Rumor of neglect ups risk of later maltreatment for kids

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When child protective services receives a report of neglect of a child with a disability, even when the report is unsubstantiated, that child is more likely than others to experience maltreatment later, according to a new study.

Children with disabilities are more likely to be referred to child protective services (CPS) than children without disabilities, the researchers say.

"What we found was that the high-risk cohort of children with disabilities experienced future maltreatment sooner and more often than other children," said lead author Dr. Caroline J. Kistin of the pediatrics department at Boston Medical Center.

"This is a high risk population that we can identify in a fairly straightforward way so we can provide additional support," she added.

The researchers analyzed data from the National Child Abuse and Neglect Data System on more than 489,000 children from 33 states, Puerto Rico, and the District of Columbia who had first-time unsubstantiated referrals for neglect in 2008.

While the vast majority did not have disabilities, nearly 12,600 of the children did have conditions included in the Individuals with Disabilities Education Act, like autism, deafness or blindness.

By 2012, 45 percent of children with disabilities had been referred again to CPS, compared to 36 percent of those without disabilities. Sixteen percent of those with disabilities had experienced substantiated maltreatment and seven percent had been placed in foster care.

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Maltreatment and foster care were both more common for kids with disabilities, the authors reported in JAMA.

There might have been more reports of maltreatment among kids with disabilities because these kids interact more with healthcare providers and specialists who are mandated reporters, but in any case this seems to be a vulnerable population, the authors wrote.

"One issue is that kids with disabilities are at increased risk for being abused or neglected and at increased risk of being identified as abused or neglected," said Howard Dubowitz, head of the Division of Child Protection and director of the Center for Families at The University of Maryland School of Medicine in Baltimore.

"We need to be really mindful that these often are particularly vulnerable kids that need extra care," Dubowitz, who was not part of the new research, told Reuters Health by phone.

Some states now approach CPS investigations focusing on what families need, rather than finding someone at fault, which is a better conceptual approach, he said.

"There clearly are many parents with kids who have disabilities who do a fabulous job," Dubowitz said.

Children commonly had multiple disabilities, including physical, behavioral and learning issues, that made it hard to tell which types of disabilities were the biggest risk factors, Kistin told Reuters Health by phone.

"Given limited funds this might be a high yield population," she said.

Most reports to CPS are of neglect and are unsubstantiated, meaning there's not enough legal evidence to prove maltreatment, she said.

"Instead of expecting CPS to expand services, I think we need to really look at other ways that other institutions can partner with CPS," which would include notifying pediatricians and schools of an unsubstantiated report of neglect, Kistin said.

"As a pediatrician if there's a report from the school system, I might not know," she said. "If we could recognize the fact that (just because it's unsubstantiated) doesn't mean that there's no risk going forward, we would see this not as the end of the referral but as opportunity for more help."