Hello Baby: Reducing Contact with Child Protective Services

• In Event: Outcomes Across the Life Course of Youth affected by Foster Care and Adoption

Abstract

Background and Purpose

Across the United States, infants are the children who are most frequently in contact with the child protection system. In 2021, infants were involved in substantiated allegations of maltreatment at a rate of 25 infants per 1,000 which is nearly 2.5 times the rate for one-year-olds, the group with the next highest rate. Among children who enter foster care, infants account for 24% of children placed in foster care for the first time; infants under 30 days of age account for 12% of admissions. Allegheny County in Pennsylvania is no different. As a percentage of children investigated for maltreatment, infants account for 17%, more than double the proportion recorded for one-year-olds. Compared to all older children, infants involved in a maltreatment report are more than twice as likely to have the report substantiated (47% vs. 21%). Regarding foster care placements, 25% of all first placements in Allegheny County involved a child who had not yet seen his/her first birthday.

Methods

We hypothesize lower rates of maltreatment and placement during the Hello Baby era when compared with prior years using a discrete time hazard model in conjunction with an interrupted time series approach. To account for gradual implementation, we apply dosage models that incorporate time-varying weights. The public health outcomes are expressed as rates per 1,000 and answer the question of whether, for the children born during the time Hello Baby was active, the maltreatment reports and foster care placements went down when compared to an earlier period. We are asking whether maltreatment and placement rates in Allegheny County are improving in comparison to itself and what was once true. Self-to-self comparisons are a necessary element of any improvement process operating at scale.

Results

We see strong evidence of a Hello Baby effect measured as changes in the number of investigations and substantiated investigations but not placements.  We interpret this as corroborating evidence that comes up just short of Stinchcombe’s critical test of theory (Stinchcombe 1968).  In scientific terms, this is a good outcome.  A program’s worth is never settled with a single test (VanderWeele 2020; Tchetgen and VanderWeele 2012).  Allegheny’s theory says that alternative service pathways will shift how families get the services they need.  The first step in learning whether that is possible is to do what Allegheny has tried – imagine an alternative, put it in place, and then see whether contact rates go down.

Conclusions

We are confident that the changes in the number of investigations and substantiated investigations are meaningful.  For there to be a stronger causal assertion, the impact we have already seen will have to be sustained, all else being equal.  In other words, Hello Baby’s success will be defined over the next few years and not just by the years that have already passed.  For the Hello Baby evaluation, county officials wanted to observe whether, with sufficient scale, it is feasible to influence how much contact families have with the child welfare system.  The results are potentially far-reaching.

Authors

• scott huhr, The University of Chicago
  Presenting Author

• Fred Wulczyn, Chapin Hall at The University of Chicago
  Non-Presenting Co-Author