The effect of substantiated and unsubstantiated investigations of child maltreatment and subsequent adolescent health

Abstract

Children with substantiated child maltreatment (CM) experience adverse health outcomes. However, it is unclear whether substantiation vs. an investigation not resulting in substantiation has a greater impact on subsequent adolescent health. Propensity scores were used to examine the effect of investigated reports on the subsequent health of 503 adolescent females. CM was categorized into three levels: 1) investigated and substantiated, 2) investigated but unsubstantiated, and 3) no investigation. Models using inverse propensity score weights estimated the effect of an investigation on subsequent teen motherhood, HIV-risk behaviors, drug use, and depressive symptoms. Females with any investigation, regardless of substantiation status, were more likely to become teen mothers, engage in HIV-risk behaviors, and use drugs compared to females with no investigated report. Substantiated CM was associated with depressive symptoms. Findings underscore the importance of maintaining case records, regardless of substantiation, to better serve adolescents at risk for deleterious outcomes. Prospective methods and propensity scores bolster causal inference and highlight how interventions implemented following investigation are an important prevention opportunity.

Keywords: Adverse health outcomes; Propensity score; Substantiation status.

Figure 1

Boxplot showing the overlap in the distribution of the propensity scores between “investigated but unsubstantiated” and “no investigation” (1 vs. 0) and “investigated and substantiated” and “no investigation” (2 vs. 0).

Figure 2

Standardized mean differences between “investigated but unsubstantiated” and “no investigation” (1 vs. 0) and “investigated and substantiated” and “no investigation” (2 vs. 0) for each confounder for the unadjusted and the propensity-score-adjusted data.