389 - Child Welfare Outcomes Among Children with and without Nurse Family Partnership: A Propensity Score Matched Assessment in Florida from 2010-2023

Publication Number: 389.4401

James G. Kaferly, University of Colorado School of Medicine, Denver, CO, United States; Gregory Tung, Colorado School of Public Health, Aurora, CO, United States; Laura Helmkamp, University of Colorado School of Medicine, Denver, CO, United States; Michael Knudtson, University of Colorado School of Medicine, Aurora, CO, United States; Natalie Murphy, University of Colorado School of Medicine, Frederick, CO, United States; Mandy A. Allison, University of Colorado School of Medicine, Denver, CO, United States

Background: Nurse-Family Partnership (NFP) trials provide evidence for the prevention of child maltreatment through home visiting programs. Home visiting programs have been widely implemented and serve diverse populations at risk for child welfare involvement; yet, program effectiveness on child welfare outcomes is limited.

Objective: To examine child welfare outcomes subsequent to a maltreatment report among NFP-served and comparison children.

Design/Methods: We linked Florida NFP and birth certificate datasets to identify first born children of primiparous birthing individuals in Florida between January 1, 2010 and September 7, 2023. Using multivariable logistic regression, we created propensity scores for NFP participation by dyad sociodemographic characteristics: age; race; ethnicity; birthplace; education level; marital status; prenatal care; insurance and child’s year and county of birth. Our sample was 38,257 children (6436 NFP and 31,821 comparison). A Florida child welfare administrative dataset was used to link NFP-served and comparison children with a maltreatment report during the study period. We generated odds ratios where the sample at risk for each subsequent outcome was the previous outcome- for example, the odds of an investigated report among those with any report, the odds of a verified report among those with an investigated report, and the odds of being removed from the home among those with a verified report. The final three outcomes - kinship placement, family permanency and termination of maternal rights - were all calculated among those ever removed from the home. We estimated program effects on maltreatment prevention and family preservation child welfare outcomes for the two cohorts of children reported to child welfare using generalized linear mixed models.

Results: We identified 1,597 NFP and 6,392 comparison children with a child welfare report. NFP children had significantly greater odds of reports (Odds Ratio [OR] 1.33, 95% confidence interval [CI] 1.24 -1.41) but not investigations (OR 0.91, CI 0.79-1.05), verification (OR 1.06, CI 0.92-1.21), removal (OR 0.99, CI 0.78-1.24), kinship placement (OR 1.21, CI 0.78-1.88), familial permanency (OR 0.71, CI 0.48-1.04) or termination of parental rights (OR 1.24, CI 0.62-2.48).

Conclusion(s): Among children with a child welfare report, post-report child welfare outcomes did not differ between NFP children and comparison children. Future research should increase sample sizes to detect what maybe small but significant program effects and develop approaches to explicitly account for child welfare policy and practice heterogeneity.

Figure 1. Identification of Nurse-Family Partnership and Comparisons Dyads Using Linked Florida Datasets
Fig 1_Update.pdfIdentification of Nurse-Family Partnership and Comparisons Dyads Using Linked Florida Datasets

Table 1. Sample Characteristics by Treatment Group: Propensity-Score Matched (PS-Matched) Comparison and Nurse Family Partnership (NFP), July 2010 – August 2023 (N = 38,257)
Table 1.pdfSample Characteristics by Treatment Group: Propensity-Score Matched (PS-Matched) Comparison and Nurse Family Partnership (NFP), July 2010 – August 2023 (N = 38,257)

Table 2. Child Welfare Outcomes Following a Maltreatment Report by Treatment Groups
Table 2.pdfChild Welfare Outcomes Following a Maltreatment Report by Treatment Groups