Opportunities for Prevention & Intervention in Child Maltreatment Investigations Involving Infants in Ontario Barbara Fallon, PhD Assistant Professor Jennifer Ma, MSW Doctoral Student

Outline Introduction to Ontario Incidence Study (OIS) Profile of young children and their caregivers in the OIS Current service provision patterns Intervention opportunities Prevention strategies

Ontario Incidence Study Core objectives: – Determine rates of investigated and substantiated maltreatment – Document forms and severity of maltreatment – Examine selected health determinants – Monitor short-term investigation outcomes – Compare rates and characteristics across cycles (93, 98, 03, 08) Specific to OIS-08 – Distinguish maltreatment incident investigations and risk assessments

OIS-2008 Sample

* = oversampling provinces

Methodological Considerations Limited to reports investigated by child welfare Information collected directly from investigating child welfare workers No post-investigation follow-up Not designed to evaluate services Methodological changes across cycles Weighted annual estimates, percentages, incidence of maltreatment

Home Visiting Programs in Ontario Healthy Babies Healthy Children (delivered by Ontario’s 37 public health units) Phone calls to every new mother shortly after the baby is born offering information and a home visit Screening/assessment for pregnant women, all new mothers, and for families with children up to age six

Research Literature Infants are most often referred to a child welfare agency by professionals, with health professionals being the most common referral source followed by police (Williams et al., 2003; Palusci, 2011). Caregiver functioning concerns, including substance use, lack of social support, parental mental health issues, young parenthood and domestic abuse are risk factors for infant maltreatment (Harden and Klein, 2011; Zhou & Chilvers, 2010; Wu et al., 2004; Putnam-Hornstein & Needell, 2011).

Study Objectives Examine the decision to provide child welfare services to infants identified to the child welfare system using a Canadian provincial data set. Identify and understand the importance of key clinical factors in the decision to provide ongoing child welfare services to infants and their caregivers to inform effective practice and policy.

Child Maltreatment Related Investigations Involving Infants

Referral Source for Infant Investigations

Rate of Infant Investigation in 2008

Type of Child Maltreatment Related Investigations Involving Infants in 2008

Primary Caregiver Concerns in Infant Investigations

Child Functioning Concerns in Infant Investigations

Household Concerns in Infant Investigations

Summary 23% of investigations referred from hospitals 22% of investigations referred from police 21% of investigations referred from non-professional referral sources 17% of investigations referred from community or social services. 45% of infants are identified to the child welfare system for a concern about their future welfare 34% of their primary caregivers were identified as victims of domestic violence 42% of households with infants have moved within the past year 6% of infants have positive toxicology at birth

Multivariate Analysis Four main types of referrals: hospital, police, non-professional, community or social services Classification analysis Examining the relationship of clinical predictors to service provision

Closed 42% Opened 59% Caregiver Cognitive Impairment Chi-Square = 18.88*** Noted 24%Not Noted 76% Closed 9% Opened 91% Closed 52% Opened 48% Caregiver Victim of Domestic Violence Chi-Square = 16.45*** Noted 20%Not Noted 56% Closed 64% Opened 36% Closed 18% Opened 82% Caregiver Few Social Supports Chi-Square = 7.64** Not Noted 38% Noted 18% Closed 42% Opened 58% Closed 74% Opened 26% Transfers to Ongoing Services Among Hospital Referred Investigations

Closed 64% Opened 36% Caregiver Few Social Supports Chi-Square = 4.68* Not Noted 72%Noted 28% Closed 70% Opened 30% Closed 48% Opened 52% Transfers to Ongoing Services Among Police Referred Investigations

Closed 57% Opened 43% Caregiver Drug/Solvent Abuse Chi-Square = 9.68** Noted 24%Not Noted 76% Closed 29% Opened 71% Closed 65% Opened 35% Caregiver Few Social Supports Chi-Square = 6.46* Not Noted 50% Noted 26% Closed 46% Opened 54% Closed 75% Opened 25% Transfers to Ongoing Services Among Non-professional Referred Investigations

Closed 56% Opened 44% Caregiver Mental Health Issues Chi-Square = 16.33*** Noted 40%Not Noted 60% Closed 29% Opened 71% Closed 74% Opened 26% Caregiver Age Chi-Square = 9.98** > (36%) < = (24%) Closed 50% Opened 50% Closed 90% Opened 10% Transfers to Ongoing Services Among Community or Social Services Referred Investigations

Conclusion Large % of risk cases Functioning of the caregiver is the strongest determinant of child welfare involvement Rapid increase in infant cases speaks to effective early identification of high risk cases and an opportunity to promote caregiver resiliency and prevent maltreatment What interventions need to be targeted by whom to these families? North American child welfare continues to be driven by case finding, the challenge of providing effective services remains Home visitation raises concerns in cases where domestic violence is present