Replicating the Alaska Longitudinal Child Abuse and Neglect Linkage (ALCANLink) Methodology

Although annual estimates indicate that about 10 percent of children from newborn to age 7 are reported to child welfare for maltreatment, cumulative incidence estimates that account for out-of-state emigration and competing cause mortality indicate that 32 percent of children born in Alaska have such reports before age 8—three times that of the annual estimate (Parrish et al 2020; Parrish et al 2017; Kim et al 2017). There has been internal validation of these estimates in Alaska, but external validation is needed. By replicating the process used to calculate these estimates in Oregon, the site team aimed to establish the feasibility of these methods for a multi-state, regional, or even national model which would deepen understanding of the factors associated with and predicting maltreatment across jurisdictional and structural boundaries.

• In Alaska and Oregon, the cumulative incidence of both states’ measures of child welfare involvement before age 9 were similar in the full birth cohort. However, the Oregon PRAMS cohort underestimates involvement with child welfare to a greater degree than the Alaska PRAMS cohort for each measure. Compared with children in Alaska, a higher proportion of Oregon children were involved with child welfare throughout the project period. This may be particularly meaningful in the first year of life, as 11.0 percent of Oregon children are reported to child welfare before their first birthday, although only 7.6 percent of Alaska children are.
• The estimated cumulative incidence of child maltreatment among the Oregon PRAMS cohort is consistently (but not significantly) an underestimate of that observed in the full birth cohort. The consistent underestimate of cumulative incidence of reports is observed for each unique type of maltreatment allegation except for sexual abuse. The difference is not statistically significant for any maltreatment type except neglect.
• To successfully replicate ALCANLink, a strong partnership with at least one stakeholder within the health department is necessary for building relationships, gaining support from additional stakeholders, and ensuring support for navigating and understanding state systems.

As part of the Alaska Division of Public Health’s agreements with the State of Oregon data stewards, data linkages were completed by Oregon Integrated Client Services (ICS).

Validation analysis using the 2009 birth cohort

Two congruent analyses were conducted for both Alaska and Oregon among the full 2009 linked birth cohort and the PRAMS linked birth cohort. Events considered were first report, first screen-in, and first substantiation, resulting in three age calculations for each child. The team calculated corresponding indicator variables (0 = No event, 1 = Event) for each event type per individual. Working with the survival package in R, the team used a Kaplan-Meier method to calculate survival and derived the cumulative incidence for the birth cohort analysis. The team used the same methodology for the PRAMS birth cohort analysis, but they used the survey package in R.

Analysis of the 2009-2011 PRAMS cohort

Using the Oregon PRAMS linked cohort from 2009—2011, the team calculated the cumulative incidence to first report, screen-in, and substantiation using the same methods described above and completed comparative analyses by group using cox-proportional hazard models.

Parrish, J. and A. Newby-Kew. “Replicating the Alaska Longitudinal Child Abuse and Neglect Linkage (ALCANLink) methodology.” OPRE Report #2021-252, Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services, 2021.