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Linking Records to Advance Child Protection: Linking Records to Advance Child Protection:

Linking Records to Advance Child Protection: - PowerPoint Presentation

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Linking Records to Advance Child Protection: - PPT Presentation

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

birth risk children cps risk birth cps children child california data records maltreatment information record services cohort indicators contact

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Slide1

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 mothersSlide14
Slide15
Slide16
Slide17

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