Universal Pre-Kindergarten for Child Maltreatment Prevention.

Importance: Universal pre-kindergarten (UPK) programs are expanding across the US. Given the detrimental consequences of child maltreatment on children's health and well-being, it is important to assess whether high-quality, full-time UPK programs can function as a population-level child maltreatment prevention strategy. Objective: To examine the association between provision of a full-time UPK program and child protective services (CPS) investigation rates by leveraging the implementation of New York City's Pre-K for All program. Design, Setting, and Participants: This cross-sectional study used county-year-child age-level data from the 2010 to 2019 National Child Abuse and Neglect Data System Child Files to compare CPS investigation rate trajectories for children aged 4 and 8 years before and after UPK implementation. The data were analyzed from January to May 2025. Exposure: Implementation of the UPK program. Main Outcomes and Measures: The primary outcome was the rate of CPS investigations per 1000 children overall and for child neglect and child physical abuse. The investigation rate trajectories were compared using difference-in-differences and event study methods. Results: A total of 1 606 525 children (mean [SD] age, 5.9 [2.0] years; 820 519 males [51%]) were included in the study. Of these children, 555 003 (35%) identified as Hispanic, 382 662 (24%) as non-Hispanic Black, 444 285 as non-Hispanic White (28%), and 213 576 children (13%) identified as other non-Hispanic race or ethnicities. The difference-in-differences analysis estimated that UPK implementation was associated with 4.0 (95% CI, -6.77 to -1.11) fewer CPS investigations per 1000 children aged 4 years relative to investigations among children aged 8 years. This finding was attributable to reductions in the rate of child neglect investigations, with no statistically significant change in physical abuse investigations. The event study models illustrate that UPK implementation led to greater reductions in CPS investigations over time, reaching a reduction of 8.0 (95% CI, -11.72 to -5.10) fewer neglect investigations per 1000 children 2 years after implementation. Moreover, the subgroup analyses by race and ethnicity show that reductions in neglect investigations were disproportionately concentrated among racial and ethnic minority populations, particularly the non-Hispanic Black population, which had a reduction of 80 (95% CI, -176.47 to -17.02) neglect investigations per 1000 children 2 years after implementation. Conclusions and Relevance: This study found that UPK may be associated with reduced CPS involvement, particularly for child neglect, and may help mitigate racial and ethnic disparities in CPS involvement. Reductions in child neglect associated with UPK could benefit children's health and well-being in the short- and long-term; these findings offer insights for policymakers and advocates regarding broader benefits associated with UPK.