Re: Maltreatment Rate as an Outcome Indicator

["R. Kinney" <robin@xxxxxxxxxxxxxxxxxxxxxxx>]

Title: Re: Maltreatment Rate as an Outcome Indicator

Sharon,

We defined our child maltreatment rates by the number of clients we are evaluating in a program with a substantiated CAN report.   We compare the rate to rate we targeted in our stated program objectives.   We look only at abuse to the child considered to be the target child.  We follow them for 5 years even though our services only last for up to 2 years.

We have a similar problem with comparing rates.  The state of Missouri can pull out the number of infants abused age 5 or under but not the total population for a specific county for a specific age group.   The other problem is that we serve only clients that are uninsured or medicaid eligible, which you would expect would be at higher risk for abuse and neglect than the general population.   The State can't give us a medicaid eligible comparison rate for CAN for because they measure the number of people Medicaid eligible by month and by the state as a whole.   

Another issue we have recently faced is that some of our infants have been abused by day care workers and not the family members that our program is targeting.  Our rate reflects, whether or not the child was abused, regardless of who or where the child was abused, thus in my opinion, doesn't accurately portray the effect of the program on this point.

I think this is an important topic that many organizations are struggling with.  Thanks for bringing it up.


Robin Kinney
Operations Mgr.                    ph. 303.403.9101    fax  303.403.9107
Nurses for Newborns Fnd.           robin@xxxxxxxxxxxxxxxxxxxxxxx







on 3/14/00 12:06 PM, Sharon Carnahan at scarnahan@xxxxxxxxxxx wrote:

An old issue is being discussed again in my area.  How do we define child maltreatment rates?  Setting aside for a moment the issue of what exactly constitutes maltreatment or harm, consider these issues.

• A program serves mothers at risk for abuse and neglect from prenatally up to 5 years.  Each year, the program runs the SSNs of all mothers in the program through the state's database.  The program then reports a maltreatment rate for the program by dividing the number of mothers with verified cases of maltreatment / the total number of mothers in the program, and compares this rate with that of the county.  However, the county looks at the number of maltreated children, and compares this with the total number of children under 18 in the county.
  

1.  Question:  Should the program look, instead, at the number of children maltreated while a parent is in the program?  If so, then does the denominator consist of all the children (sibs, foster, everyone in the homes) associated with the program?  Or only the target children? How can a program determine exactly who is living in the home?  How can a program get permission to run the SSNs of siblings?

2.  Question:  How are other similar programs reporting the maltreatment rate for a program, in an effort to compare it (favorably, one hopes) with that in the county or ZIP code?

3.  Question:  Has anyone written a review article on the problems with using maltreatment rates as an outcome measure at all, given the increased rate of surveillance in these homes by trained paraprofessionals and other workers?

4.  Question:  The program plans to follow all children after discharge for up to 18 months and track the effectiveness of the program by looking at incidents of maltreatment after discharge.  Does the program need additional written informed consent from the mothers to do this, or is the original consent to participate sufficient?