Competing risk analysis of sociodemographic risk factors for child maltreatment among children in the legal custody of state of Illinois' child welfare system.

BACKGROUND

Child maltreatment is a critical public health issue with severe consequences. Understanding the interplay of sociodemographic and developmental factors, while accounting for competing events, is essential to accurately assess maltreatment risk, improve child welfare practices, and develop targeted prevention strategies.

OBJECTIVE

This study aims to identify intersectional socio-demographic risks associated with child maltreatment for children in the legal custody of the State of Illinois.

PARTICIPANTS AND

SETTING

A retrospective cohort study was conducted with 25,463 legal custody episodes for 24,999 unique children in Illinois' legal custody from 2015 to 2022.

METHODS

Two competing risk analyses based on the cause-specific (cs) hazard regression model and the subdistribution (sd) hazard regression model were used to estimate the likelihood and time to first substantiated maltreatment during legal custody, considering competing events including death, achieving permanency, or aging out.

RESULTS

Trauma experiences (HRcs = 1.48, p-value < 0.001; HRsd = 1.53, p-value < 0.001), behavioral/emotional needs (HRcs = 1.39, p-value < 0.001; HRsd = 1.47, p-value < 0.001), and caregiver safety needs (HRcs = 1.13, p = 0.010; HRsd = 1.14, p = 0.005) were associated with a higher risk of maltreatment, holding other interacting variables at their reference levels. Interaction analysis showed that risk was elevated for male children aged 6 or older; for non-Black children in rural, low-SES areas; and marginally for those in home-based settings with few prior maltreatment events.

CONCLUSIONS

The study highlights the importance of considering socio-demographic factors and competing events in understanding maltreatment risks. The findings suggest that tailored interventions and policies are needed to address these multifaceted risks. This study contributes to child welfare literature by accounting for competing events and risk factor interactions.