed since 1988, Thornberry et al.^{Footnote 19}  found that their maltreatment while growing up (including witnessing severe domestic violence) was a risk factor for a substantiated report of their maltreating a child before age 33 years. Precocious transitions to adulthood (i.e. living with a partner before age 19; becoming a parent before age 20) were associated with a fourfold increased risk of committing maltreatment in this mostly male sample.^{Footnote 19} 

Thus, for the young mothers and the secondary caregivers described in this sample, personal histories of childhood maltreatment may be associated with both their early parenthood and their involvement with child welfare services. An early intervention program with young mothers like the one in this sample may be more efficient, more cost-effective and less stigmatizing than child welfare interventions that, by definition, can only occur once someone has become concerned and made a report to child welfare services.

A gradient by mothers' age was seen in noted alcohol or drug problems, with the youngest mothers and the secondary caregivers in families with young mothers most likely to have these problems. But referrals to drug/alcohol counselling were equally likely in the groups. It is possible that the mothers and secondary caregivers in young families should be more often referred for such services. However, it is also possible that they are not referred more often because they are already enrolled or because needed services are not available in their communities in ways that are accessible to these young families.

Our study has implications for exploring potentially unmet service needs and how to best address them. In addition, our analysis also has implications for potential diversion of families from initial child welfare involvement. Successful diversion from child welfare involvement would involve prevention of initial child maltreatment, and, ideally, prevention also of risk factors that might lead to referrals to child protection. Given that the youngest mothers may have multiple needs and stresses that would make it difficult for them to reach out to community supports and services, programs intended to prevent maltreatment may need to be proactive in reaching mothers at risk. Mothers who are able to reach out to support services (e.g. to bring their infants to a drop-in centre) may differ in important ways from mothers who most need support services.

Over two decades of follow-up in the United States has shown that the Nurse-Family Partnership (NFP) program reduces a variety of poor outcomes, including maternal and child mortality.^{Footnote 20} NFP is an intensive program of home visiting in which specially trained public health nurses work with first-time young mothers, beginning prenatally and ending at the child's second birthday.^{Footnote 21} All NFP mothers consent to enrol and, within this voluntary framework, each is actively engaged by her nurse. Randomized controlled trials in the United States demonstrated that the NFP reduces state-verified reports of child maltreatment^{Footnote 22} and risk factors for child maltreatment.^{Footnote 21Footnote 23} A randomized controlled trial of NFP is currently underway in British Columbia to determine if NFP is effective within a Canadian context.^{Footnote 24} As a complement to the randomized controlled trial, the Public Health Agency of Canada has commissioned a process evaluation to understand how and why the NFP succeeds, or fails, within different contexts within British Columbia.

Compared to other families involved in child welfare, families with young mothers are more likely to demonstrate risk factors that can be modified by an intervention programs. Young mother families have needs that, if an effective intervention had been delivered to them sooner, might never have become so pressing that child welfare services needed to become involved. Fallon et al.^{Footnote 10} noted that ongoing service provision following a child protection investigation was more likely for young mothers, and provision of such services has costs. Future work may usefully explore the cost benefit ratio (in terms of both financial and human costs) of targeted early provision of prevention services to families most at risk, versus later provision of child welfare intervention services. Early interventions to support young mothers dealing with substance abuse and mental health issues may not only avoid future child welfare investigations but also result in long-term health benefits to the mothers. Such information may prove useful to anyone considering whether or not a program is cost-effective to implement.

Strengths and limitations

Because women's reproductive history was not assessed in the CIS, a limitation of these analyses is that some of the mothers aged 22 years and older may have been teen mothers at an earlier phase of their lives. We were not able to examine characteristics of families in which the mothers were once teen mothers. As well, the measure of socioeconomic status available in this data set was limited, and our analyses could not consider potential effects of social and cultural support for early childbearing on the risk factors assessed in the CIS. In addition, we assumed that simple random sampling was used to select the sample; this assumption likely means that we have underestimated the variance in our estimates.

A strength of our research is that the comparison group we used for teen and young adult mothers involved with child welfare services was other mothers involved with child welfare services. In addition, we made the groups as similar as possible by restricting analyses to families with young children. Young mothers involved with child welfare services may be very different from young mothers described in surveys representative of the general population. In terms of young mothers' use of alcohol, for example, data from 2005-2008 indicate that mothers in the 20- to 24-year age group (the youngest available) are as or less likely than older mothers to report alcohol consumption during pregnancy (8% vs. an average across all available age groups of 11%).^{Footnote 3} In contrast, many of the young mothers in the sample we used were noted for alcohol abuse problems. Understanding the needs of these young families is enhanced by comparing them with a group that is involved with child welfare services, rather than the general population.

References