Risk factors and physical signs of child abuse in hospitalized children in Taiwan

PurposeThis study used the Criteria for Distinguishing Abuse from Accidents Chinese version (CDAA-C) to determine cases of child abuse, undetermined intent, and unintentional injury, and compared risk factors and injury profiles among hospitalized children in Taiwan.DesignA retrospective chart review study.MethodsWe selected children aged 0–3 who were hospitalized with a discharge diagnosis of injury or child maltreatment in a medical center in southern Taiwan between 2007 and 2009. The CDAA-C was used to collect children's demographics and injury types and to determine the intent of injury. Children's charts with records and notes of admission, surgery and emergency care were reviewed and analyzed.ResultsAmong 157 eligible cases, the CDAA-C identified 13 child abuse cases including additional 8 victims who were not previously coded in ICD-9-CM. Most abused children suffered from brain injuries, had ≥ 2 in jury incidents, and had a misdiagnosis in the previous visit. Abused children were younger and more likely to be born premature.ConclusionsThis study highlighted the under-diagnosis of child abuse in Taiwan. An easy-to-use standardized screening tool for child abuse in Taiwan is needed.     

Delineating disproportionality and disparity of Asian-Canadian versus White-Canadian families in the child welfare system

ObjectiveThis paper builds upon the analyses presented in three companion papers using data from the 2003 and 2008 cycles of the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2003 and CIS-2008) and the Ontario Child Abuse and Neglect Data System (OCANDS) to examine disproportionality and disparity of child welfare involvement for Asian-Canadian children involved in the child welfare system.MethodsThis study used CIS-2008 data adjusted by Census child population data to examine rates per 1000 and three disparity indexes (population-based disparity index [PDI], decision-based disparity index [DDI], and maltreatment-based disparity index [MDI]) to determine the representation of child maltreatment investigations for Asian-Canadian versus White-Canadian children involved in the child welfare system. Logistic regression analyses were conducted to determine the odds of case closure for substantiated child maltreatment investigations, and whether Asian ethnicity remained significant while controlling for child demographics and household composition, case characteristics, and clinical concerns.ResultsThis study found that Asian-Canadian children were underrepresented in the child welfare system compared to White-Canadian children (13.9 per 1000 Asian children in the Canadian population vs. 36.1 per 1000 White children in the Canadian population). Child welfare involvement for Asian-Canadian children are almost 2 times more likely to close after an investigation than White-Canadian children. The three disparity indexes (PDI, DDI, MDI) showed substantially different results with respect to the representation of child maltreatment investigations involving Asian-Canadian versus White-Canadian children for physical abuse, sexual abuse, neglect, emotional maltreatment, and exposure to domestic violence.ConclusionsDisproportionality and disparity are complex phenomena. The variation in results derived from different methods of calculating representation suggests the need for greater clarity and consistency in the definitions and methodology in examining racial disparity in child welfare research. Some methodological considerations for future child welfare research with Asian-Canadian populations were discussed.     

Social Work and Child Maltreatment Intervention in Disney Animated Feature Films: 1937–2006

Abstract

The 45 Disney animated feature films produced between 1937 and 2006 were analysed for representations of child maltreatment and child maltreatment interventions according to criteria set out in the US National Incidence Study of Child Abuse and Neglect. Although there are 263 maltreated child characters in 30 of the 45 films, they seldom show formal interventionists at work. The types of resolutions and interventions to child maltreatment in the films were analysed and contrasted with the single depiction of a social worker. The actions of this character were assessed according to national codes of ethics and standards for social worker interventions and decision making. Implications are drawn for the profession of social work and the findings are discussed within the context of previously published analyses of media representations of social workers.     

Longitudinal growth of post-traumatic stress and depressive symptoms following a child maltreatment allegation: An examination of violence exposure,family risk and placement type

Few longitudinal studies have analyzed how traumatic experiences (e.g. home removal, violence exposure) influence both depressive and Post-Traumatic Stress (PTS) symptoms in children involved with Child Protective Services (CPS). This study investigated the change trajectories of both depressive and PTS symptomatology as well as their associations over time, focusing on the effect of complex trauma. Data were obtained from the National Survey of Child and Adolescent Well-Being (1999–2007), a nationally representative study of children and adolescents who were referred to child protective services for alleged maltreatment. The Children's Depression Inventory (CDI) scale measured depressive symptoms and the Post Traumatic Stress Disorder section of a version of the Trauma Symptom Checklist for Children (TSCC) provided the measure of current trauma-related symptoms or distress. Analyses were conducted using a parallel process growth curve model. The participants' initial levels of depressive and PTS symptomatology were significantly and positively related; furthermore, any changes in these two outcomes were also correlated longitudinally. The initial assessment of PTS symptoms significantly contributed to the advancement of more severe depressive symptoms over time. No significant differences were found between youth who remained in the home and those removed from the home. However, violence exposure, sexual abuse, gender and age were significant predictors of level and rate of change in both PTS and depressive symptoms. PTS growth factors mediated the longitudinal relationship between witnessing severe violence and depressive symptoms. The findings suggest a complex developmental association between depressive and PTS symptomatology among CPS-involved youth that is rooted in early childhood experiences with complex trauma.     

Determinants of maltreatment substantiation in a sample of infants involved with the child welfare system

Children under one year of age are highly vulnerable to child maltreatment, which can lead to serious immediate and long-term physical and mental health consequences. Child welfare workers encounter unique challenges when assessing allegations of maltreatment involving infants. This study identifies correlates of maltreatment substantiation in a sample of 793 infants less than one year of age investigated by child welfare. It is based on data from the 2003 Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2003), a national study of reports of child maltreatment. The analysis consisted of two stages. First, bivariate analyses were conducted using unadjusted odds ratios and chi-square tests on variables known to be associated with substantiation. In the second stage, a logistic regression was performed to examine these associations in a multivariate model.Multivariate findings suggest that certain vulnerabilities present in the primary caregiver, such as substance abuse and few social supports, as well as the child's positive toxicology at birth are associated with substantiated infant maltreatment. Exposure to domestic violence, which is reported mostly by the police, and physical harm stemming from maltreatment are strongly associated with substantiation, whereas reports of physical abuse and neglect have an inverse relationship. The authors discuss these results and implications for policy and programs.     

Youth at risk: Adolescents and Maltreatment

Data from the National Incidence Study of Child Abuse and Neglect are used to examine the maltreatment of adolescents. The discussion considers the type of maltreatment adolescents experience and the response of service agencies. Adolescents are compared with younger children to identify differences in the form of abuse and neglect they experience and the reporting of that mistreatment. Implications of the results are noted for programs serving youth who have been abused and neglected.     

Reciprocal Associations Among Maternal and Child Characteristics of At‐Risk Families: A Longitudinal Actor–Partner Interdependence Model

Researchers have found linear associations among maternal and child characteristics. However, family systems theorists suggest that relationships are more complex and family members are interdependent. We used actor–partner interdependence modeling to unravel associations among maternal and child characteristics to predict outcomes in adolescence. We used data from 361 mother–child dyads from the Longitudinal Studies of Child Abuse and Neglect and found both actor and partner effects. Maternal depression and history of victimization were associated with children's later reports of lower mother–adolescent relationship quality. Children's perceptions of relationship quality were also associated with mothers' later depressive symptoms and perceptions of relationship quality. Overall, results highlighted interdependence among mothers and their children over time. We discuss implications for marriage and family therapists.     

A personal account of developing preventive approaches to the problem of child sexual abuse in the UK

Abstract

This paper is a revised version of a keynote address on Child Sexual Abuse Prevention presented by Carolyn Okell Jones at the first European Congress on Child Abuse and Neglect, Rhodes, Greece 6-10 April 1987, but developed by both authors.     

Reliability and validity of the Japanese version of the Survey Work–Home Interaction – NijmeGen,the SWING (SWING-J)

ABSTRACT

This study sought to validate the Japanese version of the Survey Work–Home Interaction – NijmeGen, the SWING, which assesses multi-dimensional work–family interaction by differentiating between the direction and quality of influence. We translated the SWING into the Japanese language, the SWING-J. A back-translation procedure confirmed that the translation was appropriate. A total of 2701 dual-earner parents with preschool children (1193 men and 1508 women) were surveyed. The complete questionnaire included the SWING-J, job and family domain variables, and well-being indicators. The reliability and factorial and convergent validity of the used measures were examined. As the results, four dimensions (i.e. work-to-family negative spillover, family-to-work negative spillover, work-to-family positive spillover and family-to-work positive spillover) were determined by an exploratory factor analysis. A series of confirmatory factor analyses suggested that the hypothesized four-factor model provided a reasonably good fit to the data. Convergent validity was generally supported by the expected correlations of work–family spillovers with the possible predictors and consequences. Cronbach's alpha coefficients of the four subscales of the SWING-J were satisfactory (0.75–0.86). The present study confirmed that the Japanese version of the SWING is an adequate tool to measure positive and negative spillover between working life and family life among Japanese workers.     

Psychometrics of a Child Report Measure of Maternal Support following Disclosure of Sexual Abuse

ABSTRACT

The study examined a new child report measure of maternal support following child sexual abuse. One hundred and forty-six mother–child dyads presenting for a forensic evaluation completed assessments including standardized measures of adjustment. Child participants also responded to 32 items considered for inclusion in a new measure, the Maternal Support Questionnaire–Child Report (MSQ-CR). Exploratory factor analysis of the Maternal Support Questionnaire–Child Report resulted in a three factor, 20-item solution: Emotional Support (9 items), Skeptical Preoccupation (5 items), and Protection/Retaliation (6 items). Each factor demonstrated adequate internal consistency. Construct and concurrent validity of the new measure were supported in comparison to other trauma-specific measures. The Maternal Support Questionnaire–Child Report demonstrated sound psychometric properties. Future research is needed to determine whether the Maternal Support Questionnaire–Child Report provides a more sensitive approximation of maternal support following disclosure of sexual abuse, relative to measures of global parent–child relations and to contextualize discrepancies between mother and child ratings of maternal support.     

The Child Abuse Risk Evaluation Dutch Version (CARE-NL): A retrospective validation study

Abstract

The Child Abuse Risk Evaluation – Dutch version (CARE-NL) is a structured professional guideline for assessing the risk of all types of child abuse. The CARE-NL comprises 18 risk factors: eight Parental characteristics, three Parent-Child interaction factors, five Family factors, one Child vulnerability factor, and an extra factor for child sexual abuse risk. We examined interrater reliability and predictive accuracy of the instrument in a retrospective study at Advice and Reporting Centers on Child Abuse (ARCCA) in The Netherlands. The ARCCA files contained limited information on Parental risk factors, while parental characteristics, such as mental disorder and substance abuse, are the most important risk factors for (repeated) child abuse. On the other hand, the majority of the files included ample information on child and family characteristics. The CARE-NL could be reliably coded by trained raters and the predictive accuracy for out-of-home placement (AUC = .73) and placement of the child under court supervision (AUC = .78), at two years follow-up, was adequate. Use of the CARE-NL ensures that the assessment of the risk of child abuse focuses on the most important, empirically based risk factors in a structured and coherent way.     

Describing the context and nature of emotional maltreatment reports in children

The circumstances leading to reports of emotional maltreatment are potentially unique from those of other abuse types. This study utilized data from the National Child Abuse and Neglect Data System (NCANDS), which is a federally sponsored effort requiring the submission of case-level data on all children who were subject to maltreatment investigations by state child welfare agencies. The central aims of this study were to examine case-level characteristics of sole occurrences of emotional maltreatment Child Protective Service (CPS) reports in an effort to address how caregiver and child risk correlates affect the substantiation of these allegations. A cluster analysis was performed to explore how the risk assessment factors grouped together; secondarily, the cluster groupings were examined in a logistic regression model to measure factors associated with substantiation of these abuse reports. Four unique clusters emerged, with one cluster absent any risk assessment factors entirely and another cluster solely composed of domestic violence. Caregiver risk factors with the highest odds of predicting report substantiation included caregiver substance abuse, domestic violence, and caregiver learning disabilities.     

The Experience of Trauma Recovery: A Qualitative Study of Participants in the Women Recovering from Abuse Program (WRAP)

ABSTRACT

The efficacy of intensive group treatment programs for child maltreatment has been established. The aim of this qualitative study was to understand how women with a history of child maltreatment experienced the Women Recovering from Abuse Program (WRAP), an existing intensive group treatment program. Seven women were interviewed following their participation in WRAP. Three themes emerged: Breaking Trauma-Based Patterns, Doing Therapy, and The Healing Journey as a Continuous Process. These findings deepen our understanding about how participants view the recovery process. Theoretical and clinical implications are discussed.     

Crossover Children: Examining Initial Criminal Justice System Contact Among Child Protection-Involved Youth

ABSTRACT

Child protection-involved youth face increased risk of criminal justice system contact. Such “crossover children” experience earlier police involvement and more serious criminal justice sanctions, yet little is known about their early offending. Using a cross-sectional sample of 300 crossover children before three Victorian Children's Courts in 2016–17, this mixed-methods study examines the nature and context of children's initial police charges. Findings indicate that crossover children are initially charged with disproportionately violent offending, and often incur first police charges around the time of initial care placement. For many, initial criminal justice contact occurred in the context of conflict with caregivers, ongoing maltreatment, and household adversity, or emotional and behavioural regulation challenges. Efforts towards preventing offending for child-protection-involved youth should focus on preventing childhood maltreatment, alongside targeting parent–child relationship challenges, and strengthening community and care system responses that address the impacts of complex trauma, mental health problems, and neurodisability.

IMPLICATIONS

• Compared to all sentenced children, those from statutory child protection backgrounds are charged with more serious offending at their first criminal court adjudication.

• Among “crossover children”, earlier police charges were seen for Indigenous children, those experiencing greater cumulative maltreatment, and children with emotional or behavioural challenges related to trauma, mental health, and neurodisability.

• Crossover children are most often first charged by police in the year before, and after, their first out-of-home care placement.

     

Parent-child aggression: association with child abuse potential and parenting styles

The present investigation predicted that greater use of corporal punishment as well as physical maltreatment would be associated with child abuse potential and selected parenting styles. Three independent studies were examined, two with community samples and a third with a clinical at-risk sample of parents. Parents across all studies anonymously completed the Child Abuse Potential Inventory, the Parent-Child Conflict Tactics Scale to assess physical discipline and maltreatment, as well as the Parenting Scale to measure dysfunctional parenting styles. Findings support that overall parent-child aggression, as well as physical maltreatment behaviors specifically, were associated with child abuse potential. Parent-child aggression was also related to dysfunctional parenting styles, particularly an overreactive, authoritarian parenting style. Permissive parenting was also identified as potentially associated with physical maltreatment, although the findings regarding such lax parenting styles are less clear. Intriguing findings emerged regarding the connection of psychological aggression to both child abuse potential and dysfunctional parenting style. Child abuse potential was also associated with dysfunctional parenting style, particularly harsh, overreactive approaches. Recommendations for future study with at-risk samples and additional research on permissive parenting and psychological aggression are discussed.     

Parent gender and child removal in physical abuse and neglect cases

Criminal justice research frequently investigates relationships between punishment decisions and demographic characteristics of the accused, such as gender, race, and age. While there are many similarities between criminal justice and child welfare cases, research on child maltreatment has yet to examine potential demographic influences on case outcomes. The current study examines relationships between parent gender, type of maltreatment, and child removal among agency responses to child maltreatment cases. Using data collected by the National Data Archive on Child Abuse and Neglect Data System (NCANDS), we identify differences in the likelihood of child removal from the parental home across type of maltreatment and perpetrator gender. Our results indicate that mother perpetrators of physical abuse not only face significantly higher likelihood of removal than mother perpetrators of neglect, but are more at risk for losing their children than father perpetrators of both physical abuse and neglect. Findings suggest that gendered attributions and stereotypes regarding parenting can shape assessments of parents' blameworthiness, dangerousness, and rehabilitative potential. We propose that future research on child maltreatment cases adapt and apply justice concepts and frameworks to uncover potential unwarranted demographic disparities in agency decision-making.     

Substantiating neglect of first nations and non-aboriginal children

First Nations (Native American) children are greatly overrepresented in the Canadian child welfare system, and disproportionality in the substantiation of maltreatment contributes to this overrepresentation. This study explores the factors driving disproportionality in the substantiation of maltreatment and, more specifically, neglect. Data from the Canadian Incidence Study of Reported Child Abuse and Neglect (2008) are used in multivariate analyses which examine the relationship between the substantiation of maltreatment/neglect and worker assessments of case, child, household, and caregiver characteristics. These case factors fully explain disproportionality in maltreatment substantiation for First Nations and non-Aboriginal children; the disproportionality reflects underlying differences in the case, child, household and caregiver characteristics identified in First Nations and non-Aboriginal investigations. However, case factors do not fully explain disproportionality in substantiation of neglect-only investigations. Further analysis indicates that the weight that workers assigned to caregiver substance abuse, housing problems, and presence of a lone caregiver when substantiating neglect also differed for First Nations and non-Aboriginal children. Discussion of these findings explores possible explanations for these differences, and links to broader discussions around definitions of neglect and the role of substantiation in child welfare decision making processes.     

Multisystemic Therapy for Child Abuse and Neglect: Do Parents Show Improvement in Parental Mental Health Problems and Parental Stress?

Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) is an evidence-based program for families with children who experience maltreatment. This clinical trial is the first evaluation of MST-CAN in a German-speaking area. Parental psychological problems and parental stress have been shown to be risk factors for child abuse and neglect. By the end of treatment, parents reported significantly less psychological distress than before the start of MST-CAN. Six months after treatment, this reduction was still evident. However, parents did not report any significant reduction of parental stress at any of the three time points. MST-CAN is an effective intervention for child maltreatment that not only combats child abuse and neglect but also has the potential to alleviate parental psychological distress.     

Food neglect and maltreatment re-report

This study examines the time to re-report following the close of a maltreatment investigation for cases involving food neglect. Data on families of children 0 to 17 involved in Child Protective Services (CPS) investigations from a merger of the 2010 cohort of the National Survey of Child and Adolescent Well-Being (NSCAW II) and the National Child Abuse and Neglect Data System (NCANDS) were used (n = 3580). More than half of the families had a history of CPS involvement, a third received CPS services, and one-in-ten families had their child place in out-of-home care following an investigation. After controlling for other types of maltreatment allegations and multiple covariates, families investigated for food neglect had a greater chance of being re-reported for a subsequent CPS investigations in a shorter length of time than families without an allegation of food neglect. While only a small percentage of families had a food neglect allegation, problems adequately feeding a child - whether due to severe poverty, inattentiveness, or abusive negligence - placed a family at a higher risk of a future CPS investigation.