Environmental risk refers to children whose caregiving circumstances place them at greater risk for poorer developmental outcomes. Biomedical risk refers to children with medical or other biologically-based problems associated with poorer developmental outcomes.
- Children birth to 36 months of age who have been maltreated are at substantial risk of experiencing subsequent developmental problems. In addition to maltreatment, the 10 risk factors listed in Exhibit 1 were selected based on our review of classic works on the impact of cumulative risk on developmental outcomes. Fifty-five percent of children under the age of three with substantiated cases of maltreatment are subject to at least five risk factors associated with poorer developmental outcomes.
Percentage of Maltreated Infants
& Toddlers with Selected Risk Factors
100% Child Maltreatment
58% Minority Status
48% Single Caregiver
40% Domestic Violence
39% Caregiver Substance Abuse
30% Caregiver Mental Health Problem
29% Low Caregiver Education
22% Biomedical Risk Condition
19% Teen-aged Caregiver
14% 4 or More Children in Home
Individually any of these factors may not be predictive of poor developmental outcomes, but the exposure to multiple risk factors increases the likelihood. It has been demonstrated that a single risk factor such as poverty (Duncan, Brooks-Gunn, Klebanov, 1994) or maternal mental health (Laucht, Esser, & Schmidt, 2001) can be associated with poorer developmental outcomes for infants and toddlers. The least positive developmental outcomes are, however, associated with the cumulative effect of a range of multiple risk factors (Rutter, 1979; Sameroff, Seifer, Zax, & Barocas, 1987; Sameroff, 1998).
Information was available to compare some of the demographic characteristics of substantiated infants and toddlers with children the same age entering Part C, and those in the general population (see Exhibit 2).
Percentages of Infants and Toddlers with Selected Risk Factors
Risk Factor Substantiated Maltreatment
Part C (NEILS)
Minority status 58% 47% 39% Single caregiver 48% 15% 15% Poverty 46% 32% 24% Less than high school education 29% 16% 17% Four or more children in the home 14% 8% 8% Source: NSCAW; Hebbeler et al., 2003 for NEILS & National Household Education Survey (NHES).
- Compared to classification at the time of initial contact with Child Welfare Services, over time a higher proportion of children are described as having fewer risks or with a low score on a developmental measure while over time a smaller proportion of children are described as having more risks. By 36 months after involvement with Child Welfare Services, the findings show a large increase (21% to 45%) in children who have shown improvement by having fewer risks, and the percentage of children in the highest risk classification declined by more than half from 29% to 13%.
- Few infants and toddlers with substantiated cases of maltreatment are reported to have a diagnosed medical condition (an established risk condition(2)) as described in IDEA (e.g., Down syndrome, blindness, cerebral palsy) that would make them automatically eligible for Part C services. Though not reflected in eligibility distributions, 38% of infants and toddlers entering Part C are reported by caregivers or service providers to have an established risk condition, compared to 3% of infants and toddlers with a substantiated case of maltreatment. A condition of established risk is defined as a "diagnosed physical or mental condition which has a high probability of resulting in developmental delay." Children with these conditions are eligible for Part C services without documentation of delay.