Child Abuse & Neglect 120 (2021) 105249

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Child Abuse & Neglect

journal homepage: www.elsevier.com/locate/chiabuneg

A latent class analysis of modifiable risk factors associated with

child maltreatment re-reporting and recurrence
Jeffrey Waid a, b, *, N. Jeanie Santaularia c, d, Kristine Piescher a, e, Traci LaLiberte a, e
a
School of Social Work, College of Education and Human Development, University of Minnesota - Twin Cities, United States of America
b
Institute for Translational Research in Children's Mental Health, University of Minnesota - Twin Cities, United States of America
c
Epidemiology and Community Health, School of Public Health, University of Minnesota - Twin Cities, United States of America
d
Minnesota Population Center, University of Minnesota – Twin Cities, United States of America
e
Center for Advanced Studies in Child Welfare, School of Social Work, College of Education and Human Development, University of Minnesota -
Twin Cities, United States of America

A R T I C L E I N F O A B S T R A C T

Keywords: Background: Maltreatment re-reporting and recurrence represent missed opportunities for pre­
Maltreatment vention and early intervention in child welfare settings.
Recurrence Objectives: This study identified latent classes of risk among families who experienced a child
Re-reporting
maltreatment re-report or maltreatment recurrence within 12-months of initial case closure.
Latent Class Analysis
Participants and setting: Administrative child welfare data from a large urban county were subject
to secondary analysis. Samples included children who experienced a maltreatment re-report (n =
4390), and children who experienced a second maltreatment substantiation (n = 694).
Methods: Five modifiable risk factors (i.e., mental health, substance abuse, domestic violence,
disability, parenting challenges) were extracted from the initial investigation and subject to latent
class analysis. Case characteristics (i.e., age, gender, race, ethnicity, maltreatment type) were then
compared across the latent classes in a post-hoc analysis.
Results: Re-report classes were characterized by (1) “Few Identified Challenges” (56%, n = 2458),
(2) “Mental Health and Domestic Violence Challenges” (26%, n = 1133), and (3) “Substance
Abuse, Domestic Violence, Mental Health, and Parenting Challenges” (18%, n = 790). Re-report
classes differed according to child age, race, ethnicity, neglect and physical abuse allegations.
Recurrence classes were characterized by (1) “Domestic Violence Challenges” (48%, n = 333), (2)
“Mental Health Challenges” (15%, n = 104), and (3) “Domestic Violence, Mental Health, and
Parenting Challenges” (37%, n = 257). Recurrence classes differed according to child race and
age.
Conclusions: Findings underscore the complex and co-occurring nature of maltreatment risk, and
provide insights to strengthen assessment and intervention practices to reduce repeated contacts
with child welfare systems.

* Corresponding author at: School of Social Work, College of Education and Human Development, University of Minnesota - Twin Cities, United
States of America.
E-mail address: jdwaid@umn.edu (J. Waid).

https://doi.org/10.1016/j.chiabu.2021.105249
Received 7 April 2021; Received in revised form 30 June 2021; Accepted 26 July 2021
Available online 6 August 2021
0145-2134/© 2021 Elsevier Ltd. All rights reserved.
J. Waid et al. Child Abuse & Neglect 120 (2021) 105249

1. Introduction

One of the primary goals of the child welfare system is to protect children from abuse and neglect (Children's Bureau, 2020). Within
the United States, two common indicators used to assess the child welfare systems effectiveness in preventing and responding to child
maltreatment are rates of maltreatment re-reporting and maltreatment recurrence (U.S. Department of Health and Human Services,
2021). Maltreatment re-reporting is defined as youth being an alleged victim of maltreatment in an investigation/assessment that
occurs within 12 months of a prior maltreatment investigation/assessment. Maltreatment recurrence is defined as being the identified
as a victim of a substantiated maltreatment investigation that occurs within 12 months of a prior maltreatment substantiation
(Children's Bureau, 2015).
Maltreatment re-reporting (also referred to as “re-referral” in the literature) and maltreatment recurrence (also referred to as “re-
substantiation” in the literature) present considerable challenges for child welfare organizations. It is estimated 30–60% of cases
reported to child protection in the U.S. will be re-reported within 2 years (Drake et al., 2006) and 10.6–22.6% of substantiated
maltreatment victims will experience a second substantiation within an 18-month period (Hindley et al., 2006). The burden re-
reporting and recurrence places upon child welfare organizations is considerable. Re-reporting represents a missed opportunity for
prevention and early intervention, and decreases organizational efficiency by diverting critical fiscal and human resources away from
new cases (Connell et al., 2007). Maltreatment recurrence is consequential for maltreatment victims and is associated with numerous
short and long-term problems including developmental psychopathology (Li & Godinet, 2014), delinquency (Lemmon, 2006) and
criminal justice system involvement (Carnochan et al., 2013).
A significant body of empirical research has been devoted to identifying the correlates and contributors to maltreatment re-
reporting and recurrence. Research indicates risk of maltreatment re-reporting is greatest in the six-month period following the
conclusion of the initial investigation (Connell et al., 2007; English et al., 1999) and risk of a maltreatment recurrence is greatest in the
30 days following the index maltreatment substantiation (Hindley et al., 2006; White et al., 2015). For both outcomes, rates are highest
among families who were initially referred for neglect, followed by physical abuse (Lipien & Forthofer, 2004; White et al., 2015).
Certain child, caregiver, and family characteristics are associated with maltreatment re-reporting and recurrence. Young children are
at increased risk of both re-reporting and recurrence (Fuller & Nieto, 2009; Hindley et al., 2006; Johnson-Reid et al., 2010; Marshall &
English, 1999; White et al., 2015) relative to older children. Presence of a childhood disability or childhood mental illness has been
associated with re-reporting (Loman, 2006; Sullivan & Knutson, 2000) but have primarily been identified in cases of maltreatment
recurrence (Hindley et al., 2006; White et al., 2015). Child gender and race have not previously been shown to be significant predictors
of maltreatment re-reporting or recurrence (Hindley et al., 2006; White et al., 2015) although there is some evidence to suggest
African-American and Hispanic children are less likely to be subjects of a re-report relative to White children (Connell et al., 2007).
A small number of modifiable risk factors (i.e., those amenable to intervention) have been identified in the maltreatment re-
reporting and recurrence research. A history of substance abuse has consistently been identified as a risk factor for both maltreat­
ment re-report (Casanueva et al., 2009; Connell et al., 2007; Drake et al., 2006; Wolock & Magura, 1996) and recurrence (Barth et al.,
2006; Hindley et al., 2006; Laslett et al., 2012; White et al., 2015). Parenting skill deficits (Johnson & L'Esperance, 1984; Sledjeski
et al., 2008), caregiver mental health problems (Drake et al., 2006; English et al., 1999; Murphy et al., 1992; Sledjeski et al., 2008),
parental conflict and domestic violence (DePanfilis & Zuravin, 1999; English et al., 1999; Sledjeski et al., 2008) have also been
identified.
Prior research has helped identify a range of important risk factors for maltreatment re-reporting and recurrence, yet a number of
gaps in knowledge remain. In particular, much of the current research has employed variable-centered approaches to model associ­
ations between individual predictors (e.g., child, caregiver, and family-level risk factors) to re-reporting and recurrence outcomes. This
approach is useful for understanding the relative contribution of a specific risk factor or characteristic to an outcome at the group level,
however person-centered analytic approaches (i.e., Latent Class Analysis, Latent Profile Analysis) can provide a more nuanced un­
derstanding of a phenomenon by identifying unique patterns within the data (Laursen & Hoff, 2006). To the authors knowledge only
two studies have utilized latent-class analysis to explore maltreatment re-referral, and none have explored maltreatment recurrence
using these methods. Eastman et al. (2016) linked birth records to CPS reports to identify subpopulations of infants who experienced
maltreatment re-report at any point following the index case. Eleven predictor variables were identified and included: maternal race,
age, and education, birth payment method, paternity, prenatal care, presence of a health condition, initial allegation type, reporter
type, disposition, and CPS history. Four classes were identified, and included: low risk - less education, low risk - more education,
medium risk - young mothers, and highest risk - CPS history. A second model estimated the probability of re-report based on class
membership and found the risk of re-report was highest for the highest risk - CPS history class. Another study of re-report utilized two
samples of NSCAW data to identify a 2-class model characterized by high and low baseline risk of re-report over 36-months (Kim et al.,
2020). Latent class indicators included childcare burden, socioeconomic status, material hardships, domestic violence, mental health,
social support, caregiver history of maltreatment, criminal history, parenting need and view of the community. Both the low and high-
risk class was characterized by low social support, low socioeconomic status, and high childcare burden. The high-risk class from
NSCAW I was characterized by increased risk of mental health, domestic violence, criminal history, substance abuse, parenting, and
material hardship risks. The high-risk class from NSCAW II were characterized by these same indicators, but with increases to sub­
stance abuse, material hardship, and parenting indicators (Kim et al., 2020).
Taken together, empirical research has identified a number of individual, caregiver, and family level correlates of maltreatment re-
reporting and recurrence using multivariate longitudinal methods. Person-centered analysis (i.e., latent class analysis) is a valuable
analytic approach that can extend previous research and further inform our understanding of re-reporting and recurrence by iden­
tifying how maltreatment risks co-occur. This information may be particularly valuable to child welfare practitioners who must

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conduct comprehensive assessments and plan services for a broad range of conditions, and for administrators who make decisions
about training and resource allocation at the unit or organizational level. This information may also be valuable to clinicians and
community service providers who encounter children and families at risk of child maltreatment in routine practice settings, such as
schools, outpatient clinics, and community organizations.

2. Current study

The current study utilized administrative child welfare data from a large metropolitan county to examine how modifiable risk
factors (i.e., risk factors amenable to intervention) co-occurred among children who experienced a maltreatment re-report or a sub­
stantiated maltreatment recurrence within 12 months of the initial (i.e., index) case closure. The aims were to identify unique com­
binations of modifiable risk factors among cases who experience maltreatment re-reporting or maltreatment recurrence within 12
months of the initial investigation, and determine if certain child, family, or case covariates observed with membership in a particular
latent class. The specific research questions were: (1) What combinations of modifiable risk factors are observed among cases who
experience maltreatment re-reporting and maltreatment recurrence? (2) Are certain child, family, or case covariates observed with
membership in a particular latent class?
The current study was informed by two theoretical frameworks. These included personalized prevention (August & Gewirtz, 2019)
and systems of care (Hernandez & Hodges, 2003). Personalized prevention is a framework for research and practice that explicitly
accounts for the heterogeneity of individuals and families in the organization and delivery of health and social care (August & Gewirtz,
2019). Key elements include an a priori assessment of important client characteristics which may be associated with the anticipated
outcome/treatment response, adjusting the intervention type and dosage based on the clients' characteristics, in combination with
their needs and preferences, then continually re-assessing and adjusting the intervention as needed over the course of treatment
delivery (Collins et al., 2004). Personalized prevention is useful for understanding and planning for the specific needs of children and
families who experience or at risk of maltreatment re-report and recurrence. Personalized prevention is also valuable for engaging and
supporting child welfare involved children and families, who often report a lack of autonomy in the treatment planning process and
dissatisfaction with the services they receive (Dumbrill, 2006; Tilbury & Ramsay, 2018). Systems of care (Hernandez & Hodges, 2003)
is an integrated approach to the coordination and delivery of services to children and families at the organizational level. Systems of
care is complementary to personalized prevention in that the framework is valuable for understanding the organizational and
community-level implications of co-occurring maltreatment risk, and its potential to inform the coordination and delivery of services
children and families who experience repeated contacts (i.e., re-report, recurrence) with child welfare systems. In a Systems of care
framework child serving organizations (e.g., county child welfare, school districts, community mental health providers, etc.) work
collaboratively to plan, coordinate, and deliver comprehensive services to children and their families. Core values include culturally

Table 1
Summary of case characteristics and latent class indicators for re-report and recurrence samples.
Re-report (n = 4390) Recurrence (n = 694)

M (SD) = 6.8 (4.6) M (SD) = 6.4 (4.5)

N % N %

Age
0–1 yrs 755 17.2 132 19.0
2–5 yrs 1081 24.7 162 23.3
6–9 yrs 1284 29.3 226 32.6
10–13 yrs 787 17.9 122 17.6
14+ yrs 479 10.9 52 7.5

Gender
Female 2178 49.6 360 51.9
Male 2212 50.4 334 48.1

Race
American Indian/Alaska Native 601 13.8 136 19.8
Asian 98 2.3 13 1.9
Black 1987 45.7 315 45.9
White 1178 27.1 148 21.6
Multiracial 483 11.1 73 10.6

Ethnicity
Hispanic 587 13.4 105 15.1

Maltreatment type
Neglect 2863 65.2 435 62.7
Physical 1579 36.0 252 36.3
Sexual 0 0.0 0 0
Mental/Emotional 32 0.7 2 .3

Note. Race data were missing for 43 children in re-report sample and 9 children in the recurrence sample. Age data were missing for 4 children in the
re-report sample.

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responsive, family centered, community based service planning, with include cross-systems case management, service coordination
and delivery, and monitoring of progress (Pires, 2002).

3. Methods

A secondary analysis using integrated, administrative data from the Minnesota-Linking Information for Kids (Minn-LInK) was
conducted. Minn-LInK is a statewide longitudinal data system that collects and integrates administrative data from the Minnesota
Department of Human Services, Department of Education, and Department of Corrections data systems. Data were drawn from the
population of children who experienced a child protection response (either traditional investigation or differential response) to a
report of maltreatment (n = 20,095) or were substantiated victims (n = 5567) in an investigation in a large metropolitan midwestern
county between January 1, 2014 and December 31, 2016. Children who experienced a maltreatment re-report (n = 4390) or sub­
stantiated maltreatment recurrence (n = 694) within 12 months of their initial case disposition were included in the current study. The
subsamples were not mutually exclusive, meaning children in the re-report sample may also appear in the maltreatment recurrence
sample. For additional details regarding Minn-LInk's administrative data structure and sampling procedures see Piescher et al. (2020).
The re-reporting and recurrence subsamples varied slightly in terms of child's racial identification, with Black children making up
the largest proportion of both groups (45.2% and 42.5%, respectively), followed by White (32.1% and 27.3%, respectively), Multi­
racial (9.4% and 11.9%, respectively), Native American (9.2% and 14.9%, respectively), and Asian children (4.1% and 3.3%,
respectively). A table summarizing current study sample characteristics and covariates by re-report and recurrence are provided below
(Table 1).

4. Measures

4.1. Maltreatment re-report

In keeping with U.S. Department of Health and Human Services definitions (Children's Bureau, 2015), three criteria were used to
define maltreatment re-reporting: (1) a child was identified as an alleged victim in a maltreatment report that resulted in a CPS
response (i.e., a maltreatment case was opened), (2) the child's involvement in the current report followed a previously accepted
maltreatment report in which the child was named as an alleged victim, and (3) fewer than 12 months elapsed between the index and
subsequent report. Maltreatment re-reporting included reports that received either a Family Investigation (i.e., traditional child
protection response) or Family Assessment (i.e., differential response). Report(s) of maltreatment that occurred while the index report
was open and those that occurred within 14 days of index report closure were not counted as re-reporting. Re-reporting was not
constrained to the county in which the original report occurred, meaning a re-report to any county in the state was counted as a child
protection re-report. Maltreatment re-reporting variable was coded dichotomously (yes/no).

4.2. Maltreatment recurrence

Maltreatment recurrence was defined in accordance with federal definitions (Children's Bureau, 2015) as (1) a child's identification
as a substantiated victim in an accepted maltreatment report, followed by (2) identification of the same child as a substantiated victim
in a subsequent maltreatment investigation. Because substantiation was a criterion for maltreatment recurrence, only reports that
received a Family Investigation were included. To be counted as maltreatment recurrence the subsequent substantiation must have
occurred within 12 months of the index case closure. Reports of maltreatment that occurred while the index report was open and those
that occurred within 14 days of index case closure were not counted as a maltreatment recurrence. Similar to maltreatment re-
reporting, the outcome measure was not constrained to the same county in which the original maltreatment substantiation
occurred. Maltreatment recurrence was coded dichotomously (yes/no).

4.3. Modifiable risk factors

At the conclusion of the initial maltreatment investigation caseworkers completed a structured risk assessment that was part of a
broader, more comprehensive protocol designed to enhance decision making in child protection (Minnesota Department of Human
Services, 2018). As part of the assessment process caseworkers were required to complete a risk assessment in which they endorsed or
denied the presence of specific maltreatment risk factors, as appropriate to information learned throughout the investigation/
assessment process. The risk assessment tool has demonstrated good predictive validity, with an ability to distinguish low from me­
dium and high risk cases and subsequent maltreatment re-reports. The internal consistency of the measure is slightly below acceptable
range, due to variance in how workers have been trained to use and interpret items within the tool (Loman & Siegel, 2004). Items in the
risk assessment were considered “static,” meaning the level of risk could not be changed or diminished as a result of intervention (e.g.,
number of children in the home, number of prior investigations), or “modifiable,” meaning the level of risk could be changed or
diminished as a result of child welfare intervention (e.g., reduction in risk through accommodation, modification, or safety planning).
If a caseworker endorsed the presence of a modifiable risk factor the item was coded as 1. If no risk was detected the item was coded as
0. Modifiable risk items included: “Child in the home has a developmental disability/emotional impairment (Disability),” “Either
caregiver has a history of domestic violence (Domestic Violence),” “Either caregiver has/had an alcohol or drug problem in the last 12
months (Drug and Alcohol),” “Primary caregiver has/had a mental health problem (Mental Health),” and “Primary caregiver lacks

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parenting skills (Parenting).”

4.4. Covariates

Child age, race, ethnicity, gender, and the form of maltreatment identified from the index report or index substantiation (as
appropriate to the outcome) were included as covariates. Age was coded into five categories (Birth-1 year; 2–5 years; 6–9 years; 10–13
years; and 14+ years). Gender (male; female) and Hispanic ethnicity (yes; no) were recorded as binary variables. Each form of
maltreatment recorded in the index maltreatment report or substantiation was recorded as a binary variable. Maltreatment types
included: neglect; physical abuse, sexual abuse, and mental/emotional abuse. If the form of maltreatment was not reported or sub­
stantiated the item was coded as 0. If the form of maltreatment was reported or substantiated the item was coded as 1. Race was
recorded as a categorical variable (American-Indian/Alaska Native; Asian; Black; White; Multiracial).

5. Analysis

Latent class analysis with maximum likelihood estimation investigated potential unique combinations of risk among cases of
children who experienced maltreatment re-reporting or recurrence within 12 months of index case closure. Data underwent routine
inspection for missingness prior to analysis, and a preliminary check for conditional dependence was conducted with the re-report and
recurrence samples using the bivariate Pearson method (Asparouhov & Muthén, 2015). No missing data were present among the five
risk indicators used to model the latent classes, and no correlations surpassing r = 0.20 were present in either the re-report or
recurrence samples.
Models were calculated with one to five latent classes, and statistical output were compared across the models. Output included a
probability of class membership which estimated the probability of children in the sample belonging to a particular latent class and an
estimated mean was the proportion of cases endorsing a modifiable risk item in each latent class. Goodness of Fit statistics were
calculated for each model and included a Likelihood Ratio Chi-Square (G2) for each latent class model, Bayesian Information Criteria
(BIC) which is a total value based on maximum likelihood estimates of model parameters, and Entropy which is an index based on the
uncertainty of classification. To select the model with the most appropriate number of latent classes G2, BIC, and Entropy fit statistics
were compared and contrasted with the probability of class membership and estimated means within each latent class. Indicators with
estimated means >0.50 were used to characterize each latent class. Results for models with one to five latent classes were then shared
and explored with an advisory group of practitioners, supervisors, and administrators from the metropolitan region where the study
was conducted. Selection of the final model was based on a comparison of model fit statistics, examination of estimated means within
the latent classes, and assessment of the theoretical and practical utility of the model to explain the outcomes of interest (Lanza et al.,
2013). After selecting the best fitting model, a post-hoc analysis utilized Chi-Square and Fisher's exact tests to compare sociodemo­
graphic characteristics (e.g., child age, race, gender) and maltreatment type (neglect, physical, sexual, mental/emotional) across the
latent classes.

6. Results

6.1. Maltreatment re-reporting

During the three-year window of observation 21.8% (n = 4390) of the total population of children who were subjects of a
maltreatment report experienced a re-report to child protection within 12 months of index case closure.” The average child age at index
report was 7 years (mean = 6.8, SD = 4.6). Gender distribution of males and females was nearly equal. Descriptively, Black children
represented the largest racial group experiencing re-report (45.7%, n = 1987), followed by White (27.1%, n = 1178) and Native
American children (13.8%, n = 601); however, Native American children experienced the highest proportional rates of re-report
(33.4%), followed by Multiracial (26.2%) and Black children (22.4%). A small proportion of identified as Hispanic (13.4%, n =
587). The most common forms of maltreatment recorded in the index report were neglect (65.2%, n = 2863) followed by physical
abuse (36% n = 1579); no children were re-reported for sexual abuse (Table 1). Caseworkers endorsed a history of domestic violence in
approximately one-half (51%) of cases that experienced a subsequent maltreatment re-report. Caregiver mental health challenges
(33%), parenting skill deficits (29%), and child disability were endorsed in one-third (28%) of cases, and caregiver history of drug and

Table 2
Proportion of modifiable risk among cases resulting in a maltreatment re-report or recurrence.
Re-report (n = 4390) Recurrence (n = 694)

Risk factor
Disability 0.28 0.29
Domestic violence 0.51 0.63
Drug & alcohol 0.24 0.37
Mental health 0.33 0.46
Parenting 0.29 0.46

Note. Data represents sample averages for re-report and recurrence cases.

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alcohol problems were endorsed in one-quarter (24%) of re-report cases (Table 2).
The latent class analysis of maltreatment re-reporting suggests a 3-class model best describes the data.. This was supported by
model fit statistics (G2 = 58.15, p < .00, BIC = 26,287.0, Entropy = 0.68), as well as examination of the probability of membership and
comparison of estimated means within the latent classes which suggested the 2-class model suffered from under extraction (i.e.,
relatively even probability of membership in either class, 0.56 probability of mental health risk in one latent class, no other indicators
>0.50) while the 4- and 5-class models were over extracted (i.e., relatively low probability of membership in a latent class, more than
one class containing no significant indicators). Selection of the 3-class model was further confirmed by the advisory group review and
discussion of the models theoretical and practical utility to child welfare practice (Table 3).
In the 3-class model Class 1 accounted for 56% of the sample and could be characterized primarily by “Few Identified Challenges.” A
history of domestic violence was identified in 38% of cases and child disability in 23% of cases, however low rates of parenting skill
deficits (14%), caregiver mental health issues (10%), or caregiver history of drug and alcohol problems (8%) were endorsed. Class 2
accounted for 26% of the sample and could be characterized primarily by “Mental Health and Domestic Violence Challenges.” Case­
workers endorsed moderate to high rates of caregiver mental health issues (68%) and history of domestic violence (63%). Parenting
skill deficits (45%) and child disability (45%) were identified in just under one-half of these cases, and low rates of caregiver history of
drug and alcohol problems (5%) were observed. Class 3 accounted for only 18% of the cases and could be characterized primarily by
“Substance Abuse, Domestic Violence, Mental Health, and Parenting Challenges.” Caregiver history of drug and alcohol abuse were
identified in every case (100%). A caregiver history of domestic violence (68%) was also endorsed at high rates. Caregiver mental
health (54%) and parenting challenges (53%) were endorsed in just more than half of these cases. Rates of disability were lower (20%)
for this group (Table 4).
Results of the post-hoc analysis suggest the latent classes of maltreatment re-report differed according to child age [X2 (8, n =
4386) = 126.0, p < .01), race [X2 (10, n = 4386) = 162.7, p < .01], Hispanic ethnicity [X2 (2, n = 4367) = 9.1, p = .01], neglect [X2 (2,
n = 4389) = 66.9, p < .01], and physical abuse allegations [X2 (2, n = 4389) = 9.9, p < .01]. Latent classes did not differ according to
youth gender [X2 (2, n = 4389) = 2.3, p = .31] mental/emotional abuse allegation [X2 (2, n = 4390) = 0.58, p = .79]. No allegations of
sexual abuse were observed across any of the latent re-report classes (Table 5).

7. Maltreatment recurrence

During the three-year window of observation 12.5% (n = 694) of the total population of children who were substantiated
maltreatment victims experienced a second maltreatment substantiation within 12 months of the index case closure. The average child
age was 6 years old (mean = 6.4, SD = 4.5) with a slightly greater number of female victims (51.9%, n = 360). Descriptively, Black
children experienced the highest rates of maltreatment recurrence (45.9%, n = 315), followed by White (21.6%, n = 148) and Native
American/Alaska Native children (19.8%, n = 136); however, Native American children experienced the highest proportional rates of
recurrence (16.7%), followed by Black (13.6%) and multiracial children (11.2%). The most common forms of maltreatment recorded
in the index report were neglect (62.7%, n = 435) and physical abuse (36.3% n = 252). No children experienced a substantiated
recurrence of sexual abuse (Table 1). For children experiencing maltreatment recurrence a history of domestic violence was present in
nearly two-thirds (63%) of index investigations. Caregiver mental health challenges (46%), parenting difficulties (46%), and caregiver
history of drug and alcohol problems (37%) were observed at moderate rates. Child disability was reported in just under one-third
(29%) of recurrence cases (Table 2).
The latent class analysis of maltreatment recurrence suggests a 3-class model best describes the data. Goodness of fit statistics
suggest slight improvement of BIC for a 2-class versus 3-class model, however a further comparison of the 2- and 3-class models suggest
the 2-class model was under extracted. In the 2-class model the probability of class membership was 0.67 (class 1) and 0.33 (class 2)
respectively. The classes were characterized by domestic violence (54%) or domestic violence (81%), mental health (76%), and
parenting challenges (69%). This was compared to the 3-class model which retained the domestic violence class (48%), but provided
additional explanatory value by disentangling cases with only mental health challenges (15%) from those which included co-occurring
mental health, substance abuse, and parenting challenges (37%). The 4- and 5-class models for maltreatment recurrence from the same
over extraction issues observed in the re-report sample. The selection of the 3-class model was further confirmed by the advisory group
review and discussion of the models theoretical and practical utility to current and future practice.
In the 3-class model Class 1 accounted for 48% of the sample and could be characterized primarily by “Domestic Violence

Table 3
Goodness of fit statistics for latent class models examining maltreatment re-report or recurrence.
Class Re-report Recurrence

G2 AIC BIC Entropy G2 AIC BIC Entropy

1 770.0 26,874.6 26,906.6 114.3 4585.2 4607.9

2 166.1 26,282.7 26,353.0 0.69 74.7 4557.7 4607.6 0.64
3 58.2 26,184.8 26,287.0 0.68 61.5 4556.5 4633.7 0.64
4 32.3 26,172.9 26,319.7 0.71 26.8 4533.8 4638.2 0.69
5 15.3 26,164.0 26,336.3 0.63 7.3 4526.2 4658.0 0.62

Note: Fit statistics suggest a 3-class model for the re-report sample and a 2-class model for the recurrence sample. Exploration of the probability of class
membership and estimated means suggests the 2-class model was under extracted.

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Table 4
Presence of risk by latent class for cases resulting in maltreatment re-report or recurrence.
Re-report Recurrence

Class 1 Class 2 Class 3 Class 1 Class 2 Class 3

Probability 0.56 0.26 0.18 0.48 0.15 0.37

Risk factor
Child disability 0.23 0.45 0.20 0.26 0.35 0.31
Domestic violence 0.38 0.63 0.68 0.54 0.00 1.0
Drug & alcohol 0.08 0.05 1.00 0.28 0.43 0.47
Mental health 0.10 0.68 0.54 0.00 1.0 0.82
Parenting 0.14 0.45 0.53 0.37 0.37 0.61

Note. Re-report classes were: Few Identified Challenges (Class 1), Mental Health and Domestic Violence Challenges (Class 2), and Substance Abuse,
Domestic Violence, Mental Health, and Parenting Challenges (Class 3). Recurrence classes were: Domestic Violence Challenges (Class 1), Mental
Health Challenges (Class 2), and Domestic Violence, Mental Health, and Parenting Challenges (Class 3).

Table 5
Summary of case characteristics according to latent class membership.
Re-report Recurrence

Class 1 Class 2 Class 3 Class 1 Class 2 Class 3

N % N % N % N % N % N %

Age
0–1 yrs 373 14.3 135 15.8 247 26.8 62 16.4 20 19.4 50 23.4
2–5 yrs 610 23.4 228 26.7 243 26.4 84 22.2 20 19.4 58 27.2
6–9 yrs 822 31.5 250 29.3 212 23.0 136 36.0 32 31.1 58 27.2
10–13 yrs 491 18.9 156 18.3 140 15.2 60 15.9 27 26.2 35 16.4
14 + yrs 315 12.0 84 9.9 80 8.7 36 9.5 4 3.9 12 5.6
Gender
Female 1,310 50.1 407 47.7 461 50.0 203 53.7 47 45.6 110 51.6
Male 1,305 49.9 446 52.3 461 50.0 175 46.3 56 54.4 103 48.4
Race
American Indian/Alaska Native 287 11.1 107 12.6 207 22.8 73 19.5 23 22.5 40 19.1
Asian 75 2.9 9 0.9 143 1.7 4 2.1 4 3.9 2 1.0
Black 1,290 49.8 399 47.0 298 32.8 186 49.6 38 37.3 91 43.5
White 689 26.6 243 28.6 246 27.1 84 22.4 21 20.6 43 20.6
Multiracial 248 9.6 92 10.8 143 15.7 24 6.4 16 15.7 33 15.8
Ethnicity
Hispanic 381 14.7 91 10.7 115 12.6 57 15.2 21 20.7 26 12.3
Maltreatment type
Neglect 1,586 60.7 579 67.9 698 75.7 230 60.8 67 65.0 138 64.8
Physical 981 37.5 296 34.7 302 32.8 140 37.0 31 30.1 81 38.0
Sexual 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0.0
Mental/Emotional 17 0.7 6 0.7 9 1.0 30 7.9 11 10.7 15 7.0

Note. Children may be reported or substantiated for more than one maltreatment type. Chi-square and Fisher's exact tests uncovered significant
differences across re-report classes according to child age, race, ethnicity, neglect, and physical abuse allegation type. Recurrence classes differed
according to child race and age.

Challenges.” A history of domestic violence was reported in 54% of recurrence cases. Moderate rates of parenting skill deficits (37%),
caregiver history of drug and alcohol problems (28%) and lower rates of child disability (20%) were reported. Class 2 accounted for
15% of the sample and could be characterized primarily by “Mental Health Challenges.” Caregiver mental health challenges were
endorsed in 100% of these cases. Caregiver history of drug and alcohol problems (43%), parenting skill deficits (37%) and child
disability (35%) were endorsed at moderate rates, although domestic violence was not present in this group. Class 3 accounted for 37%
of the sample and could be characterized by “Domestic Violence, Mental Health, and Parenting Challenges.” All cases (100%) were
endorsed for a history of domestic violence. High rates of caregiver mental health challenges (82%) and parenting skill deficits (61%)
were also reported. Moderate rates of caregiver history of drug and alcohol problems (47%) and child disability (31%) were also
reported (Table 4).
Results of the post-hoc analysis suggest the latent classes of maltreatment re-report differed according to child age [X2 (8, n = 693)
= 19.1, p < .01), and race [X2 (10, n = 685) = 21.7, p < .05]. Latent classes did not differ according to youth gender [X2 (2, n = 693) =
2.1, p = .35], Hispanic ethnicity [X2 (2, n = 687) = 3.8, p = .15], neglect [X2 (2, n = 693) = 1.2, p = .55], physical abuse [X2 (2, n =
693) = 2.1, p = .35], or mental/emotional abuse [X2 (2, n = 693) = 0.55, p = .70]. No sexual abuse substantiations were noted among
the latent classes of maltreatment recurrence.

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J. Waid et al. Child Abuse & Neglect 120 (2021) 105249

8. Discussion

The latent-class analysis illuminated a number of considerations for practice and future research. With respect to maltreatment re-
reporting, the largest latent class was characterized by “Few Identified Challenges.” This is consistent with previous person-centered
investigations of maltreatment re-report which identified latent classes characterized by low risk (Eastman et al., 2016; Kim et al.,
2020). The most immediate consideration resulting from this finding is to enhance the precision of index screening during the first CPS
contact. Given the low rates of identification of critical maltreatment risk factors in the largest latent class, practitioners, supervisors,
and program managers might consider whether their interview and assessment protocols are effectively adhering to the identifying
maltreatment risks during the index assessment. The latent classes “Mental Health and Domestic Violence” and “Substance Abuse, Do­
mestic Violence, Mental Health, and Parenting Challenges” extend previous research by identifying patterns of co-occurring risk which
have previously been identified in multivariate analysis (Barth et al., 2006; Drake et al., 2006; English et al., 1999; Murphy et al., 1992;
Sledjeski et al., 2008; Sledjeski et al., 2008). These findings also underscore the need for a systems of care approaches (Hernandez &
Hodges, 2003) to service delivery within child protection that attend to these indicators, including referral to community-based service
providers capable of attending to multiple co-occurring disorders and family challenges in one setting.
The post-hoc analysis of case characteristics associated with re-report class membership also provide considerations related to
culturally centered child protection investigations and assessments. Differences across classes were observed with respect to child age,
race, ethnicity, neglect, and physical abuse allegation reason. This could potentially be due to bias in the risk assessment process or the
structures in society that leave these populations more vulnerable. Structured internal and external reviews of cases to assess possible
bias may be helpful for uncovering patterns in decision making that need further attention. Supervisory reviews designed to make
decision-making explicit at the completion of risk assessments may also be useful for enhancing cultural awareness in the investi­
gation/assessment process. Organizational training designed to enhance caseworker capacity to build rapport and accurately screen
for mental health, drug and alcohol, and parenting challenges at index investigation/assessment and reduce drift from assessment
fidelity are also indicated.
Findings for maltreatment recurrence provide insights into the intractable nature of some maltreatment risks. The largest class
experiencing maltreatment recurrence was characterized by “Domestic Violence Challenges” and the second largest group was char­
acterized by “Domestic Violence, Mental Health, and Parenting Challenges.” The ubiquity of domestic violence across these cases is
consistent with previous research (White et al., 2015) and suggest a need for practitioners and service providers to be comfortable and
effective in screening and intervening to address domestic violence related issues - both within child protection and outside of this
system, as a multidisciplinary approach is needed to address these issues. The smallest recurrence class was characterized by ‘Mental
Health Challenges”, which underscores the need to disentangle mental illness from co-occurring challenges, and to continue to assess
and treat the mental health needs of families who experience maltreatment substantiation. Post-hoc analysis uncovered differences in
child age and race across recurrence classes, which further underscore the need for child welfare systems to develop maltreatment
assessment, prevention, and intervention strategies that are guided by a personalized prevention framework (August & Gewirtz, 2019).
Study results also provide a number of considerations for future child welfare screening, assessment, prevention, and intervention
efforts. The most common forms of maltreatment identified in index reports for both maltreatment re-reporting and recurrence
outcomes were neglect and physical abuse. This is consistent with prior research (Lipien & Forthofer, 2004; White et al., 2015), child
protection allegations for the state in which the study was conducted (Minnesota Department of Human Services, 2020) and for
maltreatment reports within the U.S. generally (US Department of Health and Human Services, 2021). Given the primacy of neglect
allegations and the deep-rooted and complex relationship between poverty and child maltreatment (see Heiman, 2021), child welfare
agencies must strategize with other human service entities to create and fund interventions aimed at remediating poverty-related
neglect referrals. Addressing poverty in this way may better position families to provide for their families in safe and effective
ways and prevent maltreatment re-referral and recurrence in the future.
Interestingly, none of the maltreatment re-reports or instances of recurrence included allegations of sexual abuse. This is despite
approximately 26% of all annual maltreatment reports allege sexual abuse (Minnesota Department of Human Services, 2020). This
may be due differences in the assessment and intervention process for children who are victims of sexual abuse versus children who
experience other forms of child maltreatment. For example, sexual abuse responses are often integrated and clearly defined with
respect to service provider action and family follow though (e.g., criminal investigation, alleged perpetrator is removed from the home,
etc.). Child welfare agencies are also positioned to employ many of the prevention strategies endorsed by the Centers for Disease
Control and Prevention, including promoting social norms and teaching skills to prevent sexual abuse, creating protective environ­
ments, strengthening economic support to families, enhancing parenting skills to promote healthy child development, and intervening
to lessen immediate and long-term harms (Basile et al., 2016).
Descriptively, Native American children experienced the highest rates of re-reporting and recurrence, followed by Multiracial and
Black children for re-reporting, and Black and Multiracial children for recurrence. This finding is consistent with research which
documents racial disparities within child protection and other child- and family-serving systems (Dettlaff & Boyd, 2021). It is also
important to note that race and ethnicity are proxy variables for systemic and historical factors that shape a person's access to and
ability to maintain resources, which may also impact these disparities. Future research aimed at identifying and modeling systemic and
historical factors on maltreatment re-referral and recurrence is indicated.

9. Limitations

Several limitations to the current study should be noted. A primary consideration is that the study utilized existing administrative

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data with key variables derived from a structured risk assessment. While the use of these data provides a full account of the universe of
cases using indicators to which practitioners have great familiarity, operational definitions and fidelity to the risk assessment process
could not be controlled; thus, threats to the reliability and internal validity of study measures may remain. Second, information
regarding the breadth and range of services received by families after the index investigation/assessment is not available in existing
administrative data. This information, if available, could be important for understanding likelihood of re-report or recurrence, as well
as changes in risk classification over time. Third, the scope was limited to examination of modifiable risk factors at the index
assessment for those children who had subsequent child protection involvement. As a result, changes to risk between first and sub­
sequent contacts was not examined. A latent transition analysis could be particularly useful for understanding how risk changes among
families who experience multiple recurrent child protection involvement; however, this was beyond the scope of the current study.
Fourth, the indicators used to formulate the latent classes were restricted to a limited number of modifiable risk factors, so other
ecological processes and environmental conditions that could be associated with maltreatment re-reporting and recurrence were not
accounted for. Finally, data were collected from a single metropolitan midwestern county. As such, caution should be taken in
generalizing findings to child welfare systems broadly.

10. Conclusion

The current study utilized administrative data from a large metropolitan midwestern county to create latent classes of risk for cases
experiencing maltreatment re-reporting or recurrence within 12 months of initial case closure. Findings underscore the complexity of
child maltreatment and co-occurrence of risk for both re-reporting and recurrence outcomes, and indicate the need for precision
prevention (August & Gewirtz, 2019) and systems of care (Hernandez & Hodges, 2003) approaches to child welfare screening,
assessment, prevention, and intervention efforts. The current study also highlights the utility of person-centered (i.e., latent class
analysis) as an approach to understanding maltreatment re-reporting and recurrence phenomenon in research and practice settings.
Additional research in the form of latent class transition analysis, exploring the moderating effects of service delivery on re-rereport
and recurrence, and identifying and modeling the systemic and historical factors on child welfare screening and investigation may
increase the capacity of child welfare systems and communities to effectively identify maltreatment risks, coordinate and provide
targeted prevention and early intervention services, and prevent repeated contacts with child welfare systems.

Funding

Research support is gratefully acknowledged from the Hennepin University Partnership, Hennepin County Minnesota (Award
#71891). The information reported herein reflects solely the positions of the authors.

Informed consent

As a secondary analysis of administrative data informed consent was not required.

Ethical approval

Human subject's protection was provided by the Institutional Review Board at the University of Minnesota.

Declaration of competing interest

The authors have no conflicts of interest to report.

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