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Preventable Injury Deaths : A Population-Based Proxy of Child Maltreatment Risk. Emily Putnam-Hornstein, PhD Center for Social Services Research University of California, Berkeley. background. Maltreated children known to child protective services. - PowerPoint PPT Presentation
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Preventable Injury Deaths:A Population-Based Proxy of Child Maltreatment Risk
Emily Putnam-Hornstein, PhDCenter for Social Services ResearchUniversity of California, Berkeley
background
Maltreated children not known to child protective services
Maltreated children known to child protective services
motivation• CPS: a racially biased sample of
maltreated children?
• a population-based metric of child maltreatment risk / child welfare service needs
• implications for how and where we intervene to reduce racial disparities…as well as what our short-term expectations should be
this study• uses data from two public surveillance systems as
a means of assessing bias in one source (CPS data), using the more complete data found in the other (vital injury death records)
• exploits variations in injury fatality rates as a means of quantifying bias in the racial distribution of maltreatment victims identified by CPS
• hypothesized that racial variability in excess injury death would be observed, but absent widespread bias on the part of CPS, consistent counts of substantiations for each excess death
child injury deaths
A mortality-based standard for evaluating parental behavior may be the closest we can get to “culture-free” definitions of neglect and abuse. (S.R. Johannson, 1987)
why all injury fatalities?• maltreatment-related, inflicted injuries are
severely undercounted in death records– cannot capture racial bias in one data source, using
another source potentially corrupted by the same bias
• unintentional and intentional child injury fatalities are falsely dichotomized – the outcome is the same – unintentional injury fatalities are largely preventable,
occur in the home, frequently reflect inadequate caregiving and supervision (i.e., neglect), accompanied by the same risk factors as intentional injury deaths
datainjury mortality
rates
maltreatment rates
population estimates
death statistical master files
substantiation records
bridged-race postcensal est.
year, age, race/ethnicity, manner/mechanism of death
year, age, race/ethnicity, maltreatment substantiations
year, age, race/ethnicity
maltreatment rates (per 1,000) &injury death rates (per 100,000)
020
4060
020
4060
0 1 2 3 4 0 1 2 3 4
White
Black
Hispanic
Asian/PI
Death Rate Substantiation Rate
Rat
e
Age
* Native American children excluded due to small cell sizes.
21.6 per 1,00018.8 per 100,000
20.7 per 1,00016.9 per 100,000
62.8 per 1,00045.5 per
100,0007.0 per 1,00012.3 per 100,000
excess injury deaths• rates of excess (or preventable) injury mortality
were derived based on the difference between each racial group’s rate of injury death and that of an achievable baseline
semi-arbitrary achievable death rate
excess deaths
??
Since, by its very definition, the “achievable death rate” is the upper bound estimate of some unknown fraction of injury deaths that were actually unavoidable…two other baselines were also considered.
4.5
18.5
14.9
4.0
4.0
8.2
0 10 20 30
All
Native American
Black
White
Hispanic
Asian/PI
Achievable Death Rate Excess Death Rate
excess injury deaths
substantiations per excess death
• it was posited that in the absence of widespread substantiation bias on the part of CPS, consistent numbers of substantiated cases for each excess death would be observed across racial groups
• differences in the number of substantiations per excess death were treated as an indication that CPS had substantiated a racially biased sample of the full population of children at risk of maltreatment / in need of child welfare services
definition:the number of substantiated cases of maltreatment for every injury death in excess of a specified baseline rate
substantiations per excess death
0 100 200 300 400
Asian/PINative American
HispanicBlackWhite
Asian/PINative American
HispanicBlackWhite
* Asian/PINative American
HispanicBlackWhite
Excess Death defined as > 4 injury deaths per 100,000
Excess Death defined as > 6 injury deaths per 100,000
Excess Death defined as > 8.2 injury deaths per 100 000
Number of Substantiations per Excess Death
* Excess death rate is equal to 0.
summary• established an “achievable” baseline
rate of injury death– computed rates of excess death– alternative baselines set at 50% and 75% of
this rate
• computed the corresponding number of substantiated allegations of maltreatment associated with each excess death
findings• findings from this population-level
analysis align with other recent research suggesting that racial disparities in rates of substantiated maltreatment arise from real group-level differences in risk
• per excess death, Black and Native American children had rates of substantiated maltreatment that were equivalent to or lower than White children
qualifications and limitations
• ecological analysis – racial bias unlikely to operate on such a large scale as to explain
observed disparities• method for determining how many injury deaths are
preventable– relied on a rate of death that was achieved, findings held under
alternative specifications• baseline rates of random deaths may differ due to
non-parental risk factors– excluded transportation-related deaths, findings held
• variation in the timeliness and/or quality of medical interventions to prevent death– research suggests most injury fatality victims are declared dead
prior to arrival at ER/hospital
conclusions?• to date, efforts to reduce racial disparities have
been oriented around an understanding that the overrepresentation of Black and Native American children among victims of maltreatment originated from CPS system and worker bias
• efforts to reduce racial disparities will continue to fall short if intervention strategies ignore the social and economic factors that place some children at far greater risk of abuse and neglect than others
[email protected]://cssr.berkeley.edu/
cwscmsreports/Thank you to my colleagues at the
Center for Social Services Research and the California
Department of Social ServicesSupport for this and other child
maltreatment/mortality research was provided by the HF Guggenheim Foundation. Ongoing support
for research arising from the California Performance Indicators Project is generously provided by the California Department of Social Services and the
Stuart Foundation.