Unintentional Child Injury in Child Welfare Placements

Video Brief

Dr. Nancy Weaver explains the results of a study conducted with Dr. Jesse Helton that examines the factors related to unintentional child injury, including child welfare placement type, child behavioral problems, caregiver characteristics, and neighborhood factors.

Helton, J. J., & Weaver, N. L. (2020). Unintentional child injury in child welfare placements. Child abuse & neglect99, 104231.

What we know

Typically, child welfare professionals are focused on preventing intentional injuries to children resulting from abuse and neglect. However, a quick look over any state’s child protective service (CPS) investigation protocols will show that they not only assess immediate dangers of abusive and neglectful acts, but also dangers of hazardous living conditions that may increase a child’s risk of unintentional injury, like those from falls, fires, and poisonings. However, little is known about what aspects of the home and characteristics of children and families may increase the risk of unintentional injuries in different child welfare placements. It is important to understand these risks, as injuries are the main cause of child death in the United States.

What this study adds

In this study, children were at a higher risk of unintentional injury if they were in placements that did not receive ongoing safety monitoring from child welfare agencies. Children who were left in-home following a CPS investigation, those reunified with parents following a stay in foster care, and those living with unlicensed kin were at a higher risk of unintentional injury than children living with adoptive parents, licensed kin, and traditional foster parents.  Additionally, children with behavioral problems were at higher risk of unintentional injury compared to children without behavioral problems. It was also found that some placements were protective against injury for these children with behavioral problems.  In particular, children with behavioral problems were at decreased risk of injury if living with unlicensed kin, licensed kin, or traditional foster care compared to children with behavioral problems left in-home following a CPS investigation.

What does this mean for practice or policy

The findings may suggest that there is a benefit of training associated with licensure, or that the initial requirements pre-placement about the safety of the homes are effective in reducing injury risk. Authors discuss research that shows how supervision for younger children and parent-child conversations with older children are effective in reducing injury.  Injury prevention trainings could be modified for child welfare populations and tailored to specific households. For biological families at risk for child abuse and neglect, what may be needed is better understanding of the interaction of environment and behavioral precursors of injurious acts. On the other hand, foster and kin parents may need more traditional injury prevention programming to target children without problematic internal or externalizing behavioral problems. 

How do we know this is a good study

The current study utilized data from the National Survey of Child and Adolescent Well-Being. These data were collected through a series of in-person interviews assessing child well-being, investigative case characteristics, and family demographics among 5,873 cases starting in 2010. These data were collected over the course of three waves (4 months, 18 months, and 36 months after the case closed). Children in the study were ages 3 through 17.  The study examined measures of injury, placement, behavioral problems, child demographics, caregiver characteristics, number of children in household, family poverty, and neighborhood.