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.     

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.     

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.     

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.     

The Youngest Victims of Violence: Examining the Mental Health Needs of Young Children Who Are Involved in the Child Welfare and Juvenile Justice Systems

Children placed in the state’s custody due to neglect, abuse or maltreatment are one of America’s most vulnerable populations. Seventy-five percent of child victims of maltreatment are under the age of 12. Not only is their suffering a problem, these children are also at increased risk for delinquent behavior later in life. While research has documented the potential long-term consequences of child abuse and neglect, the mental health needs of young children involved in the foster care and juvenile justice systems have been largely overlooked. This study examined the social, emotional and behavioral difficulties of 670 children, age 3–11, who were involved in the child welfare and juvenile justice systems. Children in this study were living in residential treatment facilities, group homes, foster care homes or were receiving intensive home-based services. To assess the children’s mental health needs caregivers completed the parent form of the Strengths and Difficulties Questionnaire (Goodman, Journal of Child Psychology and Psychiatry 38:581–586, 1997). The findings indicated a high prevalence of mental health problems, with 81 % of the children in the sample having a total difficulties score in the borderline or abnormal range and 90 % of the children having borderline or abnormal scores on at least one of the subscales (conduct, emotional, peer or attention problems). When characteristics such as gender, race and age were considered significant differences were found among boys and girls, Caucasian and minority children, and age groups. The findings highlight the importance of mental health assessment and interventions that are gender and culturally sensitive and developmentally appropriate.     

Does changing mandated reporting laws improve child maltreatment reporting in large U.S. counties?

The effects of changes in mandated child maltreatment reporting laws have not been systematically evaluated. To better understand the effects of these changes, the objectives of the present study are: (1) to assess the relationships between report rates and state universal and clergy reporting laws in 2010; (2) to compare the changes in total, confirmed, and maltreatment type report rates and with changes in reporting laws from 2000 to 2010, and (3) to examine whether there is any relationship with report rates and the nature of the mandated reporting law change. We used county-level data from the U.S. National Child Abuse and Neglect Data System for the years 2000 and 2010 to evaluate changes in reporting rates for total reports, confirmed reports, and confirmed maltreatment types while controlling for concurrent changes in child and community variables. We found that trends in 2010 for increased total and confirmed reports were similar to 2000 for counties with universal and/or clergy reporting requirements, which significantly contributed to report rates even after controlling for child and community factors. Universal reporting was associated with higher report rates for physical and sexual abuse, and clergy reporting requirements were associated with more sexual abuse, medical neglect and psychological maltreatment confirmed reports. However, while counties in states that changed their clergy reporting laws had higher increases in total reports, they had fewer confirmed physical and sexual abuse, neglect, and psychological maltreatment reports. More pronounced changes were noted in a state that made more pronounced changes in its clergy reporting laws. Policymakers should consider whether changing requirements for mandated reporting meaningfully improves child maltreatment identification.     

A Critical Review of the Empirical Literature: Identifying Correlates of Child Neglect

More than half the children in the United States who were victims of maltreatment in 2000 were victims of neglect (USDHHS, 2002). The majority of all child maltreatment related fatalities in 2000 were the result of neglect (USDHHS, 2002), and 27.8% of these fatalities were associated with both physical abuse and neglect (USDHH, 2002). Neglected children are more likely to be younger children (USDHHS, 2000), and the highest rate of child fatality due to maltreatment is between the ages of zero and five (Petit & Curtis, 1997; Gustavsson & Segal, 1994; USDHHS, 1999). The purpose of this article is to present the findings of a systematic review of the research on child neglect from 1990 to 2002. The review critiques method and synthesizes of the current body of knowledge on child neglect.     

Child Maltreatment, Abortion Availability, and Economic Conditions

Child maltreatment is a substantial problem in the U.S. yet has received relatively little attention from economists. This article examines the relationship between abortion availability and economic factors at the time children were conceived and subsequent measures of child maltreatment in the U.S. as well as the influence of contemporaneous economic conditions. Our measures of child maltreatment are state-level rates of child abuse and neglect reports, the fraction of children receiving social services, and child deaths and murders. The results indicate that legalized abortion for each successive cohort led to a decline in total reported incidents of child abuse and neglect of about 10 percent and a negative effect on the fraction of children receiving social services. Child deaths and murders are not related to abortion legalization. Medicaid funding restrictions are associated with an increase in substantiated reports of abuse and an increase in murders by relatives or parents; other post-legalization restrictions are not consistently associated with the various measures of child maltreatment. The effects of welfare benefits, average income, and unemployment rates are mixed.     

Why should child welfare pay more attention to emotional maltreatment?

A significant body of research indicates that emotional maltreatment (EMT) is harmful to children, resulting in long-term negative impacts on emotional and behavioral development. The child welfare system's focus on physical abuse, physical neglect, and sexual abuse has led a relative lack of attention to EMT. Reported rates of EMT vary widely across states – ranging from 0.2% to 44.9% in a recent national report on child maltreatment – indicating that it is not being measured consistently. This paper uses data collected by the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) to (1) describe the nature and characteristics of emotional maltreatment experienced by 846 LONGSCAN youth across time, and (2) describe the relation between four subtypes of emotional maltreatment (psychological safety and security, acceptance and self-esteem, autonomy, and restriction) and child trauma symptoms and risk behaviors at age 18. Exposure to EMT was related to increased trauma symptoms and risky behaviors. EMT is common, identifiable, harmful, and potentially preventable; and a better understanding of it will help to inform the provision of effective child welfare and mental health services to children and their families. Findings suggest a need for greater understanding of parental behaviors, and the motivations behind them, that result in emotionally harmful outcomes for children, as well as a better understanding of appropriate interventions for children who experience various types of EMT.     

Pathways Linking Childhood Maltreatment and Adolescent Sexual Risk Behaviors: The Role of Attachment Security

Previous research has shown an association between child maltreatment (sexual abuse, physical abuse, neglect, or witnessing interparental violence) and adolescent sexual risk behaviors (SRBs). The mechanisms explaining this association are not well understood, but attachment theory could provide further insight into them. This study examined the relationships between child maltreatment and SRBs and investigated anxious and avoidant attachment as mediators. The sample comprised 1,900 sexually active adolescents (13 to 17 years old; 60.8% girls) attending Quebec high schools. The results of path analyses indicated that neglect was associated with a higher number of sexual partners, casual sexual behavior, and being younger at first intercourse. Anxious attachment mediated the relation between neglect and number of sexual partners, whereas avoidant attachment explained the relation between neglect and number of sexual partners, casual sexual behavior, and age at first intercourse (for boys only). Sexual abuse was directly associated with all three SRBs. Neither anxious attachment nor avoidant attachment mediated these associations. Youth with a history of neglect and sexual abuse represent a vulnerable population that is likely to engage in SRBs. Interventions designed to induce a positive change in attachment security may reduce SRBs among victims of neglect.     

Child abuse and neglect re-reports: Combining and comparing data from two national sources

This study compared child-level estimates of child maltreatment re-report and recurrence in two national sets of data on child maltreatment: state administrative data submitted to the National Child Abuse and Neglect Data System (NCANDS) and caseworker interviews from the National Survey of Child and Adolescent Well-Being (NSCAW). Maltreatment data from NCANDS and NSCAW were merged for 2230 children that had intersecting information from both sets. The percentage of child cases with at least one re-report of abuse or neglect over the study period differed depending on the data set. The NCANDS re-report estimate was 32.3% (95% CI 26.5%, 38.6%) whereas the estimate based on NSCAW caseworker interviews was 22.9% (95% CI 17.6%, 29.2%). More than a quarter of the children with observations from the union of the two data sets had a re-report identified by one source but not the other (set difference). Most often, the set difference in re-reports appeared in NCANDS, but was not reported by an NSCAW caseworker. When the set difference from NCANDS was added to the re-reports by NSCAW caseworkers, the resulting union of re-reports increased the point estimate in the NSCAW–NCANDS intersection to 40.9% (95% CI 34.3%, 47.8%). Restricting the comparisons to only substantiated re-reports (recurrence) narrowed the differences in absolute terms but the set difference in recurrence rates was proportionally similar. Potential explanations for non-intersecting re-reports and recurrence between the two data sets were examined. Findings illuminate methodological challenges that may arise when child maltreatment re-report and recurrence data from administrative and survey sources are merged, and the value of the union of state-level administrative data with national survey data for studies of safety and well-being of children reported for maltreatment.     

Prevalence of Child Sexual Abuse in the Nordic Countries: A Literature Review

This review examined child sexual abuse in the Nordic countries focusing on prevalence rates and victims’ age and relationship to the perpetrator. The results show a prevalence of child sexual abuse (broadly defined) between 3–23% for boys and 11–36% for girls. The prevalence rates for contact abuse were 1–12% for boys and 6–30% for girls, while 0.3–6.8% of the boys and 1.1–13.5% of the girls reported penetrating abuse. The findings suggest an increased risk of abuse from early adolescence. In adolescence, peers may constitute the largest group of perpetrators. The results highlight the need for preventive efforts also targeting peer abuse. Future research should include cross-national and repeated studies using comparable methodology.     

Differential response in child protection: How much is too much?

Recurring maltreatment can have devastating, lifelong consequences for children who are victims of abuse and neglect. The primary mission of child protection services (CPS) agencies is to prevent the recurrence of child maltreatment by offering families services designed to prevent future maltreatment. In order for these services to be effective, however, families must actually engage in them. This study focuses on how differential response programs impact families' successful engagement in services as indicated by long-term child safety outcomes.Differential response refers to a dual track system that allows public CPS agencies to respond to accepted reports of child abuse or neglect with either a traditional investigative response (TR) or an alternative response (AR). The AR is designed to be a less authoritative and less adversarial approach to families presenting a low- to moderate-risk of maltreatment. The AR involves collaboration with the family in a comprehensive assessment of the family's needs, risks and strengths and a referral to services on a voluntary basis. States implementing DR systems statewide vary greatly in the percentage of accepted reports that are assigned to the AR track. The goal of this study is to determine what rate of AR utilization is most effective in reducing subsequent reports of abuse and neglect for cases assigned to the AR.This study compares child safety outcomes for children assigned to the AR and those assigned to the TR within each of the fourteen states which implemented DR statewide between 2000–2012. The analysis uses Cox proportional hazards regression. Data for this observational study are drawn from the 2000–2012 data in the National Child Abuse and Neglect Data System (NCANDS) child files. Child safety is measured by re-reporting of the child to CPS.The theoretical model underpinning the study is McCurdy and Daro's (2001) Integrated Theory of Participant Involvement (ITPI) which outlines a conceptual model of parental engagement in services. This study hypothesizes that AR utilization rates affect the risk level of cases assigned to the AR. The ITPI model offers a possible explanation as to why higher risk cases may not be as responsive to the AR approach which depends upon the family's voluntary participation in services.The key finding of this study is that, in states assigning > 33% of reports to the AR, children on the AR track are being re-reported at equal or higher rates than those on the TR track. Only in those states utilizing the AR track for < 33% of the cases are AR cases being consistently re-reported at lower rates than those on the TR track. This article explores ways to improve the accuracy of track assignment decisions to prevent the assignment of higher risk families to the alternative response.     

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.     

Out-of-home maltreatment: An analysis of risk in various settings for children

Abuse and neglect of children in out-of-home care are common, but comparisons of relative risk among such facilities are rare. Data from Indiana for the period 1984–1990 permit an examination of maltreatment in various settings and computations of rates of physical and sexual abuse and neglect. Findings suggest that children in daycare homes and centers and schools are less likely to be maltreated than those in foster homes, residential homes, or state institutions and hospitals. These differences in risk may reflect variation in staff morale and turnover, different ages and experiences of children, alternative emphases on custody, control or nurturance by the home or institution, and different approaches to substantiating abuse. However, in three of the seven out-of-home settings, there are higher rates of maltreatment than for children in their own homes. Some implications of these findings are explored.     

What is driving increasing child welfare caseloads in Ontario? Analysis of the 1993 and 1998 Ontario incidence studies

Rates of substantiated maltreatment documented by the 1993 and 1998 Ontario Incidence Studies of Reported Child Abuse and Neglect doubled between 1993 and 1998. Although increasing public awareness and changes in investigation procedures appear to account for part of this change, the increase also reflects a significant shift in the types of maltreatment agencies are investigating and substantiating. Exposure to spousal violence has increased eightfold, and the proportion of neglect cases has more than doubled, whereas cases of sexual abuse are decreasing. The field requires a differentiated response to address the maltreatment-specific challenges underlying child welfare caseload increases in Canada.     

Have child maltreatment and child placement rates declined?

It is argued that the actual incidence of child maltreatment remains elusive and is, in fact, indeterminate. Factors that might be reflected in variations in child maltreatment rates, other than child harm or endangerment at least partially attributable to caretakers, are explored. But since most children residing in foster care in the United States have been placed there for the alleged reasons of child abuse and neglect, we might expect trends over time in the rate of alleged maltreatment to have some bearing on the out-of-home placement population rate. On the contrary, it is shown that the child placement population rate has risen in recent years, even though the overall child maltreatment rate has not. Based on existing data, the child placement population in the United States is calculated to have been nearly one million children on any given day in 2011, higher than at any point throughout the previous century. Brief comparisons are made with child maltreatment and child placement trends in other countries.     

Understanding and responding to chronic neglect: A mixed methods case record examination

Neglect is the most prevalent form of maltreatment, and thus comprises the bulk of cases for Child Protective Service (CPS) agencies, yet it remains under-studied. Cases in which children experience repeated or “chronic” neglect are particularly concerning. A growing body of research indicates that the effects of chronic neglect create a harmful accumulation of problems for child well-being, including detrimental impact on early brain development, emotional regulation, and cognitive development. The aim of this retrospective case record review study was to examine risk and protective factors of chronic neglect and relevant CPS agency responses and practices. Results demonstrated that families experiencing chronic neglect had multiple significant stressors (four or more stressors for all families in this study), such as domestic violence, poverty, children with behavioral problems, and/or substance abuse, indicating chaotic and toxic living environments. Key implications are outlined for strengthening CPS response to cases of chronic neglect, including the need for comprehensive assessment of families, more effective and consistent use of standardized risk assessment tools, and better recognition of past patterns of neglect to mitigate the risk of accumulation of harm.     

Types and timing of child maltreatment and early school success: A population-based investigation

The purpose of the present study was to investigate the prevalence of types of child maltreatment and co-occurring risks in an entire county population of children in public education and to examine the unique relations of the child maltreatment types and timing on children's early academic success while accounting for the children's multiple-risk context. A cohort of 11,835 second grade students who were born in the county and attended the public school district served as participants. Information on first reported experiences of substantiated physical abuse, neglect, unsubstantiated child maltreatment reports, health, maternal, and social risks, and academic and behavioral outcomes was obtained and linked through a county-wide integrated data system. Results indicated that after controlling for demographics and the set of other risks, substantiated child neglect and unsubstantiated reports were associated with poorer outcomes than physical abuse. Also, first substantiated child maltreatment and unsubstantiated reports prior to kindergarten were related to a more comprehensive set of poor outcomes than post-kindergarten first reports. The differential patterns that emerged for the association between age of first reported maltreatment by type and educational outcomes were discussed with implications for future research and policy.