Faculty Bibliography

Identifying families with increased risk and preventing child neglect recurrence are important goals for the child protection system and the public health priority to mitigate Adverse Childhood Experiences (ACEs). While much has been studied about the factors leading to neglect, less is known about the specific factors contributing to neglect recurrence after CPS investigation. We used Child Files from FY2015-2020 in the National Child Abuse and Neglect Data System and the Neglect and Prevention Policies Dataset to first describe recurrence and then to identify the contributions of child, family, report characteristics, state neglect definitions, and CPS post investigation service referrals. We found that confirmed child maltreatment of all types most often recurs as neglect, but there are also significant proportions of children who have a second confirmed report with the same type of maltreatment. There are significant associations with neglect recurrence for exposures at all levels of the socioecological model including some child, family and report factors, and more state definitions are associated with more confirmed neglect recurrence. The effects of race were blunted when adjusted for family financial factors. Some post-investigation services were associated with decreased neglect recurrence, but most were not. CPS agencies and states can look for certain case characteristics and provide services to reduce neglect recurrence.

Harsh parenting and intimate partner violence increased during the pandemic. However, pediatrician-led evidence-based models that link primary care, home visiting, and child maltreatment prevention have been neglected, despite C. Henry Kempe's successful programs from 1971 to 1973. The Kempe randomized trial included comprehensive pediatric follow-up by a single physician and a lay health visitor whenever indicated, and/or weekly visits by a public health nurse in the home 50 years ago. The interventions responded to abnormal parenting practices and early warning signs during pregnancy, labor and delivery, and postnatally and reduced the hospitalization for serious injuries among those 2 years old. The Kempe trial was not cited in many publications but only 402 times in Google Scholar in October 2023. Kempe's call for promoting emotional health and parent bonding 40 years ago was echoed in the American Academy of Pediatrics"™ Bright Futures and Policy Statements on Promoting Relational Health in 2021. Relational health is a strengths-based approach, which can promote safe, stable, and nurturing relationships, buffer adversity, and build resilience. Screening for relational health should be integrated into Obstetric and Pediatric Care, and home visitation should become linked to primary care as a basic health benefit. Pediatric care must be transformed based on the evidence in the Kempe trial, focus on promoting primary prevention and trusted relationships from pregnancy on, and engage community resources to address unmet social needs, enabling integrated behavioral health, and changing financial incentives that now prioritize procedures and crisis interventions over cognitive services and prevention. The education and training of future pediatricians needs to emphasize the importance of relational health in the family, and the moment is now to collaborate and implement these forgotten interventions.