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Child Abuse & Neglect, Vol. 18, No. 7, pp.

577-585, 1994
Copyright 0 1994 Elsevier Science Ltd
Pergamon Pnnted in the USA. All rights reserved
014%2134/94 $6.00 + .OO

01452134(94)EOO19-P

TYPES AND FREQUENCY OF CHILD


MALTREATMENT BY FAMILY FOSTER CARE
PROVIDERS IN AN URBAN POPULATION

MARY I. BENEDICT

Department of Maternal and Child Health, Johns Hopkins University, School of Hygiene and Public Health,
Baltimore, MD, USA

SUSAN ZURAVIN

University of Maryland School of Social Work, Baltimore, MD, USA

DIANE BRANDT AND HELEN ABBEY

Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD, USA

Abstract-Types and frequency of child abuse and neglect reports in family foster care in Baltimore, Maryland as
compared to reports among nonfoster families are reported. Data on maltreatment incidents in foster homes were
abstracted from Child Protective Services investigation records for the years 1984- 1988. Comparisons were made to
community reports. Results indicated that foster families had over a three-fold increased frequency of maltreatment
reports as compared to nonfoster families. Report frequency was highest for physical abuse with a seven-fold risk of
report as compared to nonfoster families. Overall, 20% of foster care reports were substantiated as compared to 35%
of nonfoster reports, although the risk of having a substantiated report was significantly higher in foster care. The
distribution of report types in foster care differed from those in the community with physical abuse the most frequent
allegation in foster care, as compared to neglect as the most frequent allegation in the community. Explanations for
these findings including differences in criteria for report and substantiation are advanced.

Key Words--Child abuse and neglect, Sexual abuse, Foster care, Prevalence.

INTRODUCTION

SINCE THE 1970s the foster care system has been under scrutiny by a variety of professional
groups because of perceived problems in providing adequate care and planning for this at-risk
population of children. As a result of this attention, legislation has been enacted to facilitate
permanent living situations for children (Maluccio, Fein, Hamilton, Kilier, & Ward, 1980;
Maluccio & Fein, 1983); many jurisdictions have proposed standards and implemented reforms
in the provision of essential health and welfare services to foster children (Mushlin, Levitt, &
Anderson, 1986; Standards for Health Care Services, 1988; White, Benedict, & Jaffe, 1987);
and the Federal Child Abuse Prevention and Treatment Act has been amended to require

This study was supported by The National Center of Child Abuse and Neglect, ACYF, ACF, DHHS, Grant ##O-CA-
1367.

Received for publication October 22, 1992; final revision received March 23, 1993; accepted March 24, 1993.
Requests for reprints should be addressed to Mary I. Benedict, MSW, DrPH, The Johns Hopkins University, School
of Hygiene and Public Health, Department of Maternal and Child Health, 624 North Broadway, Baltimore, MD 2 1205.
577
578 M. 1. Benedict, S. Zuravin, D. Brandt, and H. Abbey

reporting of child maltreatment in out-of-home settings. Currently, at least 46 states mandate


the reporting of suspected maltreatment of children in foster care (Besharov, 1987).
Despite these accomplishments, there is still widespread concern that “children. . . placed
in foster care for their own protection are not receiving the care that the state has an obligation
to provide. These children, removed from their biological families, often because of allegations
of abuse and neglect, are further harmed, physically and emotionally, while in state custody”
(Mushlin, Levitt, & Anderson, 1986). With approximately 300,000 children in foster care as
of 1988 (Tatara, 198X), and with the numbers increasing since then, the need to evaluate the
extent of this “harm” is clearly evident.
The scope of harm/maltreatment reported within states’ foster care systems varies widely.
Research reports have had different purposes and methodologies and have found varying
results. Ryan’s survey of 27 states yielded estimates from 3 to 67 reports per thousand homes
with substantiation, that is, validation of the reports after investigation, in 2 to 27 per thousand
foster homes (Ryan, 1983).
Bolton, Laner, and Gai (198 l), compared reported incidents of maltreatment occurring in
Maricopa County, Arizona, foster homes versus all other types of living situations. They
concluded that the foster child population appeared to be at higher risk for a maltreatment
report than the nonfoster child population (7% vs. 2%). The authors, however, report no
significant differences in substantiation rates involving foster homes (29.8%) as compared to
nonfoster homes (35.4%).
Rosenthal, Motz, Edmonson, and Groze (199 1) described characteristics of maltreatment
reports in a sample of family, group, and institutional providers in Colorado. The most frequent
type of report was for physical abuse. The investigators reported confirmation (substantiation)
of 38% of family foster home reports. They did not have statistics for community reports.
In a study of 125 investigations of foster homes in Hennepin County, Minnesota, Cavara
and Ogren (1983) reported the highest substantiation rate for sexual abuse of (45.5%) followed
by physical abuse (38.1%) and neglect at (28.6%) with a average substantiation rate of 35.8%.
Runyan and Gould (1985), in a study of the impact of foster care on delinquent behavior,
compared foster children placed because of maltreatment with maltreated children left in their
own homes. They found that 25% of the subjects in home care were subsequently re-reported
for abuse or neglect as compared to 5% who were maltreated while in foster care. They
concluded that foster care reduces but does not eliminate the risk of subsequent maltreatment.
Comparisons of foster family and nonfoster family maltreatment reporting rates are problem-
atic because of differing definitions, reporting, and investigation procedures across and within
jurisdictions. In addition, the denominators for the reporting rates are not always clearly
identified and described. Individual children or homes are generally used, and the rates can
vary dramatically depending on how the denominator is calculated.
Despite these methodological variations, it is only through comparison of statistics from
various jurisdictions that an overall picture of the scope and characteristics of maltreatment
in foster care can be developed.
The current study was designed to describe the prevalence, types, and severity of mal-
treatment reports in family foster homes in Baltimore, Maryland. The questions are whether
rates of report and substantiation are higher or lower for foster parents as compared to nonfoster
families in the community, and whether the distribution of the major types of maltreatment
differs in foster homes as compared to community families.

METHODS

Study Site
Foster family care in this study refers to substitute care provided by families who have been
approved by the public child welfare agency-the major provider of such services in the state.
Child maltreatment by family foster care providers 579

These foster homes have been screened, evaluated, and licensed and are typically approved
for a specified number of children. In Maryland, these children may be relatives or nonrelatives
of the foster parents. During the study period (1984-1988), The Baltimore City Foster Care
Program, a division of the Department of Social Services, supervised an average of 768 licensed
foster homes open per year with an estimated 2,700 children in care at some time during any
one year. Foster children’s median age was 9 years (range O-21 years), 80% were African-
American and their length of stay in care using longitudinal analysis had an estimated median
of 6 months and mean of 12 months (Benedict & White, 1991).
When a maltreatment report is made against a foster home (or a family in the community)
it is investigated by Child Protective Services (CPS), the program within the Department of
Social Services with specific responsibility to investigate and intervene where any (i.e., foster
care or community) child abuse or neglect has been alleged. The unit of report is the family.
A report may involve one or more children, more than one type of maltreatment, and the same
families may be reported more than once over time.
There are two differences in procedure/regulation related to the investigation of maltreatment
in foster care in Baltimore City as compared to the community. First, no corporal discipline
by foster parents is condoned as compared to the nonfoster community, where spanking as a
form of discipline has not been legislated against. Second, although CPS is required to investi-
gate an alleged incident in foster care, substantiation is decided in a joint conference between
foster care and CPS officials. In nonfoster situations, CPS alone makes the decisions about
substantiation and case outcome.

Definitions
Maltreatment definitions from the State of Maryland annotated code apply to both foster
care and community incidents and are as follows: Physical abuse is “any physical injury. . .
sustained as a result of malicious acts by any parent, adoptive parent, or other person who
has permanent custody or responsibility for supervision of a child less than 18 years of age.”
Sexual abuse includes “any acts involving sexual molestation, or exploitation including but
not limited to incest, rape, carnal knowledge, sodomy or unnatural or perverted sexual practices
of a child by any parent or other person who has permanent or temporary care or custody. . .”
Neglect occurs when “a child has suffered or is suffering significant physical or mental
harm or injury as a result of conditions created by the absence of his parents. . . or custodian
or by the failure of that person to give proper care and attention to the child and his problems.”
A report was defined as an incident of alleged maltreatment regardless of how many calls
were made to the agency about the situation. An incident might involve more than one child
and more than one type of maltreatment.
Substantiation or validation of a report (incident) occurred when the injury or risk of injury
of a child was determined to be the result of an action by the caretaker; or when there was
evidence to suggest that the caretaker had neglected a child or failed to prevent abuse or
neglect. The definition of caretaker, however, could include family members other than the
foster parents, if those family members were considered temporary babysitters. Also, a foster
parent could be charged as neglectful if there were reason to believe that he/she was negligent
in protecting a child from sexual or physical abuse by a noncaretaker. This could also happen
in the community.

Study Procedure
Data on maltreatment reports in Baltimore City foster homes were abstracted from CPS
investigation records for the years 1984- 1988. Reports were excluded from group homes and
institutional facilities that also provide out-of-home placement for children as well as reports
on children placed in homes licensed and supervised by other agencies such as Juvenile
Services.
580 M. I. Benedict, S. Zuravin, D. Brandt, and H. Abbey

The Baltimore City Department of Social Services provided statistics documenting the
number of reports in the nonfoster community during some of the years of interest. Substantia-
tion figures for those community reports were only available from the city for 1985, so those
substantiation rates were used for 1986 and 1987 reports. The assumption was made that the
proportions substantiated did not change significantly over the 3-year period. There were no
known changes in policy during that time period.
Denominator information, the number of families in Baltimore City with children under age
18 for the years of interest, was estimated from census information obtained from the Maryland
Department of State Planning. A variation of a person-time denominator for reports was
developed. Since families are the unit of report for maltreatment reports, the rate was the
number of reports within the time period divided by the total family-time at risk observed
over the interval. This figure may be interpreted as an estimate of the average family report
rate over the interval and was calculated as families minus l/2 reports times the time period
of interest (Schlesselman, 1982). The advantage of such a measure was to allow a somewhat
more precise estimate of the denominator since we know that families moved in and out of
the risk pool over the time period of study.
Odds ratios to estimate the strength of association and 95% confidence intervals were
calculated. The confidence intervals allowed us to be 95% “confident” that the odds ratio fell
between the two limits. They were calculated according to the Cornfield method (Schlessel-
man, 1982).

RESULTS

Four hundred and forty-three reports were received on 285 foster family homes between
1984- 1988 for an average of 1.5 reports per foster home. Physical abuse alone was alleged
in over 60% of the reports, neglect in 17.4%, and sexual abuse 10.7%. Although the majority
of reports identified only one type of maltreatment, 10.5% of the reports presented with
combinations of maltreatment types, either on the same child or different children during the
same incident.
Substantiation differed by type of maltreatment. Whereas physical abuse allegations com-
prised the highest proportion of reports, sexual abuse had the highest substantiation rate with
over 55% of reports validated. Physical abuse, on the other hand had the lowest substantiation
with less than 9% of reports validated. Substantiation of neglect complaints varied from 40%
to 20% over the time period.
Type of maltreatment, a proxy indicator for severity, could only be collected where mal-
treatment was substantiated. The most frequent physical abuse injuries were cuts/bruises with
a small proportion of children (7.2%) having fractures or bums. For approximately 25% of
the physical abuse reports, severity or type of injury was unknown because of length of time
elapsed between incident and report.
Where sexual abuse was substantiated, intercourse or attempted intercourse was a component
for 63.3% of reports. The types of sexual contact for the remainder of reports were fondling,
harassment, or exposure by the perpetrator. The types of neglect most frequently substantiated
were inadequate supervision by the caretaker (34.9%), neglect of the child’s physical health
care (31.4%) with neglect of hygiene, nutrition, and household sanitation implicated in over
20% of reports. Children involved in 14% of reports required medical care as a immediate
result of the maltreatment.
Foster parents were the designated perpetrators in over 80% of physical abuse and neglect
allegations, but only 40% of sexual abuse allegations. Where sexual abuse was suspected,
foster siblings and others were the alleged perpetrators more frequently.
Although the foster care worker was the official report source in two thirds of the cases,
Child m~t~atment by family foster care providers 581

Table 1. Number and Percent of Physical Abuse, Sexual Abase and Neglect Reports, Odds Ratios and Confidence
Intervals in Baltimore City Foster Families as Compared to Nonfoster Families 19851987
Foster Care Familiesb Nonfoster Familiesb

Percent Percent
Number Families Number Families Risk Confidence”
Reoorts Reoorted Renorts Renorted Ratios Intervals

Total Reports” 291 15.0 20795 4.1 3.63 (320, 4.12)


Physical Abuse 201 10.4 7474 1.5 6.99 (6.02, 8.12)
Sexual Abuse 4.5 2.3 2745 5 4.26 (3.13, 5.79)
Neglect 73 3.8 10574 2.1 1.79 (I .40, 2.27)

a Each report could have more than one type of maltreatment.


b Denominator is Family-Time at Risk = Number of Families - (l/2) Number of Reports X Time Period (3 years).
The Foster Care Denominator = 1938. The Baltimore City Denominator = 503869.
’ Confidence Intervals that do not include the value one, show a significant association.

those reports were initiated by the child almost 60% of the time. The child would tell the
worker or some other person what happened and a report would be generated.

Comparison with Baltimore City or State Statistics


Table 1 displays foster care reports in comparison to reports on nonfoster community families
for the years 19X.5- 1987, which was the time period available for comparison from Baltimore
City records.
Although foster family reports accounted for only 1.1% of the total reports in the time
period, foster families were significantly more likely to be reported for all types of mal~eatment
compared to nonfoster families. The highest proportion of reports in foster care was for physical
abuse and foster families were almost seven times more likely to be reported for physical
abuse as compared to families in the community. Secondly, foster families had a four-fold
greater risk of report for sexual abuse. The same families were almost twice as likely to be
reported for neglect than nonfoster families.
The distribution of foster care reports by type of maltreatment was significantly different
from that in the nonfoster community. Physical abuse reports accounted for almost two thirds
of the total foster care reports as compared to only 35.9% of nonfoster reports. In comparison,
neglect was the most frequent type of report in the ~o~unity. Sexual abuse was involved in
similar propo~io~s of reports in both populations (15.5% in foster care and 13.2% in the
nonfoster community).
Comparison of substantiation rates was possible with Baltimore City generated statistics for
physical abuse and sexual abuse only (Table 2).
Whereas there was a seven-fold greater risk of report for physical abuse among foster
families as compared to nonfoster families, the proportion of reports substantiated was signifi-
cantly lower in foster care (8.9% versus 36.6% substantiated). For sexual abuse, on the other

Table 2. Subs~ntiat~ Reports in Baltimore City Foster Care (19851987) as Compared to Nonfoster City
Reports, Odds Ratios, and Confidence Intervals
FosteP Care Baltimore” City
Substantiated Risk Confidence
Reports n % n % Ratios Intervals

Physical Abuse 18 8.9 2736 36.6 .17 (10, .28)


Sexual Abuse 25 55.5 1487 54.2 I .06 (56, 1.99)

a Denominators are total reports in each category (See Table 1).


582 M. I. Benedict, S. Zuravin, D. Brandt, and H. Abbey

hand, the substantiation of foster care reports (over 50%) was very similar to that in Baltimore
City as a whole, although reporting of foster homes was significantly higher. In an additional
analysis, the risk of having a substantiated report was significantly higher in foster care than
in the community. Foster homes had almost double the risk (ratio 1.77) for a substantiated
physical abuse report despite the low proportion substantiated. The risk of a substantiated
sexual abuse report in foster care was almost four times that of the community homes (ratio
3.89). These results consider all incidents while a child is in foster care no matter who the
perpetrator might be.
Severity of maltreatment as defined by maltreatment injury type was available for comparison
for physical abuse only. Cuts, bruises, and welts were the most frequent abuse injuries in
community families (69%) with severe injury, including bums and fractures in 7% of the total.
These figures are very similar to our foster care sample where the type of maltreatment was
known. Injury in nonfatal abuse may be similar in the two populations but interpretations
should be made with extreme caution because of missing information in over 20% of the
foster care reports. Using fatality data, one could argue that physical abuse in the community
is much more severe than in foster care. There were 17 fatalities in the nonfoster population
in 1986 for the entire state and none in foster care for the 5 study years.
Comparison of types of neglect classified as moderate or severe (Magura & Moses, 1983)
was possible with a sample of preschool age children with substantiated neglect reports in
Baltimore City (Benedict, 1990). As one might expect in a younger sample, a larger proportion
of homes with young nonfoster children were reported because of lack of appropriate supervi-
sion, however, the proportions of reports identifying problems of household sanitation, personal
hygiene, and nutrition problems appeared greater in foster care, although the differences were
not significant (20% versus 13%). Health-care neglect was similar for both populations (32%).
No comparable information was available to allow comparisons of severity of sexual abuse
between foster care and community homes.

DISCUSSION

Foster parents were significantly more likely to be reported in all categories than were
families in the general community. These results are consistent with the results of other studies
(Bolton et al., 1981; Carbino, 1988) In addition, the distribution of reports by type was different
from that in the wider community for physical abuse and neglect. Physical abuse was the most
frequent type of foster care report whereas city and national data indicate that neglect is the
most frequent community report (American Humane Association, 1988). Ryan, McFadden,
and Wiencek (1987) have also reported a similar distribution of reports in their sample of
reports from five states. Unlike physical abuse and neglect, the proportion of sexual abuse
reports appeared similar to most community statistics (American Humane Association, 1988).
Substantiation after investigation also showed a different pattern in foster care as compared
to the nonfoster community. The risk of having a substantiated report was higher in foster
care, although the proportion of reports that were substantiated (20%) was lower than in the
community or in comparison with the figures of other researchers (Bolton et al., 198 1; Cavara &
Ogren 1983; Rosenthal et al., 1991).
There are several possible explanations or speculations to explain these differences. The
higher reporting rates in foster care may relate to the close supervision of foster homes by the
child welfare system as compared to families in the community. Foster homes are much more
likely to have “outsiders” visiting them on a regular basis so may be more at risk for
scrutiny of their parenting practices than nonfoster families resulting in biases toward increased
reporting.
Or, we may be seeing underreporting in the nonfoster community related to a variety of
Child maltreatment by family foster care providers 583

factors including community reluctance to report (Zellman, 1990) or agency guidelines for
screening of community calls. Some combination of over and underreporting may be the issue.
Characteristics of foster families may be different from those of community families, which
could affect risk of report. For example, it is possible that foster family size is greater than
that of nonfoster families, given that some foster families have children of their own in addition
to the foster children. This study could not measure family size directly, but each additional
child in the family is one more child to put the family at risk of report. On the other hand,
these foster families have been thoroughly screened including family interviews, police clear-
ances, health records, and home inspections before children are placed, so there is the assump-
tion that proper care is more likely to be assured than in the general community.
The physical abuse reporting accounts for the major proportion of reporting in foster care,
and may be explained by the different criteria for report. There are the specific guidelines in
Maryland related to corporal discipline by foster care providers. No corporal punishment is
allowed at all, so that any spanking or other hitting of a foster child will usually lead to a
report. Foster care workers are required to report any deviation from this “no hitting” policy.
These policies differ from the community regulations as a whole, where some jurisdictions
(although not Baltimore City) still allow corporal discipline in the schools and attitudes about
disciplinary practices vary according to local cultural norms.
Anecdotally, the high frequency of physical abuse reports could be affected by the foster
children themselves or their relatives. Most of the children and their families know of the
reporting regulations and some report the foster parents when they think it may help children
return to family or move from the current placement. Or, children who have been maltreated
before placement might be at higher risk either as a victim of further maltreatment or as a
perpetrator (Carbino, 1988). This study could not address this issue because only 40% of
children entered foster care because of substantiated abuse and neglect in their own families
and the sample of substantiated cases in foster care was too small to allow definitive analysis.
This area should be addressed, however, in any subsequent study.
The problem of substantiation of reports introduces other issues in comparing foster and
nonfoster rates as well as comparing foster care rates across studies. As stated above, the
overall Baltimore City foster care substantiation rate was lower than the nonfoster rate in the
city and foster care substantiation rates in some other jurisdiction. Substantiation in the commu-
nity depends on a host of factors, including the investigating team’s judgment of the statements
of the parents, and children as well as the injury to the child and clinical judgement of future
risk (Wells, 1987). These factors associated with substantiation in foster care have not been
studied, so any comments are speculative.
The lower proportion of reports substantiated in this foster care sample is driven by the
rates for physical abuse. The high reporting may reflect the agency’s policies related to corporal
punishment, but the low substantiation may reflect more closely community norms of discipline
or other issues related to foster care, such as the shortage of homes and the agency’s reluctance
to close a home perceived as good in the past. If so, perhaps more definition before the fact
of the circumstances under which the “no corporal punishment” policy has been violated
could lead to fewer unsubstantiated reports.
Sexual abuse presents a different problem. Whereas parenting and discipline skills can be
taught and practiced in training and role-playing sessions, aberrant sexual behavior with relation
to foster children is not so likely to be detected before the fact through interview. Theoretically,
unsuitable foster parents have been screened-out initially through police checks, however,
prospective parents with problems but not involved with the legal system would not necessarily
be identified. Another issue particularly related to sexual abuse in this sample was that not all
the perpetrators were foster parents. A report could be made and substantiated when the
perpetrator was another foster child or was some other person not necessarily in the caretaker
role, yet the situation would still be reported and handled as if the foster parents should be
584 M. I. Benedict, S. Zuravin, D. Brandt, and H. Abbey

able to protect those in their care from all situations. It is not known if such a situation could
also happen in the community, but the definition of “caretaker” may be applied differently
in foster care or ignored entirely.
Other structural characteristics of the foster care system that could not be addressed in this
analysis but could be important in explaining the current findings include the concern agencies
have about legal liability (Carbino, 1988), and the impact of placement decisions in a system
with an inadequate number of foster parents. As Ryan and colleagues have found, foster
families who have excellent skills may be overloaded with difficult, needy children leading
to a breakdown in the ability to cope (Ryan, McFadden, & Wiencek, 1988). Such formerly
well-functioning families could thus become involved in maltreatment incidents.
In conclusion, maltreatment by foster care providers is an important issue where prevention
and intervention strategies specific to the foster care system need to be developed. An under-
standing of the scope and characteristics of maltreatment within that system is critical to
enhance our ability to intervene successfully; that is, to develop and implement guidelines for
services that not only protect children while under state ju~sdiction but also protect the rights
of the foster families from the increased risk of unfounded reports. Finally, the application of
guidelines should be consistent and clearly understood by agency staff, foster families, and
children.

Acknowledgement-his study would not have been possible without the support and collaboration of the Baltimore
City Department of Social Services.

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Benedict, M., & White, R. (1991). Factors associated with foster care length of stay. Child Welfare, LXX, 45-57.
Besharov, D. J.(1987). Reporting out-of-the home maltreatment: Penalties and protections. Child Welfare, XVI, 399-
408.
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reported child m~~~trnent ~pula~on. Chj~dren and Youth Services Review, 3, 37-53.
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foster families: A report of a symposium. Madison, WI: The School of Social Work, University of Wisconsin-
Madison.
Cavara, M., & Ogren, C. (1983). Protocol to investigate child abuse in foster care. Child Abuse & Neglect, 7, 287-
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Magura, S., & Moses, B. (1983). Child Maltreatment Rating Scales. New York: Child Welfare League of America.
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Rbumk-Cette etude s’est penchee sur la maltraitance dans des foyers d’accueil comparei a celle qu’on retrouve
dam la communaute en gefieial. Les cas a l’eiude venaient des dossiers de la protection de I’enfance durant les annees
1984-88. Les resultats demontrent que darts les families d’accueil la frequence des mauvais traitements efait trois
fois celle des families de la communaute en genefal. Dans les cas d’abus physiques, la frequence e&t sept fois plus
grande. Vingt pour cent des cas de maltraitance dans les families d’accueil ont et6 prouves, compares a 35 p.c. dans
les autres familles. Toutefois, il est plus probable que la maltraitance soit prouvee en foyer d’accueil. Les types de
signalements diffeiaient d’un groupe a l’autre : les familles d’accueil eiaient plus porteis a infliger des seGices
physiques tandis que les families dam la communaute en geriefal eiaient plus aptes a negliger leurs enfants. Les
auteurs proposent des raisons pour expliquer les diffefences, y compris les criteies pour signalement et les criteies
pour valider la maltraitrance.

Resumen-Se estudian 10s tipos y frecuencia de reportes de abuso a 10s nines y negligencia en familias sustitutas de
Baltimore, Maryland en comparaciod con reportes de familias no sustitutas. Los datos sobre incidentes de maltrato
en hogares sustitutas fueron tomados de 10s archives de 10s Servicios de Proteccioli Infantil de 10s anos 1984-1988.
Se compararon 10s reportes de la comunidad. Los resultados indicaron que las familias sustitutas ten& frecuencia
de reportes de mahrato tres veces mayor que las familias no sustitutas. La frecuencia de reporte fue mayor en abuso
fisico con siete veces mas reportes que las familias no sustitutas. En general, 20% de 10s reportes de hogares sustitutos
fueron confirmados al compararlos con el35% de 10s hogares no abusivos apesar de que el riesgo de que 10s reportes
fueran confirmados fue significativamente mayor en 10s cases de hogares sustitutos. La dishibucioli de 10s tipos de
reporte en hogares sustitutos diferian de 10s de la comunidad siendo el abuso fisico el alegato ma6 frecuente en 10s
hogares sustitutos comparado con la negligencia que es el mai frecuente en la comunidad. Se presentan explicaciones
de estos resultados incluyenco diferencias en 10s criterios para 10s reportes y su confirmaciok