Source:
Investigators from Pennsylvania State University, University Park, PA, conducted a retrospective cohort study to assess the associations between intensity of child protective services (CPS) interventions for girls exposed to suspected maltreatment prior to their 13th birthday, with sexual and reproductive health during their adolescence (13 to 17 years of age). For the study, the investigators abstracted data from the Wisconsin Administrative Data Core, which includes demographic information, medical assistance (MA) claims data (either Medicaid or Children’s Health Insurance Program), social services information, and child welfare administrative records. Study participants were girls, born between 2000 and 2002, who were named in a CPS investigation as suspected recipients of physical, sexual, or emotional abuse prior to 13 years of age; only girls who received MA for ≥85% of months between the age of 13 and 17 were included in the analyses. CPS interventions were classified as investigation only, in-home services, or foster care. Sexual and reproductive outcomes were determined by reviewing ICD-9 and ICD-10 diagnosis codes and included sexually transmitted infection (STI), pregnancy, live birth, and an aggregate of any adverse sexual or reproductive health outcome (any of the other outcomes, suspected exposure to STI, and ICD-9/ICD-10 code for high-risk sexual behavior). Regression analyses were used to assess risk of outcomes among girls who received in-home services, or were placed into foster care, compared to those for whom CPS interventions were limited to investigation only. Multiple sociodemographic variables were included in the regression models.
Data were analyzed on 9,392 female adolescents who had been named in a CPS investigation prior to the age of 13 years. CPS intervention was limited to investigation only in 6,163 (65.6%) study participants, 1,260 (13.4%) received in-home services, and 1,969 (21.0%) were placed in foster care. Between the ages of 13 and 17, 8.4% of the female adolescents had a confirmed STI, 11.2% became pregnant, 6.1% had a live birth, and 23.5% had an adverse sexual health outcome. Compared to those in the investigation only CPS group, girls who were placed in foster care were significantly less likely to become pregnant (adjusted odds ratio [aOR], 0.82; 95% CI, 0.69, 0.98) or give birth (aOR, 0.78; 95% CI, 0.61, 0.99). There were no differences between those in foster care and those in the investigation-only group for the other outcomes, and there were no significant differences in any outcome between those with in-home services and those in the investigation-only group.
The authors conclude that rates of adverse sexual outcome in maltreated girls were high and that CPS interventions were of limited influence.
Dr. Doolittle has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
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