About ALCANLink
Background
Child maltreatment, which includes all forms of physical and sexual abuse, neglect, and mental injury, is not only a child welfare issue, but a substantial public health problem. In Alaska, during an average year, approximately 10% of the child population ages 0-17 years will be reported to child welfare due to a suspicion of child maltreatment. Largely, our understanding of the burden of maltreatment in our state has been based on annual point-in-time prevalence estimates. However, this “snapshot” only indicates maltreatment reported in a given year, which can result in a false perception that only a small proportion of children in Alaska have contact with child welfare. To understand the accumulated child burden, cumulative incidence estimates can help us understand the actual severity and resulting public health burden in our population. Without data to measure the underlying population and the accumulated burden in the population we are unable to accurately identify populations that may be at increased risk and factors that protect against maltreatment.
Although large geographically, Alaska has a small population resulting in many centralized services. This centralization of services is conducive to leveraging health informatics and through the integration of administrative and epidemiologic information a public health approach can be implemented to prevent child maltreatment. By integrating Alaska birth records to other administrative records through a process called data linkage we can begin to answer prospective, population-based questions about the probability (or likelihood) that children born in Alaska will experience reported or substantiated maltreatment, or other outcomes due to maltreatment. The purpose of this project is to develop an understanding of the cumulative risk (or child burden) of reported maltreatment experienced during childhood in Alaska and to facilitate comprehensive epidemiologic investigation to describe who, what, when, where, and why maltreatment occurs.
What is the purpose of ALCANLink?
The purpose of ALCANLink is to develop an understanding of the cumulative risk (or child burden) of reported maltreatment experienced during childhood in Alaska, and to facilitate comprehensive epidemiologic investigations to describe who, what, when, where, and why maltreatment occurs.
Methods
Using existing resources, the section of Women’s, Children’s, and Family Health, within the Alaska Division of Public Health operates the Alaska Longitudinal Child Abuse and Neglect Linkage project (ALCANLink) to examine maltreatment over time. ALCANLink was initially developed through a three-way partnership between a local funder, the Alaska Department of Health and Social Services, and the University of North Carolina at Chapel Hill.
Unlike other projects in the US that link entire birth records with child welfare records, ALCANLink integrates only those records that were sampled and subsequently responded to the Pregnancy Risk Assessment Monitoring System (PRAMS) survey. PRAMS samples approximately 1 in every 6 live births in Alaska and mothers who respond to PRAMS provide implicit consent to have their responses integrated with other administrative data. Using probabilistic linkage methodology we integrated 2009- 2011 PRAMS records with child welfare, vital records, child death review, permanent fund dividend, and others.
These epidemiologic data are used to better understand the factors that contribute and/or protect child and families from becoming involved with child welfare and seeks to identify opportunities for preventing maltreatment in the population based on this knowledge. These data can be used to direct limited resources to help prioritize prevention and promote early interventions that may prevent the conditions that lead to child welfare involvement.
These data are only available and used for population level epidemiologic evaluation to help direct prevention/intervention efforts as directed under AS 18.05 and AS 18.15.
How and what data are linked?
ALCANLink uses probabilistic linkage methodology to integrate data from the 2009-2011 PRAMS records with child welfare, vital records, child death review, permanent fund dividend, and the CUBS survey responses for the core annual linkages. Additional linkages to other sources such as law enforcement, Medicaid, Court records, and education are being developed. These epidemiologic data are used to better understand the factors that contribute to and/or protect children and families from becoming involved with child welfare.
Data are linked using an iterative deterministic followed by probabilistic classification process. This process enables us to detect true matches through manual review of selected cases that have a high probability match score. The linkage scoring and matching uses the Jaro-Winkler algorithm and weighting based on the method developed by Contiero et al.
