Children with any level of child protective services involvement had three times the odds of dying by suicide — a new finding that highlights the need for more robust supportive services and mental health care, even for children whose abuse is not confirmed.

"One thing most people do not realize is that although millions of children are reported to CPS each year, very few of those children will actually receive any services after being investigated," said Lindsey Palmer, a Ph.D. candidate at the University of Southern California's Suzanne Dworak-Peck School of Social Work and the lead author of the study, published April 1 in the Journal of Adolescent Health. "What happens to these families and children? I would not claim to have any simple 'policy fixes,' but I do hope that this and other analyses reinforce that we must consider how the front end of the child protection system is designed and what we hope to achieve."

In the United States, about one in three children go through an investigation after an allegation of maltreatment; after investigations, protective services have confirmed that one in eight American children experience abuse or neglect before they're 18. This study looked at all registered California births between Jan. 1, 1999, and Dec. 31, 2000 — a two-year period during which approximately 1.05 million babies were born — and followed those children through 2017, when they were turning 17 or 18. 

Of the children in the study, 170 killed themselves; and of those 170 children, more than half — 56.5% — had past allegations of abuse or neglect. Children with any CPS involvement had odds of suicide three times as high as children with no CPS history. And although much research focuses on children who are removed into foster care, this study found no significant difference between children with substantiated abuse claims, including those who were placed in foster care, and children who only had an allegation. 

"The mandate of CPS is to protect children from child abuse and neglect, which may include investigating allegations of maltreatment and providing services to confirmed — substantiated — victims of maltreatment," Palmer, a trained social worker, told The Academic Times. "The agency is not necessarily designed or funded to offer primary and secondary prevention measures, which would include offering services and/or mental health screenings to families before they are reported to CPS or to families with unsubstantiated allegations." 

The number of children who killed themselves was, as Palmer put it, "thankfully" somewhat small. The researchers addressed this by using a matched case-control study design, with 170 cases and 678 matched controls. They used a conditional logistic regression model to account for demographic variations. "That way, the variables in the ... model test how the CPS-specific variables affect the outcome," Palmer said.

The results indicate that states need better screening and referrals for children who are alleged victims of abuse or neglect, even when the allegations cannot or haven't yet been substantiated by investigators. Notably, many children have access to firearms that put them at greater risk for suicide.

The authors wrote that CPS ought to strengthen its ability to refer children and families to community-based programs and improve care coordination. Certain jurisdictions already provide some services like this — Los Angeles County, Palmer said, refers people to voluntary programs at several points before a claim is found to be substantiated or unsubstantiated. But there is much more to be done to protect vulnerable children's health and well-being, in a country that already lacks comprehensive suicide prevention services.

Palmer said she hopes "that more attention will be paid to the large population of children who are reported but never substantiated and likely not connected to community services."

The study, "A population-based examination of suicide and child protection system involvement," published April 1 in the Journal of Adolescent Health, was authored by Lindsey Palmer and John Prindle, University of Southern California; and Emily Putnam-Hornstein, University of California, Berkeley, University of North Carolina at Chapel Hill, and University of Southern California.