A California Case Study Emily PutnamHornstein PhD University of Southern California Barbara Needell PhD University of California at Berkeley 3 rd Annual State of Health Care Conference ID: 152749
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Linking Records to Advance Child Protection:
A California Case Study
Emily Putnam-Hornstein, PhD
University of Southern California
Barbara Needell, PhD
University of California at Berkeley
3
rd
Annual State of Health Care ConferenceSlide2
background
California Child Welfare Indicators Projectlongstanding university/agency partnershiplongitudinal configuration of state’s child protective services datatechnical assistance to California counties & stateconsultation services to other state child welfare agenciespublicly available website for tracking outcomes and performance indicators (interactive queries)
data available for research…Slide3
In 2011, more than 6 million children were referred for possible maltreatment in the United States; nearly 700,000 were substantiated as victimsEstimated lifetime cost of child maltreatment is $124 billion each year
(Fang, et al., 2012)A growing body of research indicates that children who experience abuse or neglect are at heightened risk of adverse health outcomes, including:Obesity, cancer, strokes (Felitti, et al., 1998)Teen pregnancy (Noll & Shenk, 2013)Self-injurious behaviors (Rhodes, et al., 2013)What we know (National)Slide4
What we know (California)Slide5
What we do
Birth
Maltreatment
Referral
Investigation
Services
CPS involvementSlide6
a “snapshot” of Maltreated Children
beforeCPS Data
afterChildren not Reported for MaltreatmentSlide7
Moving away from data silos…
birth datadeath data
p
opulation-based information
child protective service records
before
CPS DataafterChildren not Reported for MaltreatmentSlide8
record linkages 101
File AFile B
SSN
SSN
First Name
First Name
Middle Name
Middle Initial
Last Name
Last Name
Date of Birth
Date of Birth
Address
Zip Code
d
eterministic match
probabilistic matchSlide9
linked dataset
birth records
LINKED DATA
birth
cps contact
birth
no cps contact 4.3 million514,000cps recordsSlide10
expanded information
vital birth records
population-based informationchild protective service records
California Birth Cohort
Child A
Child B
Child CChild DReferral by Age 5Slide11
“Risk factor”: a term used in epidemiology to define a characteristic that is either directly or indirectly
associated with risk of disease or other adverse health outcomesStable / Fixed at birth (e.g., male gender is a risk factor for injury)Time varying – developing through exposure to adversities in the social or physical environment This information can be used to identify individuals/groups/communities particularly vulnerable to a given adverse outcome in order to strategically target prevention and intervention programs and policiesLanguageSlide12
b
irth record variablesSlide13
selected findings…
14% of children in birth cohort were reported to CPS by age 5Lower bound estimate…could not match 16% of CPS records Cumulative rate of CPS involvement 3x higher than single year estimates suggest11 of 12 variables were significantly associated with CPS contactCrude risk ratios >2 were observed for 7 variablesContact with CPS is hardly a rare event for certain groups
34% children without paternity established25% of children born to teen mothersSlide14Slide15Slide16Slide17
an epidemiologic risk assessment tool
? (“back of the envelope” calculations…)We classified as “high risk” any child with three or more of the following (theoretically modifiable) risk factors at birth:late prenatal care
(after the first trimester)missing paternity<=high school degree3+ children in the familymaternal age <=24 yearsMedi-Cal birth for a US-born
motherThink of this as a means of “sorting” children – looking for proxy indicators that give us additional information about an infant’s likelihood of referralSlide18
Risk assessment toolsSlide19
administered at birth?
Full Birth Cohort
Children Reported to CPSSlide20
recognizing the risk associated with the presence of multiple risk factors…
High Risk on Every Modifiable Risk Factor: 89%
probability of CPS reportLow Risk on Every Modifiable Risk Factor: 3% probability of CPS reportSlide21
Concluding thoughts…
Data that are universally collected at birth can be used to identify those children that are at greatest risk of later CPS involvement Compared with the demographics of the birth cohort as a whole, these young children are defined by the presence of multiple risk factorsA standardized assessment tool can never replace more comprehensive assessments of a family’s strengths and risks, but against an invariable backdrop of limited resources, the ability to prioritize investigations and adjust levels of case monitoring in order to meet the greater needs of a targeted swath of at-risk children and families has the potential for cost-savings to be realized, while also improving child
well-beingSlide22
“Each person in the world creates a Book of Life. This Book starts with birth and ends with death. Its pages are made up of the records of the principal events in life. Record linkage is the name given to the process of assembling the pages of this Book…” (Dunn, 1946)
Record LinkagesGovernment
University Partners
Ongoing CollaborationSlide23
Questions?ehornste@usc.edu
bneedell@berkeley.eduhttp://cssr.berkeley.edu/ucb_childwelfare/ Slide24
Thank you to our colleagues at the Center for Social Services Research and the California Department of Social Services
Ongoing support for research arising from the California Performance Indicators Project and related activities is generously provided by CDSS, the Stuart Foundation, and Casey Family Programs
Record linkages funded by the Harry Frank Guggenheim Foundation, the Conrad N. Hilton Foundation, and First 5 LA
Acknowledgements