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.     

Comparing different types of child abuse and spouse abuse offenders

This study examined differences in offenders' background characteristics, personal and interpersonal problems, and family climate between three types of child abuse offenders (neglecters, physical abusers, and psychological abusers) and two forms of spouse abuse offenders (physical abusers and psychological abusers) in two large samples (child abuse n = 2,910; spouse abuse; n = 7,035) of cases officially identified over a 8-year period (1988-1995) by the U.S. Air Force Family Advocacy Program. Comparisons addressed demographic factors, personal and interpersonal problems, and aspects of family climate. Among child abusers, results supported the conclusion that types of child abuse varied with offender demographics and family climate factors. For spouse abusers, however, types of abuse were not as distinctly different in terms of the comparison variables. In general, therefore, for child abuse--but not for spouse abuse--findings challenge the view of abuse as a unitary phenomenon.     

Child Sexual Abuse Intervention: An Exploratory Study of Policy Concerns and Implications for Program Development

ABSTRACT

This exploratory study was designed to determine public opinion regarding intervention options for intrafamilial child sexual abuse offenders, victims, and families. The study investigated the public's willingness to support strategies of victim protection, offender control, and treatment services in various types of child sexual abuse intervention strategies. The respondents to the statewide survey generally supported established, adversarial intervention strategies, and had mixed reactions lo several of the diversion program strategies. The findings suggest that policy makers may have to compromise lo obtain public support when designing and implementing intervention programs for intrafamilial child sexual abuse. The article addresses policy issues and concludes with implications for program development.     

Prevalence,Characteristics, and Associations of Sexual Abuse with Sociodemographics and Consensual Sex in a Population-Based Sample of Swedish Adolescents

The purpose of this study was to investigate lifetime prevalence and characteristics of self-reported child sexual abuse and associations between child sexual abuse, gender, sociodemographic data, and consensual sexual experiences. A questionnaire was completed by 4,339 Swedish high school seniors. Three categories of child sexual abuse were studied: noncontact, contact without penetration, and penetrating child sexual abuse. Penetrating child sexual abuse was correlated with the most severe abuse characteristics. Students reporting child sexual abuse, especially penetrating child sexual abuse, were more likely to not be living with both parents, to have parents with lower socioeconomic status, and to have their first consensual intercourse at a young age. The study showed that distinct categories of child sexual abuse must be employed since each category shows a specific pattern concerning abuse characteristics, sociodemographics, and consensual sex.     

Economic predictors of child maltreatment in an Australian population-based birth cohort

A correlation between socioeconomic disadvantage and child maltreatment has long been observed, but the drivers of this association are poorly understood. We sought to estimate the effects of economic factors on risk of child maltreatment after adjusting for other known influences using the Australian Temperament Project, a population-based birth cohort of 2443 individuals and their parents. We used logistic regression to estimate associations of childhood economic factors (parental education, occupation, and unemployment; type of housing; and retrospective perception of poverty) with retrospective reports of perceived child maltreatment (physical abuse, sexual abuse, emotional abuse, neglect, and witnessing of domestic violence), controlling for demographic factors, parental mental health and substance use, and child health. We then used these estimates to approximate the proportions of child maltreatment—population attributable fractions—that are theoretically preventable by addressing childhood economic disadvantage. Economic factors were associated with all types of child maltreatment. For the most part, these associations diminished only partially when controlling for noneconomic confounders, supporting hypotheses of causal relationships. Jointly, economic factors were significant predictors of physical abuse, sexual abuse, and witnessing of domestic violence but not of emotional abuse or neglect. Retrospective perceptions of childhood poverty were, in particular, strongly associated with most forms of child maltreatment but not with sexual abuse after accounting for other economic factors. We estimated that 27% of all child maltreatment was jointly attributable to economic factors. These findings suggest that strategies that reduce economic disadvantage are likely to hold significant potential to reduce the prevalence of child maltreatment.     

Early indicators of child abuse and neglect: a multi‐professional Delphi study

Through the application of the Delphi technique, this study draws on the expertise of British child protection academics and practitioners from a wide range of disciplines in seeking to develop a consensus opinion on possible early indicators of child abuse and neglect. The search for early indicators is described in the context of a secondary preventative approach to the problem of child maltreatment. A very tentative conclusion arising from the study is that the early indicators of child abuse and neglect that achieved consensus of agreement may help in diagnosing child abuse and neglect at an earlier stage, although they are not necessarily diagnostic. Alternative explanations, differential diagnoses and information‐gathering are paramount, as is a willingness and ability to act on concerns. Although great caution is urged, it is suggested that the findings from the study are credible and of interest to those who are working towards more timely recognition and referral of abused and neglected children. Copyright © 2003 John Wiley & Sons, Ltd.     

Risk assessment in child sexual abuse cases

Despite continuing improvements in risk assessment for child protective services (CPS) and movement toward actuarial prediction of child maltreatment, current models have not adequately addressed child sexual abuse. Sexual abuse cases present unique and ambiguous indicators to the investigating professional, and risk factors differ from those related to physical abuse and neglect. Incorporation of research on risk factors specifically related to sexual offender recidivism into existing CPS risk assessment models may improve the ability to assess the risk of future sexual maltreatment to children. This article reviews the literature on risk factors for sexual offense recidivism and discusses their relevance and application to CPS assessment models. An evidence-based model for assessing risk in child sexual abuse cases is proposed.     

Developmental issues in child abuse: Implications for intervention

This paper reviews some of the issues in child abuse such as problems of definition, characteristics of abuser and abused, and etiology. It emphasizes that child abuse can start at any age. A developmental approach is suggested in order to understand the relationship between the child's stage of development and its idiosyncratic potential for stimulating aggression on the part of the parent. This approach offers a broad framework in which phase specific stressors, characteristics of the child, the abuse prone personality of the abuser, as well as the family system and external stress factors, can be considered together and upon which intervention strategies can be planned.Lynn Ohrenstein is Administrative Supervisor at the Jewish Board of Family and Children's Services, a doctoral candidate at Yeshiva University, and in private practice.This is an expanded version of a paper delivered November 4, 1982 by the author at an interdivisional meeting at the Jewish Board of Family and Children's Services devoted to Issues on Domestic Violence.     

The impact of child, family, and child protective services factors on reports of child sexual abuse recurrence

This study identified selected child factors (e.g., age, gender, race/ethnicity, disabilities, prior victimization, and relationship to perpetrator of abuse), family risk factors (e.g., substance abuse, domestic violence, inadequate housing, and financial problems), and services provided by child protective services that likely increased reports of child sexual abuse recurrence by type of reporter. Survival analysis was conducted using the National Child Abuse and Neglect Data System data set of 2002-2004. Child disability, being a prior victim, having a perpetrator as a caregiver, family financial problems, and receiving family supportive services increased the likelihood for reports of child sexual abuse by mandated reporters. Being Hispanic, having a disability, having a perpetrator as a caregiver, financial problems, and receiving family preservation services statistically decreased the likelihood for reports of child sexual abuse recurrence.     

The Contribution of Role Characteristics and Supervisory Functions to Supervision Effectiveness

This study examined the factors that contribute to the perceived effectiveness of supervision for child welfare workers. Specifically, we examined role characteristics such as: exposure to child abuse cases, years of work experience, and role stress, as well as the supervisory functions of administration, education, and emotional support to effectiveness of supervision. The findings revealed that the supervisory function of administration, as well as social workers’ high exposure to child abuse cases and role stress, correlated negatively with perceived supervision effectiveness. In contrast, the use of the supervisory functions of education and support correlated positively with perceived supervision effectiveness. The findings suggest that high exposure to child abuse cases and role stress can impair social workers’ ability to benefit from effective supervision. In addition, the study highlights the importance of the supervisory functions of support and education and their positive impact on this population of social workers in Israel.     

Maladaptive Schemas as Mediators in the Relationship Between Child Sexual Abuse and Displaced Aggression

Child sexual abuse is one of the most serious forms of abuse due to the psychological consequences that persist even into adulthood. Expressions of anger among child sexual abuse survivors remain common even years after the event. While child sexual abuse has been extensively studied, the expression of displaced aggression has been studied less. Some factors, such as the maladaptive early schemas, might account for this deficiency. The objective of this study was to analyze the relationships between child sexual abuse, displaced aggression, and these schemas according to gender and determine if these early schemas mediate the relationship between child sexual abuse and displaced aggression. A total of 168 Spanish subjects who were victims of child sexual abuse completed measures of childhood trauma, displaced aggression, and early maladaptive schemas. The results depict the relationship between child sexual abuse, displaced aggression, and early maladaptive schemas. Women scored higher than men in child sexual abuse, emotional abuse, disconnection or rejection and impaired autonomy. Mediational analysis found a significant mediation effect of disconnection or rejection on the relationship between child sexual abuse and displaced aggression; however, impaired autonomy did not mediate significantly.     

Differentiating Children with and without a History of Repeated Problematic Sexual Behavior

Although the issue of dissociative amnesia in adult survivors of child sexual abuse has been contentious, many research studies have shown that there is a subset of child sexual abuse survivors who have forgotten their abuse and later remembered it. Child sexual abuse survivors with dissociative amnesia histories have different formative and therapeutic issues than survivors of child sexual abuse who have had continuous memory of their abuse. This article first discusses those differences in terms of the moderating risk factors for developing dissociative amnesia (e.g., age, ethnicity, gender, etc.) and then mediating risk factors (e.g., social support, trait dissociativity, etc.). The differences between the two types of survivors are then explored in terms of treatment issues.     

Correlates of Sexual Abuse in a Sample of Adolescent Girls Admitted to Psychiatric Inpatient Care

We examined correlations of child sexual abuse among 300 adolescent girls in psychiatric inpatient treatment. Diagnostic and Statistical Manual of Mental Disorders (4th ed.)-based psychiatric diagnoses were obtained from the Schedule for Affective Disorder and Schizophrenia for School-Age Children—Present and Lifetime and from data on family and behavioral characteristics from the European Addiction Severity Index (EuropASI). A total of 79 girls (26.3%) had experienced child sexual abuse during their lifetime. Child sexual abuse was associated with an adolescent’s home environment, sibling status, smoking, posttraumatic stress disorder diagnosis, self-mutilating behavior, and suicidal behavior. At least 62% of the perpetrators were acquaintances of the victims. Correlates of child sexual abuse can be used to identify child sexual abuse victims and persons at heightened risk for child sexual abuse.     

Pornography and the Organization of Intrafamilial and Extrafamilial Child Sexual Abuse: Developing a Conceptual Model

This paper uses a case study (the experience of having been sexually abused as a child) and a review of the relevant literature as the basis for developing a conceptual model of the relationship between intrafamilial and extrafamilial child sexual abuse and child sexual exploitation, and the role of adult and child pornography in it. The paper illustrates some of the characteristics and effects of pornography and child sexual abuse including: gender; intra- and intergenerational patterns of victimization; coercion and compliance; the sexualization of the child; pornography and prostitution; and the function of incest as a form of pimping for the perpetrator and as grooming for extrafamilial abuse. It also illustrates the way in which pornography is a part of all forms of intrafamilial and extrafamilial abuse and is itself a form of organized abuse. © 1997 John Wiley & Sons, Ltd.     

The joint contribution of experiencing and witnessing violence during childhood on child abuse in the parent role

This article examines adult respondents' abuse of children as a consequence of their own childhood experiences of abuse, both direct experiences of childhood violence (hitting) and exposure to interparental violence (witnessing). In particular, the study examines the extent to which these factors function interactively: Are both experience and exposure necessary or is either sufficient to increase disproportionately the probability of child abuse? Using data from the Second National Family Violence Survey, results of a logistic regression analysis show that either or both factors produced higher than average and relatively similar rates of child abuse. Only respondents with neither form of family violence reported lower than average rates of abuse of their own children. The analysis controlled for gender, race, family income, and family structure; race was the only control variable to be significantly associated with child abuse. Finally, no control variable modified the interaction between the family violence variables.