A Comparison of Methods for Estimating Child Maltreatment Rates: Evaluation Approaches for a Child Maltreatment Prevention Initiative

Shayala Williams, MPH Katherine Rosanbalm, PhD Christina Christopoulos, PhD Kenneth A. Dodge, PhD

Background and Goals The Durham Family Initiative (DFI) began on January 1, It uses an ecological approach with an overarching goal of reducing the incidence of child maltreatment in Durham County, North Carolina by 50% within a decade. Official DSS reports of child maltreatment are widely believed to be biased and to underestimate the true prevalence of child maltreatment, so we sought supplementary methodologies to measure DFI’s success. Two experimental methodologies, a neighborhood survey and a survey of professionals, were implemented to measure maltreatment rates from the perspectives of those who have close contact with children. The goal of this study was to compare these methodologies and present the advantages and disadvantages of each one.

The Neighborhood Survey The neighborhood survey was an in-person, door-to-door survey conducted between April and December of The survey design called for a stratified random sample based on income and population. All block groups in Durham County with 50 or more households were stratified into six clusters based on income level and population size, with the first cluster representing the most impoverished block groups and the sixth cluster representing the most affluent. The goal was to complete at least 25 interviews in each cluster. The survey contained sections intended to measure self- and neighbor- reported incidence of several types of negative and positive parental behaviors, including negative behaviors that could be classified as maltreatment.

The Neighborhood Survey Parenting Items Neighbor-Reported Parenting Items –Respondents were asked to report on several parental behaviors based on their own observations of a neighboring mother of a 4-, 5-, or 6-year old child during the previous 30 days. Self-Reported Parenting Items –The self-reported parenting items were self- administered and handed to the interviewer in a sealed envelope upon completion in order to maintain respondent anonymity. –The youngest child in the household between the ages 1-10 was the focus of the self-reported parenting items. Only the responses for target children ages 4-6 are used in this analysis for comparison with the neighbor-reported items and the official rates for children ages 4-6 in Durham County.

The Neighborhood Survey Respondent Characteristics

The Survey of Professionals The survey of professionals was conducted between November 2004 and January This mail and internet-based survey was conducted anonymously so that professionals could answer frankly without fear of any consequences. The study design called for a random sample of professionals in Durham County stratified by profession. Surveys were sent out to 1,686 professionals in Durham County who come into contact with children and families on a regular basis and are likely to have some experience with decisions about the detection and reporting of child maltreatment. Data were weighted so that each profession counted equally in analyses.

The Survey of Professionals Response Rate

Survey Results: Maltreatment Items

Comparison of Baseline Rates Across Sources

Advantages/Limitations of Each Method MethodAdvantagesDisadvantages Official RatesData are readily available, least expensive surveillance method. Only a fraction of cases are reported to authorities, changes in social awareness or state guidelines may impact the rate of reports and substantiations. Neighborhood Survey Self-Report High response rate, sampling methodology makes results generalizable to entire county, collected anonymously. Expensive and time consuming to conduct, must take care to assure respondents’ anonymity. Neighborhood Survey Neighbor-Report High response rate, results are generalizable to county, neighbor reporter may be more honest than in self-reports. Expensive and time consuming to conduct. Survey of Professionals Relatively inexpensive to conduct, anonymous. Low and inconsistent response rate across professions, only applicable to those children seen by professionals, does not provide a point prevalence.

Conclusions While just over one percent of children aged 4 to 6 years old in Durham County received a substantiation for maltreatment by DSS, 55% of neighborhood survey respondents reported witnessing a nearby mother of a 4- to 6-year-old behave in a manner consistent with maltreatment, and 49% of respondents reported behaviors towards their own 4- to 6-year-old consistent with maltreatment. Professionals reported that over a third of children they encountered while working had been maltreated by a primary caregiver. Consistent with other studies, the self, neighbor, and professional reported rates of child maltreatment found in our surveys are many times higher than the official substantiated rates. Official rates underestimate the rate of child maltreatment in Durham County. Neighborhood and professional surveys may be useful supplemental data for research on the fluctuation of child maltreatment rates over time.

Future Directions The neighborhood and professional surveys will be repeated, allowing us to compare changes in rates over time among the methods. This will give us more information on the validity of each method. Collection of official statistics from the DSS Data Warehouse is ongoing and will be supplemented with: –Collection of information on all Emergency Room visits by children in Durham County with certain diagnostic codes. –Collection of various child well-being indicators from the community such as infant mortality rates, percent of low birth weight infants, and percent of children involved in early intervention services.

For More Information: Shayala Williams, MPH Statistician Office: (919) Center for Child and Family Policy Duke University Box Durham, NC