Policy & Practice | October 2021

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(95% Confidence Interval: [-449, -33]), equivalent to a 5 percent decline in maltreatment reports, and that the reduction was driven primarily by fewer reports of neglect. Our results also indicated that state EITC benefits reduced rates of neglect the most among children under age 5, the popu lation with the highest baseline rates of neglect. We did not find a significant association between state-level EITC benefits and types of maltreatment other than neglect (physical abuse, emotional abuse, and sexual abuse). Overall, our results add to growing evidence that anti-poverty programs can reduce maltreatment risk and divert families from needing CPS involvement. 8,9,10 Public programs that improve income sufficiency or sta bility may be well suited for primary prevention efforts (i.e., preventing mal treatment before it begins), since the benefits of such programs can reach families regardless of—and hopefully before—any involvement with CPS. Our results highlight the important role that income supports may play in preventing child neglect. Neglect makes up the majority (75 percent) of maltreatment cases and is thought to be more closely associated with financial and material hardship than other forms of child maltreatment. CPS interven tions to address maltreatment often focus on changing parenting behaviors, but anti-poverty policies may be better suited to address financial hardship. 11 Health and human services organi zations are well positioned to advocate for policies that promote economic security and prevent maltreatment. Support for such policies is timely, as policymakers consider making permanent significant and historic changes to U.S. social safety in 2021. These changes include expansions to the Child Tax Credit and the EITC under the American Rescue Act of 2021, which are projected to reduce the number of children below the poverty line by more than 40 percent. 12 Implications for Policy and Practice

Furthermore, workers in health and human services can play a role in directing families to public benefits, which is important given that many families do not receive the public benefits for which they are eligible. Reference Notes 1. U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2018). Child maltreatment 2018. https:// www.acf.hhs.gov/sites/default/files/ documents/cb/cm2018.pdf 2. Kim, H., Wildeman, C., Johnson-Reid, M., & Drake, B. (2017). Lifetime prevalence of investigating child maltreatment among US children. American Journal of Public 3. Wildeman, C., Emanuel, N., Leventhal, J. M., Putnam-Hornstein, E., Waldfogel, J., & Lee, H. (2014). The prevalence of confirmed maltreatment among US children, 2004 to 2011. JAMA Pediatrics, 168 (8), 706–713. https://doi.org/10.1001/ jamapediatrics.2014.410 4. Fortson, B. L., Klevens, J., Merrick, M. T., Gilbert, L.K., & Alexander, S.P. (2016). Preventing child abuse and neglect: A technical package for policy, norm, and programmatic activities. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. https://www.cdc.gov/violenceprevention/ pdf/can-prevention-technical-package.pdf 5. IRS. Earned income tax credit & other refundable credits. https://www.eitc.irs .gov/eitc-central/about-eitc/about-eitc 6. Simon, D., McInerney, M., & Goodell, S. (October 4, 2018). The earned income tax credit, poverty, and health. Health Affairs Policy Brief. https://doi.org/10.1377/ hpb20180817.769687 7. Kovski, N L., Hill, H., Mooney, S., Rivara, F.P., Morgan, E.R., & Rowhani-Rahbar, A. (2021). Association of state-level earned income tax credits with rates of reported child maltreatment, 2004–2017. Child Maltreatment. https:// doi.org/10.1177/1077559520987302 8. Rostad, W. L., Ports, K.A., Tang, S., & Klevens, J. (2020). Reducing the number of children entering foster care: Effects of state earned income tax credits. Child Maltreatment, 25( 4), 393–397. https:// doi.org/10.1177/1077559519900922 9. Klevens, J., Luo, F., Xu, L. Peterson, C., & Latzman, N.E. (2016). Paid family leave’s Health, 107 (2), 274–280. https:// doi.org/10.2105/AJPH.2016.303545

effect on hospital admissions for pediatric abusive head trauma. Injury Prevention, 22 (6), 442–445. https://doi.org/10.1136/ injuryprev-2015-041702 10. Berger, L.M., Font, S.A., Slack, K.S., & Waldfogel, J. (2017). Income and child maltreatment in unmarried families: Evidence from the earned income tax credit. Review of Economics of the Household, 15 (4), 1345–1372. https:// doi.org/10.1007/s11150-016-9346-9 11. Feely, M., Raissian, K.M., Schneider, W., & Bullinger, L.R. (2020). The social welfare policy landscape and child protective services: Opportunities for and barriers to creating systems synergy. The ANNALS of the American Academy of Political and Social Science, 692 (1), 140–161. https:// doi.org/10.1177/0002716220973566 12. Marr, C., Cox, K., Hingtgen, S., & Windham, K. (March 21, 2021). Congress should adopt American Families Plan’s permanent expansions of child tax credit and EITC, make additional provisions permanent. Center on Budget and Policy Priorities. https://www.cbpp.org/ research/federal-tax/congress-should adopt-american-families-plans-permanent expansions-of-child

Nicole L. Kovski , MS, MPP; Daniel J. Evans School of Public Policy and

Governance, University of Washington, Seattle, WA

Heather D. Hill , MPP, PhD; Daniel J. Evans School of Public Policy and

Governance, University of Washington, Seattle, WA

Stephen J. Mooney , MS, PhD; Harborview Injury Prevention and Research Center; Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA Frederick P. Rivara , MD, MPH; Harborview Injury Prevention and Research Center; Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA Ali Rowhani-Rahbar , MD, MPH, PhD; Harborview Injury Prevention and Research Center; Department of Epidemiology, School of Public Health; Department of Pediatrics, School of

Medicine, University of Washington, Seattle, WA

October 2021 Policy&Practice 31