Re: Maltreatment Rate as an Outcome Indicator

["Sally Martin, Ph.D., CFLE" <smartin@xxxxxxxxxxx>]

Sharon, I'm dealing with these same issues.  There is the Old's article addressing this topic. 

With regard to our HFA program, we have two comparison groups, one receiving a different treatment and the second receiving only community referrals.  Unfortunately, we do not have a big enough n in either comparison group yet.  I discussed this issue with Deborah Daro some time ago searching for similar high-risk groups with which to compare our data but was unsuccessful in finding such a group. When asked about the rate, I talk about the rate in our very high risk population compared to the rate in the general population with lots of emphasis on our inability to make direct comparisons.  Although I have not had the time to do so, perhaps we could look back at the literature on the screening instrument and see if it would provide any predictive rates. 

 

With regard to consent, we indicated in our original consent form that we would follow the children for 5 years.  Parents had to sign a separate line giving us consent to search the central records.  In our searches, we look for records pertaining to the mother, the father (if we have permission), and the child in the program.  Therefore, if the parent had maltreated a child other than the target child, we should get that information.  Again, this brings up different issues with regard to program evaluation.

 

I'll be interested to see other responses to your questions. 

 

                                        Sally Martin

-----Original Message-----
From: Sharon Carnahan <scarnahan@xxxxxxxxxxx>
To: Child Maltreatment Researchers <CHILD-MALTREATMENT-RESEARCH-L@xxxxxxxxxxx>
Date: Tuesday, March 14, 2000 11:56 AM
Subject: Maltreatment Rate as an Outcome Indicator

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?