CIS-2008 Major Findings Supplementary Tables: Physical Harm Requiring Medical Treatment in Substantiated Maltreatment Investigations

Introduction

The Canadian Incidence Study of Reported Child Abuse and Neglect-2008 (CIS-2008) is the third nation-wide study to examine the incidence of reported child maltreatment and the characteristics of children and families investigated by child welfare authorities in Canada. In addition to the tables presented in the Major Finding report [fn value=1]Public Health Agency of Canada (PHAC). (2010). Canadian incidence study of reported child abuse and neglect, 2008: Major findings. Ottawa: Authors.[/fn], the Supplementary Tables Information Sheet Series describes key child, household and investigation characteristics by primary category of substantiated maltreatment including confirmed risk. This Information Sheet examines substantiated maltreatment investigations in which medical treatment was required as a result of physical harm to a child.[fn value=2]Physical harm was only collected for maltreatment investigations. In this analysis, physical harm was not examined by primary category of maltreatment as the numbers were too low to be reliably estimated when broken down by maltreatment type.[/fn]
 

Findings

There were an estimated 174,411 maltreatment investigations conducted in Canada in 2008. At the end of the initial investigation, an estimated 85,440 maltreatment investigations were substantiated (49%). Of these substantiated maltreatment investigations, at least one type of physical harm was noted in 8% of investigations (an estimated 7,069 investigations).

Figure 1 outlines the type of physical harm which was present as a result of maltreatment in substantiated investigations. Investigating workers were asked to report all forms of physical harm that occurred to the child. The most common form of physical harm noted was bruises, cuts, and scrapes which were identified in 6% of substantiated maltreatment investigations. Children experienced broken bones as a result of maltreatment in an estimated 175 cases (less than 1%), head trauma in 325 cases (less than 1%), burns/scalds in 172 cases (less than 1%), and other health conditions in 1,989 cases (2%). Please note that the number of fatalities was too low to be reliably estimated.
 

Figure 1: Nature of physical harm in substantiated maltreatment investigations in Canada in 2008

In 34% of investigations with noted physical harm (estimated 2,414 investigations), the harm was severe enough to require medical treatment (see Figure 2).
 

Figure 2: Physical harm requiring medical treatment in substantiated maltreatment investigations in Canada in 2008

Although medical treatment was required in only 34% of investigations noting physical harm, when each form of physical harm is examined independently, it is evident that medical treatment was required in the majority of substantiated maltreatment investigations for all but one form of physical harm. Figure 3 displays that in 85% of investigations noting broken bones, 96% of investigations noting head trauma, 61% of investigations noting burns and scalds and 66% of investigations noting other health conditions, the physical harm was severe enough to require medical treatment. Bruises, cuts, and scrapes were the form of physical harm least likely to require medical treatment as only 17% of investigations noting this form of physical harm needed medical treatment.
 

Figure 3: Forms of physical harm requiring medical treatment in substantiated maltreatment investigations in Canada in 2008

Background to the CIS-2008

Responsibility for protecting and supporting children at risk of abuse and neglect falls under the jurisdiction of the 13 Canadian provinces and territories and a system of Aboriginal child welfare agencies which have increasing responsibility for protecting and supporting Aboriginal children. Because of variations in the types of situations that each jurisdiction includes under its child welfare mandate as well as differences in the way service statistics are kept, it is difficult to obtain a nation-wide profile of the children and families receiving child welfare services. The Canadian Incidence Study of Reported Child Abuse and Neglect (CIS) is designed to provide such a profile by collecting information on a periodic basis from every jurisdiction using a standardized set of definitions. With core funding from the Public Health Agency of Canada and in-kind and financial support from a consortium of federal, provincial, territorial, Aboriginal and academic stakeholders, the CIS-2008 is the third nation-wide study of the incidence and characteristics of investigated child abuse and neglect across Canada.
 

Methodology

The CIS-2008 used a multi-stage sampling design to select a representative sample of 112 child welfare service agencies in Canada and then to select a sample of cases within these agencies. Information was collected directly from child protection workers on a representative sample of 15,980 child protection investigations conducted during a three-month sampling period in the fall of 2008. This sample was weighted to reflect provincial annual estimates.

For maltreatment investigations, information was collected regarding the primary form of maltreatment investigated as well as the level of substantiation for that maltreatment. Thirty-two forms of maltreatment were listed on the data collection instrument, and these were collapsed into five broad categories: physical abuse (e.g., hit with hand), sexual abuse (e.g., exploitation), neglect (e.g., educational neglect), emotional maltreatment (e.g., verbal abuse or belittling), and exposure to intimate partner violence (e.g., direct witness to physical violence). Workers listed the primary concern for the investigation, and could also list secondary and tertiary concerns.

For each form of maltreatment listed, workers assigned a level of substantiation. Maltreatment could be substantiated (i.e., the balance of evidence indicated that an incident of maltreatment had occurred), suspected (i.e., maltreatment could not be confirmed nor ruled out) or unfounded (i.e., the balance of evidence indicated that an incident of maltreatment had not occurred).

A detailed presentation of the study methodology and of the definitions of each variable is available at www.cwrp.ca/sites/default/files/publications/en/CIS-2008_StudyMethods.pdf.
 

Limitations of the CIS-2008

The CIS collects information directly child welfare workers at the point when they completed their initial investigation of a report of possible child abuse or neglect, or risk of future maltreatment. Therefore, the scope of the study is limited to the type of information available to them at that point. The CIS does not include information about unreported maltreatment nor about cases that were investigated only by the police. Also, reports that were made to child welfare authorities but were screened out (not opened for investigation) were not included. Similarly, reports on cases currently open at the time of case selection were not included. The study did not track longer-term service events that occurred beyond the initial investigation.

Three limitations to estimation method used to derive annual estimated should also be noted. The agency size correction uses child population as a proxy for agency size; this does not account for variations in per capita investigation rates across agencies in the same strata. The annualization weight corrects for seasonal fluctuation in the volume of investigations, but it does not correct for seasonal variations in types of investigations conducted. Finally, the annualization weight includes cases that were investigated more than once in the year as a result of the case being re-opened following a first investigation completed earlier in the same year. Accordingly, the weighted annual estimates represent the child maltreatment-related investigations, rather than investigated children.

Comparisons across CIS reports must be made with caution. The forms of maltreatment tracked by each cycle were modified to take into account changes in investigation mandates and practices. Comparisons across cycles must in particular take into consideration the fact that the CIS-2008 was the first to explicitly track risk-only investigations. In addition, readers are cautioned to avoid making direct comparisons with provincial and First Nations oversampling report because of differences in the way national and oversampling estimates are derived.