Predictors of Child and Parent Offender Removal in Incidents of Child Neglect in U.S. Army Families
===================================================================================================

* Christin M. Ogle
* Steven P. Nemcek
* Jing Zhou
* Stephen J. Cozza

## Abstract

This study examined predictors of child and parent offender removal from the home following substantiated incidents of child neglect in U.S. Army families. Case records (*n* = 390) were coded to identify neglect types and incident characteristics associated with removal in prior studies. Results indicate that the removal of a child and the removal of a parent from the home following an incident of neglect are associated with distinct neglect types and incident characteristics. In bivariate analyses, failure to provide physical needs (FTP), family mental health problems, and co-occurring abuse were each associated with higher odds of child removal. In multivariate analyses, offender substance use, co-occurring abuse, and early parenting, but not FTP, were associated with child removal. Interaction models indicated that high-severity FTP incidents in families with mental health problems were more likely to result in child removal compared with other neglect incidents. In contrast, incidents involving emotional neglect and service member offenders were associated with higher odds of parent removal. Findings advance understanding of the characteristics of neglect incidents associated with family separations, which can improve the judiciousness of legal decisions regarding removal actions and inform prevention efforts that effectively protect children from harm while minimizing disruptions to family integrity.

*   child neglect types
*   child removal
*   parent removal
*   child welfare decision-making

Child welfare services in the United States have the implicit goal of family preservation. Although traditionally assumed, this goal has also been explicitly codified into American law.1 Family preservation efforts need to be balanced with the potentially conflicting goal of ensuring the safety of children in a home. Nowhere is this balance more challenging than in circumstances involving prior or current child maltreatment. The protective actions child welfare professionals take in an attempt to ensure child safety not infrequently involve decisions to separate families, by removing the child or the offending parent from the home. According to data collected by the U.S. Department of Health and Human Services (DHHS), 20 percent of child maltreatment victims in the United States were removed from their homes in 2022.2 Because of the frequency of removal actions and the impact of these decisions on child safety, a growing body of research has examined factors that influence the decision to remove a child or parent offender from the home.3,–,6

Understanding factors that influence decision-making in child welfare has become increasingly important in the context of equivocal findings regarding the impact of child removal on children’s health and well-being. For example, some reports suggest that children removed from the home evince increases in quality of life7,8 and decreases in mental health problems in the one to two year period following removal.9 In contrast, a series of meta-analyses examining the functioning of maltreated children who were removed from home and placed into foster care compared with maltreated children who remained with their parents and with children from the general population indicate that foster children did not substantially differ from maltreated children who remained at home.10 Foster youth also exhibited lower levels of functioning and more externalizing behavioral problems than children from the general population.10 Research on adults with histories of out-of-home placement also indicates that out-of-home placement is associated with long-term mental health problems, poor subjective health, smoking, obesity, lower educational attainment, poverty, and use of public assistance in adulthood11 as well as entry into the adult criminal justice system.12 Although no prior studies have examined child outcomes associated with parent offender removal from the home, research on parent-child separation in other contexts (e.g., parental incarceration and parental deportation) suggests that parent offender removal may incur negative consequences for children.13,–,16

The equivocal nature of child outcomes following removal actions may be explained by differences in the psychosocial circumstances of the family and characteristics of the maltreatment incidents that precede the removal. Research concerning factors that predict child removal has focused on the influence of parent gender,3,17 child and parent race,3,18,–,20 maltreatment severity and recurrence,3,5,21,22 parental substance use,3,4,6,23,24 and parental mental illness.3,18,25,–,27 The majority of this work has examined predictors of child removal following incidents of child maltreatment broadly defined. Less is known about incident characteristics associated with child removal following specific types of child maltreatment (i.e., physical, emotional, and sexual abuse), including child neglect. Results from the few existing studies suggest that children who experience neglect are more likely to be removed from home compared with children who experience physical, sexual, or emotional abuse.5,19 In addition, children who experience neglect and another type of maltreatment concomitantly are more likely to be removed compared with children who experience a single maltreatment type.22

Similarly, little is known about predictors of parental removal following child maltreatment, and no prior studies have examined parent removal following incidents of child neglect. Existing research has focused on parental removal following incidents of child maltreatment broadly defined in U.S. Army families.4 Results indicated that service member parent offenders who used substances during the maltreatment incident were more than twice as likely to be removed, and incidents that involved parental substance use and co-occurring spouse abuse were the most likely to result in parental removal.

Research, prevention, and policy efforts regarding parental removal have been limited by the lack of publicly available data on the frequency of parental removal following child maltreatment incidents.28 In contrast to the DHHS annual reports of national rates of child removal,2 DHHS does not report aggregated state-level rates of parental removal from the home following incidents of child maltreatment, possibly because such actions can be initiated by a range of agencies and authorities. In the civilian population, parent removal may occur because of parental arrest by law enforcement, protective orders issued by courts, and in divorce proceedings or legal separations in which custody is awarded to one parent. In military communities, commanders also have broad authority to confine service member parents as part of disciplinary actions in response to family violence incidents. In military families that live on military installations, civilian parent offenders can be barred from accessing the base. Civilian authorities, including civilian law enforcement, can also coordinate with military law enforcement to arrange for the removal of civilian parent offenders from the home.

Other differences between the military and civilian child welfare agencies may affect child welfare decision-making regarding family separations. In the military, the Department of Defense (DOD) Family Advocacy Program (FAP) is the agency charged with the investigation, treatment, and prevention of child maltreatment involving service members or their dependents. FAP prioritizes family preservation and balances efforts to protect family integrity while ensuring child safety, similar to civilian child protective services (CPS).29 In contrast to the civilian sector, in which decisions regarding child protective actions and incident substantiation are often made by a single CPS case manager, DOD policy stipulates that multidisciplinary teams of professionals from social work, forensic health care (i.e., medical forensic service providers who specialize in the care of survivors of crime, including sexual assault, intimate partner violence, and child sexual abuse), law enforcement, and criminal justice work together in clinical case staff meetings (CCSM) and on incident determination committees (IDC) to provide a coordinated community response to allegations of suspected child maltreatment.29 In particular, CCSMs generate clinical recommendations for services and treatment for child maltreatment victims and abusers and provide coordinated case management. Members of IDCs evaluate whether a reported incident of child abuse or neglect meets standardized criteria for child maltreatment and whether the act significantly affected the victim. In contrast to the civilian sector, in which definitions of child abuse and neglect vary across jurisdictions, the DoD has adopted uniform definitions of child abuse and neglect that are employed at military installations worldwide. The DoD also utilizes an electronic algorithm for substantiation decisions in response to concerns about the reliability of child welfare decision-making in both the civilian and military sectors.30,31

It is important for professionals working in the civilian sector to understand the patterns of child maltreatment and factors that predict removal decisions in military families, given that child maltreatment incidents in military communities must be investigated by both military and civilian authorities. When FAP receives a reported allegation of child abuse or neglect, the local CPS agency must be notified and at least one CPS caseworker is required to serve on the CCSM and the IDC to assist in generating clinical recommendations, including necessary child protective actions and decisions regarding whether or not the incident meets the DOD definition of child abuse or neglect.29 Civilian law enforcement may also be involved in coordinating the removal of civilian parent offenders. In addition, DOD policy stipulates that IDCs must include a licensed professional from the forensic health care system with expertise in family violence and that members of the IDC must have opportunities to consult with licensed forensic health care professionals to assist with decision-making regarding the treatment and placement of child victims.29 Consultation provided by child forensic psychiatrists involved in child abuse and neglect incidents may also entail risk assessments, protective actions to ensure the safety of the victim and other children cared for in the home, as well as opinions regarding termination of parental rights.32,33

Greater understanding of factors that influence child and parent offender removal actions after incidents of neglect is crucial to both civilian and military forensic psychiatrists, given the high frequency and lethality of child neglect and the role of forensic psychiatrists in child welfare decision-making in cases involving child neglect. National data indicate that three-quarters of child maltreatment victims in 2022 experienced neglect and that neglect was involved in 85 percent of incidents that resulted in child fatality.2 Of the children who were removed from home and placed in foster care in 2022, neglect was identified as the circumstance associated with the child’s removal in 62 percent of cases.34 Compared with other types of maltreatment, neglect is also associated with higher risk of recurrence,35,–,37 which may indicate the inadequacy of the child welfare response to protect children from future harm following incidents of reported neglect. The growing empirical evidence demonstrating that neglect is a heterogeneous phenomenon characterized by multiple distinct types of neglectful caregiving rather than a single, broad category of maltreatment38,39 further underscores the need for more nuanced analyses that examine differences in removal actions across neglect types. Few prior studies have examined factors that influence removal actions after child maltreatment incidents involving different neglect types, and results have been mixed.18,24,35 Some studies indicate that children who are physically neglected are more likely to be removed compared with children who experience other types of neglect or abuse (e.g., physical or sexual abuse),24,35 whereas other studies indicate that children who experience supervisory neglect are at heightened risk of removal compared with children who experience physical neglect or physical abuse.18 The present study aims to address current research gaps by examining the extent to which child or parent offender removal actions are differentially associated with child neglect types and other incident characteristics in substantiated incidents of child neglect in U.S. Army families.

## Method

### Sample and Procedure

The initial sample included 400 substantiated incidents of child neglect that were randomly selected from the 2,718 incidents of substantiated child neglect at four U.S. Army installations in 2003 to 2009. All incidents met criteria for child neglect according to DOD policy,40 which defines child neglect as “The negligent treatment of a child through acts or omissions by an individual responsible for the child’s welfare under circumstances indicating the child’s welfare is harmed or threatened.” (Ref. 40, p 22). Using random sampling stratified by year, data were collected from the case records of 100 incidents per site. Incidents were excluded and replaced if less than 80 percent of the case record was complete. Less than one percent (*n* = 3) of incidents were excluded for this reason. In the current analysis, 7 incidents involving nonparental child maltreatment were also excluded.

A 244-item record review form was developed to record and code neglect incident characteristics using information drawn from case records. When incidents involved more than one child, data were collected only for the child with the next birthday after the date of the record review. Neglect types (failure to provide (FTP) physical needs, lack of supervision, emotional neglect, moral-legal neglect, and educational neglect) and abuse types (physical, emotional, and sexual) involved in each incident of neglect were coded based on criteria outlined in the Modified Maltreatment Classification System (MMCS),41 a reliable and valid method of classifying maltreatment types that has been widely used in research and in applied settings.42,43 Coding was conducted by members of the research team who participated in two one-hour training sessions. Cohen’s κ was used to assess interrater reliability of neglect type coding in 40 (10%) randomly selected incidents. Average κ for each neglect type was greater than .80. Discrepancies in coding among raters were discussed until raters reached a consensus. Incident severity was also coded based on MMCS criteria. Incidents with neglect severity scores of 1 to 3 and 4 to 5 were classified as low and high severity, respectively. Study procedures were approved by the Institutional Review Board at the Uniformed Services University of the Health Sciences.

### Measures

#### Child and Parent Offender Removal

Dichotomous measures of child removal from home and parent offender removal from home were drawn from administrative data collected by the Army FAP Case Review Committee.

#### Predictors of Child and Parent Offender Removal

The following neglect types were examined as predictors of child and parent offender removal from home: FTP, lack of supervision, emotional neglect, and moral-legal neglect. Because of low frequency in this sample, educational neglect was excluded from the analyses. A brief description of each neglect type is provided in Appendix I.

The child, parent, and family characteristics that were examined as predictors of child and parent offender removal from home were assessed using information reported by case workers on standard intake forms or administrative data collected by the Army FAP Case Review Committee. Predictors included incident severity, child victim age, child victim sex, child race, offender age at birth of child, offender type (service member parent, civilian parent, both), highest military rank in the family, number of children in the home (one versus two or more), service member parent marital status (married versus unmarried), offender substance use at the time of the incident, parental offender previously known to FAP, child victim previously known to FAP, family physical health problems, family mental health problems, and co-occurring physical or sexual abuse. All characteristics were assessed using dichotomous single-item measures, except for family mental health problems, which were based on endorsement of items querying family mental health problems and family history of suicide attempts.

### Statistical Analysis

To examine differences in the frequencies of child removal from home and parent offender removal from home in incidents involving different child neglect types, chi-square tests were used to compare the number of incidents that involved each neglect type versus incidents that did not involve that type (“other”) for incidents that resulted in child or parent offender removal.

To identify the child, parent, family, and incident characteristics associated with increased odds of child removal from home and parent offender removal from home, a series of bivariate logistic regressions were conducted with child removal from home and parent offender removal from home examined as outcomes. Bivariate predictors were then examined in multivariate logistic regressions to assess the extent to which they were associated with increased odds of child or parent offender removal from home while controlling for their shared variance. Predictors included in the multivariate models were selected based on their bivariate associations with removal actions in our study or their differential associations with various neglect types or child welfare outcomes in prior studies.3,4,23,24,26,35 Missing data were limited to incident severity and demographic characteristics (i.e., child age, child sex, child race, offender age at birth of child, highest military rank in the family, number of children in the family). Given that the percentage of missing data for each variable was low (.26 − 3.59%) participants with missing data were retained in the analyses.

## Results

Demographic characteristics of maltreated children and their families are shown in Table 1. The parent who engaged in neglectful caregiving was either the service member, the service member’s spouse, or both the service member and spouse in 27.18, 40.77, and 32.05 percent of incidents, respectively. The mean age of parents who engaged in neglectful caregiving was 27.46 (standard deviation (*SD*) = 5.65).

View this table:
[Table 1](http://jaapl.org/content/early/2025/02/21/JAAPL.240114-24/T1)

Table 1 
Demographic Characteristics of Maltreated Children and Their Families

### Child and Parent Offender Removal from Home

The child victim was removed from home in 14.87 percent (*n* = 58) of cases. The parent offender was removed from home in 12.05 percent (*n* = 47) of cases. Table 2 presents the number of incidents that resulted in child removal from home and parent offender removal from home for each neglect type. Child victims were removed from the home more frequently in physical neglect incidents (χ2 = 5.86, *p* < .05) and less frequently in emotional neglect incidents (χ2 = 6.48, *p* < .01) compared with incidents that did not involve these neglect types. In contrast, parent offenders were removed from the home more frequently in emotional neglect incidents (χ2 = 27.95, *p* < .001) and less frequently in physical neglect (χ2 = 9.75, *p* < .001) and supervisory neglect (χ2 = 9.68, *p* < .01) incidents compared with incidents that did not involve these neglect types.

View this table:
[Table 2](http://jaapl.org/content/early/2025/02/21/JAAPL.240114-24/T2)

Table 2 
Child and Parent Offender Removal from Home by Child Neglect Types

Results from the bivariate logistic regressions conducted to identify the child, parent offender, family, and incident characteristics associated with child removal from home and parent offender removal from home are found in Table 3. Whereas FTP (odds ratio (OR) = 1.99, 95% confidence interval (CI) [1.13, 3.51]), co-occurring physical or sexual abuse (OR = 2.59, 95% CI [1.13, 5.95]), younger offender age at the birth of the child (OR = .92, 95% CI [.85, .99]), and family mental health problems (OR = 1.96, 95% CI [1.04, 3.69]) were each associated with higher odds of child removal from home, emotional neglect was associated with lower odds of child removal from home (OR = .45, 95% CI [.24, .84]).

View this table:
[Table 3](http://jaapl.org/content/early/2025/02/21/JAAPL.240114-24/T3)

Table 3 
Bivariate Associations Between Incident Characteristics and Child and Parent Offender Removal from Home

In contrast, the odds of parent offender removal from home were nearly six times higher in incidents involving emotional neglect (OR = 5.78, 95% CI [2.84, 11.76]) and over three times higher in high-severity incidents (OR = 3.67, 95% CI [1.80, 7.46]) but significantly lower in incidents involving FTP (OR = .27, 95% CI [.11, .64]) and supervisory neglect (OR = .33, 95% CI [.16, .68]). Incidents that involved offender substance use also had higher odds of parent offender removal from home (OR = 2.25, 95% CI [1.17, 4.31]). In addition, incidents in which the service member parent was identified as the neglectful caregiver were associated with higher odds of parent removal compared with incidents in which the civilian parent or both the civilian parent and the service member parent were identified as neglectful caregivers (OR = 3.40, 95% CI [1.61, 7.17] and OR = 2.61, 95% CI [1.23, 5.54], respectively).

Results from the multivariate logistic regressions are noted in Table 4. (The following child, parent offender, and family characteristics were not significantly associated with child or parent offender removal from home and were therefore not retained in the multivariate analyses: child sex, age, and race; child previously known to FAP; offender previously known to FAP; highest family rank; multiple children in the home; service member parent marital status; and family physical health problems.) Co-occurring physical or sexual abuse (OR = 3.70, 95% CI [1.40, 9.80]) and offender incident-related substance use (OR = 2.11, 95% CI [1.04, 4.25]) were each associated with greater odds of child removal from home. In addition, younger offender parent age at the birth of the child victim was associated with higher risk of child removal from home (OR = .88, 95% CI [.81, .95]).

View this table:
[Table 4](http://jaapl.org/content/early/2025/02/21/JAAPL.240114-24/T4)

Table 4 
Multivariate Associations Between Incident Characteristics and Child and Parent Offender Removal from Home

Given that none of the neglect types, including FTP, were associated with child removal when the model was adjusted for other child, parent, family, and incident characteristics, we conducted a series of exploratory two-way interactions between FTP and select incident characteristics to identify which combinations of characteristics in the context of physical neglect might confer elevated risk of child removal. We focused on incident severity, parental mental health problems, and parent offender substance use based on the strength of their association with child removal in our bivariate analyses and in prior studies.3,4,23,25,27,44 Each interaction term was tested in a separate multivariate regression adjusted for covariates, followed by simple effects analyses for significant interactions. The following two interactions were significant in predicting child removal from home: family mental health problems × FTP, Wald χ2 = 4.14, *p* < .05 and high incident severity × FTP, χ2 = 4.38, *p* < .05. Simple effects analyses indicated that children involved in physical neglect incidents that occurred in families with mental health problems were three times more likely to be removed from home compared with children involved in physical neglect incidents in families without mental health problems (OR = 3.32, 95% CI [1.30, 8.51]). Similarly, children involved in physical neglect incidents that were identified as highly severe had higher odds of being removed from home compared with children involved in low severity neglect incidents (OR = 3.53, 95% CI [1.35, 9.24]). In contrast, neither family mental health problems nor incident severity were associated with child removal in incidents that involved neglect types other than FTP (OR = .66, 95% CI [.20, 2.25] and OR = .88, 95% CI [.35, 2.22], respectively).

To further identify high-risk groups, a multivariable logistic regression with a three-level categorical predictor indexing high-severity FTP incidents in families with mental health problems versus other FTP incidents (e.g., incidents that occurred in families with or without family mental health problems or high severity) and versus other neglect types (i.e., all incidents other than those involving FTP) indicated that children involved in high-severity FTP incidents in families with documented mental health problems had higher odds of being removed from home compared with children involved in other FTP incidents (OR = 4.90, 95% CI [1.64, 14.60]) and children who experienced other neglect types (OR = 6.75, 95% CI [2.21, 20.58]).

Results from the multivariate regression predicting parent offender removal (Table 4) indicated that emotional neglect was associated with higher odds of parent offender removal from home (OR = 4.73, 95% CI [1.49, 15.00]). In addition, incidents in which the service member parent was documented as the singular neglectful caregiver were associated with greater odds of parent removal from home compared with incidents in which both the service member and the civilian parents were identified as neglectful caregivers (OR = 2.58, 95% CI [1.10, 6.04]). FTP, supervisory neglect, incident severity, and offender incident-related substance use were no longer significantly associated with parent removal when the model was adjusted for other child, parent, family, and incident characteristics.

## Discussion

The present study provides novel information regarding factors associated with child and parental removal decisions following substantiated incidents of child neglect in U.S. Army families. Prior studies have been primarily limited to predictors of child removal from the home following incidents of general neglect compared with other forms of maltreatment3,5,17,19 and to predictors of child removal among children who experienced neglect plus a subsequent report of maltreatment.35 By examining differences in the likelihood of child and parent offender removal from the home following substantiated incidents of child neglect characterized by four neglect types as well as neglect incident characteristics associated with elevated risk of child and parent offender removal, the present study advances understanding of the circumstances in which family separation decisions are made. This information may help to identify the characteristics of families at risk for removal actions that might be prioritized for intervention services. Tailoring prevention and intervention services to families with particular high-risk characteristics may optimize the impact of intervention efforts on children’s risk of harm while minimizing disruptions to family integrity.

Our findings indicate that the removal of a child and the removal of a parent offender from the home following an incident of neglect are associated with distinct neglect types and incident characteristics. Although child removal from the home occurred more frequently following incidents of physical neglect compared with other neglect types, findings from the multivariate analyses showed that none of the neglect types were differentially associated with increased odds of child removal from the home. Instead, other incident characteristics, including co-occurring physical and sexual abuse, offender incident-related substance use, and younger parental age at birth of the child, were each associated with greater odds of child removal.

These findings are consistent with prior research indicating that children involved in maltreatment incidents characterized by multiple maltreatment types are more likely to be removed21,22 as well as studies indicating that parental substance use and early parenting are each associated with increased risk of child removal.3,22,–,24 In general, this pattern of results aligns with what we would anticipate creates dangerous home environments for children and in turn increases their risk of removal. Parents with substance use problems and young parents, who have less mature parenting skills as well as fewer (financial, material, and socioemotional) resources, may be less capable of providing for their children’s physical and psychosocial needs. These conditions may place children at elevated risk of multiple types of maltreatment. The cumulative harm conferred by co-occurring abuse and neglect may be viewed by case workers as urgent and therefore warrant more immediate intervention (e.g., out-of-home placement) to ensure child safety. Collectively, these findings also underscore the importance of assessment and targeted prevention efforts for parents who have substance use problems, early intervention for substance use problems in parents, and the integration of parenting skills programs with parental substance use treatment.

Additional exploratory analyses indicated that children from families with documented mental health problems who experience high-severity physical neglect were five to six times more likely to be removed from the home, even when controlling for other incident and sociodemographic characteristics. These findings may be of particular importance to child welfare professionals in both civilian and military communities who must balance the need to ensure child safety with the goal of family preservation, including forensic psychiatrists who provide risk assessments and consultation regarding recommended protective actions. Greater understanding of the incident characteristics that in combination confer the highest risk of child removal may improve the judiciousness of child welfare decision-making, which is crucial given the potential consequences of these decisions. In addition, these findings suggest that targeted prevention efforts for parents with mental health problems as well as the integration of parenting skills training with parental mental health treatment may be promising approaches to the prevention of severe child neglect that is likely to result in child removal.

In contrast to child removal, emotional neglect and service member parent offender were each associated with increased risk of parent removal from the home. The composition of our sample, which was composed of military families, may provide an explanatory framework for these results. A previous analysis showed that 87 percent of the emotional neglect incidents in our sample involved child exposure to domestic abuse.45 In addition, 75 percent of incidents that resulted in a parent offender being removed from the home involved child exposure to domestic abuse. When children’s exposure to domestic abuse occurs in military families and the service member parent is the offender, the military commanding officer has the broad authority to order the service member to return to barracks housing, issue a military protection order, or hold the service member in pretrial confinement during the incident investigation or legal proceedings process. Given that the military has a unique mechanism for removing service member parent offenders from the home compared with offender parents in the civilian population, replication of our findings is needed to determine their generalizability. Despite this caveat, our examination of neglect incident characteristics associated with parent offender removal from the home is a novel contribution to the literature given the paucity of prior studies on this topic.

In the general population, Black children have been shown to be at significantly higher risk of removal compared with White children,18,–,20,46 even when accounting for differences in rates of child maltreatment across racial groups. In contrast, child race was not associated with child or parent removal in our sample of Army families. We propose two possible explanations for this null finding. Racial disparities in children’s involvement in the civilian child welfare system have been attributed to biases in child welfare decision-making.46,–,48 The military’s use of multidisciplinary CCSMs and IDCs combined with their reliance on a decision tree algorithm to make incident substantiation decisions may reduce racial bias throughout the military child welfare decision-making process (e.g., reporting, investigation, substantiation, service provision) and result less disproportionately in children removed from Black families compared with White families.

Alternatively, our null findings may reflect diminished racial disparities in military families more generally, resulting from stable employment, subsidized housing allowances, subsidized child care, and universal access to health care that make military families more equitable on the basis of socioeconomic class, race, and health relative to the civilian population.49,50 Notably, less racial disparity in rates of child maltreatment in military families compared with civilian families51 and to the general U.S. population52 has been documented in prior studies. The range of economic benefits afforded to military families may also reduce racial disparities in unsafe household conditions that lead to child or parent removal. Additional research is needed to further examine the role of race in child removal decisions in the military versus the civilian child welfare systems.

Several additional characteristics of our study should be noted, as they may influence the generalizability of our results. First, our ability to detect significant differences between incidents involving moral-legal neglect and other neglect types may have been limited by the low frequency of moral-legal neglect in our sample. Second, the case records from which we created our analytic dataset did not contain information on the timing of the removal in relation to the maltreatment incident, the duration of the child and parent removal, or child outcomes following family separation. As a result, we were unable to assess the extent to which child and parent offender removal prevented additional maltreatment. Similarly, the case records from which we drew our predictor variables did not contain information regarding the type and timing of family mental health diagnoses and whether or not treatment was obtained. Although parental mental illness is commonly identified as a risk factor for child maltreatment,53,–,55 the majority of prior studies have failed to capture the dynamic nature of parental mental illness and the extent to which its association with heightened risk of children maltreatment can be modified by treatment.56 Notably, recent research indicates that parents who receive treatment for their mental health disorders have a lower risk of maltreating their children compared with matched community peers.57 Finally, given that the multivariate interactions examined in the present study were exploratory in nature, replication in future research is required.

Despite these caveats, this study provides novel information regarding factors associated with increased risk of child and parent removal from the home. The incident characteristics that were identified as predictors of child and parent removal delineate familial contexts in which child safety was compromised to an extent that family separation was deemed warranted. Findings can inform the development of prevention strategies that effectively protect children from harm while minimizing disruptions to family integrity. Our results may also be used by forensic evaluators to assist the court in understanding the characteristics of child neglect incidents that are most strongly associated with child and parent removal actions, which can inform removal and parental rights decisions. Additional longitudinal research on the long-term psychosocial and health outcomes associated with child and parent offender removal following child neglect is needed to determine whether these removal actions effectively protect children from subsequent maltreatment without undermining child well-being. Future work that links specific maltreatment types to removal decisions and child outcomes might also further strengthen the opinions proffered by forensic evaluators. This line of research may improve the judiciousness of removal decisions and aid in the development of child welfare and legal policies that advance prevention and harm reduction efforts.

## Acknowledgments

The authors would like to thank Jessica Simanjuntak, BA; Sierra Martin, BA; and Natasha Dhanraj, BS for their editorial assistance.

## Appendix I41

Failure to Provide (FTP) Physical Needs: A caregiver fails to exercise a minimum degree of care in meeting the child’s physical needs in any of the following domains: providing adequate food; ensuring sanitary clothing that is weather appropriate and permits the child freedom of movement; providing adequate shelter; ensuring adequate medical, dental, and mental health care; and ensuring the child’s adequate hygiene. FTP included seven subtypes: Adequate Food and Nutrition, Appropriate Clothing, Shelter, Hygiene, Health Care, Dental, and Mental Health.

Lack of Supervision: A caregiver does not take adequate precautions to ensure a child’s safety in and out of the home based on the child’s particular emotional and developmental needs. This may include permitting exposure to dangerous situations (e.g., allowing the child to play in an unsafe area, permitting the child to accompany someone with a known history of violent acts) as well as failing to evaluate conditions pertaining to the child’s safety (e.g., neglecting to screen the background or competency of alternate caregivers, failing to ascertain the child’s whereabouts). Lack of supervision includes the following three subtypes: General Lack of Supervision, Unsafe Environment, and Substitute Care.

Emotional Neglect: A caregiver is harmfully insensitive to the child’s developmental level or persistently or extremely thwarts the meeting of the children’s basic emotional needs, such as the need for a family environment free of excessive hostility and violence, for an available and stable attachment figure, for positive regard and the absence of excessively negative or unrealistic evaluations, to explore the environment and extrafamilial relationships, and to individuate within the bounds of parental acceptance, structure, and limit setting, without developmentally inappropriate responsibility or constraints placed on the child. Emotional neglect includes the following subtypes: Inadequate Nurturance or Affection, Expected to Assume Inappropriate Level of Responsibility, Not Permitted Age-Appropriate Socialization, Abandonment, and Protection from Violence.

Moral-Legal Neglect: A caregiver fails to demonstrate a minimum degree of care in assisting the child to integrate with the expectations of society. This may involve exposing the child to or involving the child in illegal activity or in other activities that may promote delinquency or antisocial behavior.Educational Neglect: A caregiver fails to ensure the child is adequately educated or properly socialized by regularly attending school.

## Footnotes

*   Disclosures of financial or other potential conflicts of interest: None.

*   © 2025 American Academy of Psychiatry and the Law

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