Re: FW: Pediatricians Alerted to the Dangers to Children Living With Men Unrelated to Them

[Sherrill Clark <sjclark@xxxxxxxxxxxxxxxxxxx>]

I agree.   You not only have to distinguish between the two situations, but 
you have to distinguish between two populations.   In the first case you 
are starting off with a group of children; in the second case you have a 
group of children who have already been neglected/abused.  The 
probabilities of each group are not equivalent. Sherrill
At 06:32 PM 6/17/2002 -0400, you wrote:
>Very interesting thread.  Does the article, or does anyone, have 
>explanations for the finding?
>
>At 02:37 PM 6/17/02 -0500, John Rosen wrote:
>>I think it would be useful to distinguish between two situations:
>>
>>         (a) The initial decision to remove a child/potential victim from 
>> the home, and
>>         (b) any subsequent decision regarding reunification.
>>
>>I agree with Aron Shlonsky that, in case (a) the false positive rate 
>>would be unacceptably high.  In case (b), however, I suspect that the 
>>"base rate" level of continued/re-abuse would be sufficiently high so 
>>that the foster care agency and Court would indeed want to take into 
>>account the presence at home of an unrelated adult.
>>
>>Thanks to Niki Delson for starting this important thread.
>>
>>         John Rosen
>>         Kansas Innovations, Inc.
>>         www.kii.com
>>
>>
>>-----Original Message-----
>>From: Aron Shlonsky [mailto:shlonsky@uclink4.berkeley.edu]
>>
>>A strong word of caution here.  Death is a very rare event while poverty is
>>not, and the rate of "exposure" to households with unrelated adults is
>>extremely high.  Most of us struggle to make ends meet even with a dual
>>income.  I can't help but think that the rate of "false positives"
>>(mistakenly labeling a family as high risk when they are not)  would be
>>extremely high using just this crude measure (simply the presence of a
>>person and nothing about the quality of that person). The unintended
>>consequences of focusing policy and CPS response on just this item may be
>>unacceptable.  I'm not saying that's what is happening here or in these
>>studies, but I cringe when I think about what could be...
>>
>>Aron
>>
>>At 09:04 PM 6/14/2002 -0700, you wrote:
>> >There has been a flurry in the news in recent weeks about a monograph 
>> in the
>> >April issue of the journal Pediatrics in which pediatricians are alerted to
>> >the presence of a mother's boyfriend or stepfather as a risk factor for
>> >abuse of children. The article says that
>> >
>> >  Objective. Approximately 2000 children die annually in the United States
>> >from maltreatment. Although maternal and child risk factors for child abuse
>> >have been identified, the role of household composition has not been
>> >well-established. Our objective was to evaluate household composition as a
>> >risk factor for fatal child maltreatment.
>> >
>> >Methodology. Population-based, case-control study using data from the
>> >Missouri Child Fatality Review Panel system, 1992-1994. Households were
>> >categorized based on adult residents' relationship to the deceased child.
>> >Cases were all maltreatment injury deaths among children <5 years old.
>> >Controls were randomly selected from natural-cause deaths during the same
>> >period and frequency-matched to cases on age. The main outcome measure was
>> >maltreatment death.
>> >
>> >Results. Children residing in households with adults unrelated to them were
>> >8 times more likely to die of maltreatment than children in households with
>> >2 biological parents (adjusted odds ratio [aOR]: 8.8; 95% confidence
>> >interval [CI]: 3.6-21.5). Risk of maltreatment death also was elevated for
>> >children residing with step, foster, or adoptive parents (aOR: 4.7; 95% CI:
>> >1.6-12.0), and in households with other adult relatives present (aOR: 2.2;
>> >95% CI: 1.1-4.5). Risk of maltreatment death was not increased for children
>> >living with only 1 biological parent (aOR: 1.1; 95% CI: 0.8-2.0).
>> >
>> >Conclusions. Children living in households with 1 or more male adults that
>> >are not related to them are at increased risk for maltreatment injury 
>> death.
>> >This risk is not elevated for children living with a single parent, as long
>> >as no other adults live in the home. Pediatrics 2002; 109:615-621;
>> >epidemiology, injury, child abuse and neglect, fatalities, mortality,
>> >maltreatment, case-control study, death, risk factors, behavior.
>> >
>> >
>> >
>> >***************************************************************************
>> >  Niki Delson at Delson-Kokish Associates, P.O. Box 476, Trinidad, CA 95570
>> >         Clinical and Forensic Evaluations, Consultation & Training
>> >                  (707)677-3181-voice   (707)677-0187-fax
>> >                    niki@delko.net         www.delko.net
>> >***************************************************************************
>>
>>Aron Shlonsky, MSW, MPH
>>Research Associate
>>UC Berkeley
>>School of Social Welfare
>>Center for Social Services Research
>>16 Haviland Hall #7400
>>Berkeley, CA  94720-7400
>>(510) 642-8139
>>(510) 642-1895 fax
>>shlonsky@uclink4.berkeley.edu
>
>Sandra J. Bishop, Ph.D.
>Assistant Director
>Bush Center in Child Development and Social Policy
>Yale University
>310 Prospect Street
>New Haven, CT 06511
>Phone: 203-432-9935
>FAX:      203-432-9933
>E-mail: sandra.bishop@yale.edu
>www.yale.edu/bushcenter