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Journal Article

Citation

Okechukwu A, Abraham I. JAMA Netw. Open 2022; 5(7): e2221516.

Copyright

(Copyright © 2022, American Medical Association)

DOI

10.1001/jamanetworkopen.2022.21516

PMID

35816319

Abstract

In 2020, approximately 3.9 million child abuse and neglect reports were filed to Child Protective Services (CPS) in the US. Approximately 17% of these reports were substantiated, with 618 000 documented instances of child maltreatment, mainly neglect (76%), and more than 124 000 children receiving foster care services. Rates of child maltreatment were highest among American Indian or Alaska Native children (15.5 per 1000 children in the population of the same race or ethnicity) and African American children (13.2 per 1000 children).

In a quantitative policy analysis, Johnson-Motoyama and colleagues2 examine the association of state policies governing the Supplemental Nutrition Assistance Program (SNAP) with CPS involvement and foster care placement in the US. Their econometric analysis shows that states with more income generosity policies related to SNAP observed decreases in reported child maltreatment and neglect, substantiated cases, and intake into foster care. The findings suggest that ensuring child and family food security may be instrumental in preventing child maltreatment and foster care referral. The availability of discretionary family funding, such as generous SNAP benefits, may indeed reduce CPS reporting and prevent recidivism.

No matter how rigorous in conceptualization and execution, there are inherent risks to association analyses formalized in regression models of multivariable inputs but a singular univariable output—a common econometric approach. The first risk concerns the interpretation of the directionality embedded in an econometric model; here, that the X variable of greater access to SNAP (as a proxy for food security) translates into the Y variable of less child maltreatment. The step to implying causality is just a small one. The step to inferring singularity of the presumed cause may be even smaller.

The second risk is decontextualization. The determinants of child maltreatment, subsequent CPS involvement, and protective actions are contextual, complex, and multidimensional,3 with food insecurity being only 1 factor. However related they may be, food insecurity and child maltreatment are both cause and consequence of distal social-ecological dynamics that affect the health and well-being of children, families, and communities, as Belsky4 argued so convincingly in his classical 1980 article on the ecology of child maltreatment. Expanding Bronfenbrenner’s ecological systems theory, Belsky reported that child maltreatment is “multiply determined by forces at work in the individual (ontogenic development) and the family (the microsystem), as well as the community (the exosystem), and the culture (the macrosystem) in which both the individual and family are embedded.” Johnson-Motoyama et al2 add empirical evidence that macrosystem policies such as SNAP prevent child maltreatment and the need for foster care, especially the more generous these policies are. This evidence must be contextualized within the larger contemporary body of research on associations between child maltreatment and individual, family, and neighborhood poverty; housing instability; food insecurity; structural racism and injustice; and socioeconomic inequities and inequalities ...


Language: en

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