Examining Substantiation Patterns Among Caregivers with Intellectual Disabilities In a State Child Welfare System

Background Kentucky has nearly double the national rate of child abuse and neglect referrals, and state law makes intellectual capacity explicitly salient in custody-related determinations. Guided by intersectional Critical Disability Theory and cumulative vulnerability frameworks, this study examined whether caregiver intellectual disability is associated with substantiation in Kentucky, and whether this association varies by child disability status, co-occurring risk factors, community type, and cumulative documented vulnerability.

Methods De-identified administrative child welfare records from Kentucky submitted to NCANDS for federal fiscal year 2023 were analyzed (N = 62,461 investigated reports). The primary outcome was substantiation. The focal predictor was caregiver intellectual disability (binary). Covariates included child demographics, child disability status, caregiver mental illness and substance misuse, intimate partner violence, housing inadequacy, maltreatment complexity, and community characteristics. Missing data were addressed via multiple imputation with chained equations (50 imputations); analyses used multivariable logistic regression with robust standard errors.

Results In fully adjusted models, caregiver intellectual disability was associated with significantly higher odds of substantiation (OR = 1.77, 95% CI [1.30, 2.41]). Child disability was also independently associated with substantiation (OR = 1.66, 95% CI [1.56, 1.78]), while the caregiver intellectual disability × child disability interaction was not significant. Predicted probabilities followed an additive pattern: 22% (neither disability), 30% (child disability only), 31% (caregiver intellectual disability only), and 40% (both). Moderation analyses revealed largely stable associations across race, poverty, and caregiver mental illness. Two notable exceptions emerged: under intimate partner violence, substantiation probability increased more sharply for caregivers with intellectual disability (26.5% to 60.4%) versus those without (18.2% to 40.4%; difference-in-differences = +11.7 pp); under substance misuse, probabilities converged at high levels (~52%; difference-in-differences = −14.2 pp). Geographic context did not significantly moderate the association, though predicted probabilities remained consistently elevated for caregivers with intellectual disability across all community types. A cumulative vulnerability index showed a strong, approximately linear association with substantiation, with a similar gradient observed regardless of caregiver intellectual disability status.

Conclusions Substantiation in Kentucky is strongly patterned by cumulative documented vulnerability, while caregiver intellectual disability is consistently associated with elevated substantiation probability even after accounting for child disability, family risk indicators, and community context. The predominantly additive findings — with moderation concentrated in contexts with salient co-occurring vulnerabilities — support interpreting caregiver intellectual disability as a contextual elevation factor within substantiation decision-making rather than evidence of a distinct risk process. These results underscore the need for disability-informed, accommodation-oriented assessment practices that distinguish disability status from parenting capacity and address structural drivers of documented vulnerability in child welfare investigations.