Mapping the Elder Mistreatment Iceberg: U.S. Hospitalizations With Elder Abuse and Neglect Diagnoses

Purpose: This study describes U.S. hospitalizations with diagnostic codes indicating elder mistreatment (EM). Method: Using the 2003 Nationwide Inpatient Sample (NIS) of the Healthcare Costs and Utilization Project (HCUP), inpatient stays coded with diagnoses of adult abuse and/or neglect are compared with stays of other hospitalized adults age 60 and older. Results: Few hospitalizations (< 0.02%) were coded with EM diagnoses in 2003. Compared to other hospitalizations of older adults, patients with EM codes were twice as likely to be women (OR = 2.12, 95% CI = 1.63–2.75), significantly more likely to be emergency department admissions (78.0% vs. 56.8%, p < .0001), and, on average, more likely to have longer stays (7.0 vs. 5.6 days, p = 0.01). Patients with EM codes were also three to four times more likely to be discharged to a facility such as a nursing home rather than “routinely” discharged (i.e., to home or self-care) (OR = 3.66, 95% CI = 2.92–4.59). Elder mistreatment–coded hospitalizations compared to all other hospitalizations had on average lower total charges ($21,479 vs. $25,127, p < .001), with neglect cases having the highest charges in 2003 ($29,389). Implications: Knowledge about EM is often likened to the “tip of the iceberg.” Our study contributes to “mapping the EM iceberg”; however, findings based on diagnostic codes are limited and should not be used to minimize the problem of EM. With the so-called graying of America, training is needed in recognizing EM along with research to improve our nation's response to the mistreatment of our elderly population.     

A Comparison of Child Fatalities by Physical Abuse Versus Neglect: Child,Family, Service,and Worker Characteristics

ABSTRACT

In the field of child welfare, attention has been given to risk factors for child maltreatment fatalities with little attention to the difference between children who die from abuse versus neglect. As part of a larger study, child welfare workers (n = 104) from 14 different states responded to an anonymous online survey that described the child, family, and case characteristics before death and worker characteristics/experiences before and after death. Results supported that prior to death, neglectful families presented with less risk than abusive families, in the areas of parent–child attachment, child behavior problems, and changes in household composition while reporting that they received more services. With regard to child welfare practice, workers did not report any differences in how they handled cases before death nor did they report differences in their posttraumatic stress symptoms at the time of the survey. These findings can be used as a springboard for future research that focuses on fatal maltreatment.     

Self-Neglect and Neglect of Vulnerable Older Adults: Reexamination of Etiology

Using assessment and investigation data from the reported APS cases in Texas, this study examines the types of elder self-neglect and neglect, including medical neglect. It then examines the association between self-neglect and neglect and individual economic resources as well as health care and social service programs for the poor. The findings show that elder self-neglect/neglect is, in large part, attributable to frail older adults' and their families' lack of resources to pay for essential goods and services and the inadequate healthcare and other formal support programs for the older adults and their caregivers. This inadequate public policy coverage, rather than individual and intrafamily risk factors per se, needs to be considered as a significant cause of elder self-neglect/neglect.     

A Study of Social Workers' Job Satisfaction as Based on an Optimal Model of Care for the Terminally Ill

ABSTRACT

To address the need for empirical evidence on how culture is and should be addressed in child protection work in Australia to ensure equity in service delivery, this study reviewed 120 case files of children from ethnic-minority, Aboriginal, and Anglo backgrounds and conducted 46 qualitative interviews with ethnic-minority client families and the caseworkers who service them. Overall, the results indicated that the issue of culture for ethnic-minority families receives less consideration than it does for Aboriginal families and more than it does for Anglo families, indicating that cross-cultural parity is yet to be achieved. To ensure equity in service delivery, it is important that culture is neither overlooked nor used to essentialize the needs and experiences of ethnic-minority families; balancing the amount of attention that culture receives in child protection work may help “normalize the novel”—that is, reduce the use of cultural stereotypes without reducing the significance of cultural factors in child protection work with culturally nonmainstream families. Mandatory consultation with “multicultural” caseworkers may help get the balance right and warrants future research.     

Methodological and Validity Issues Involved in the Collection of Sensitive Information From Children in Foster Care

ABSTRACT

The Illinois Child Well-Being Study (ICWBS) established a red-flag reporting system (RFRS) embedded in the Audio Computer Assisted Self Interview (ACASI) portion of its child survey to flag reports of violence toward the child, suicidality, neglect, and/or sexual exploitation. When those RFRS questions were positively answered, the reported incident was relayed to the child's caseworker and investigated. This study describes the RFRS, the analysis of the children's reports, and a content analysis of the caseworkers' investigation. In this study, 166 children were interviewed and 28 children reported 36 RFRS incidents. On investigation, only 6 RFRS incidents were verified; most RFRS incidents were reported in error. The results of this study may help researchers using similar RFRS protocols.     

晚清民初小说娱乐功能的被忽视与归依

晚清启蒙思潮的鼓荡,促成文学与政治的联姻。新小说家期待视野的扭曲和启蒙行动的错觉,在改变小说的文类地位的同时,也相对忽视了小说的娱乐文化。民初小说家检讨晚清小说观念,批评与扬弃了小说观念的载道趋向。小说趋向娱乐文化的归栖,既是对小说娱乐母体的沿袭与发展,也是对晚清启蒙思潮的反叛与弥补,中国小说观念近代化进程正是在由家国关注到情感娱乐的转变中,实现传统向现代的嬗变。     

Vulnerable children's rights to participation,protection, and provision: The process of defining the problem in Swedish child and family welfare

This study addresses the relationship between children's participation and the protection and provision offered to them by social services in Sweden. It applies a theoretical framework for analysing child welfare that is anchored in the United Nations Convention on the Rights of the Child. How child participation may affect child protection and provision is examined empirically using case documentation from 2 municipalities. The main finding is that when children are not given voice or opportunity to influence the framing of what “the problem” is, the design of protection and care tends to be poorly matched to the actual problems documented in the child investigation and vice versa; when children can influence framing, this is associated with well‐matched protection and care. This suggests that traditional child welfare ethos, to the effect that protection should be of such overriding concern that children even should be protected from participation, is misguided. The study further illustrates the intrinsic problems with the family orientation of Swedish social services and its reliance on partnership with parents, which makes it difficult to live up to the Convention on the Rights of the Child. Incorporating child participation into existing service models can transform Swedish social services to an augmented child‐focused system that by ensuring participation also promotes protection and provision.     

Development of an evidence‐informed in‐home family services model for families and children at risk of abuse and neglect

This paper describes the components of a programme designed to prevent child maltreatment which includes the promising practices of a continuous engagement process, cognitive‐behavioural parent and skill teaching, and development of formal and informal supports for families. The programme was also designed to be implemented wide scale. Methods for assessment of strengths and needs, individualization of goals and intervention strategies, and assessment of goal achievement are also described. Finally, preliminary results of a programme implementation fidelity and outcome evaluation are summarized. The authors conclude that this programme is ready for a more rigorous efficacy trial to continue to build the evidence base for this promising intervention addressing a prevalent social problem.     

Multi‐type maltreatment and the long‐term adjustment of adults

Multi‐type maltreatment refers to the experience of more than one form of child maltreatment (sexual abuse, physical abuse, psychological maltreatment, neglect and witnessing family violence). Researchers have largely ignored the presence of other types of child abuse and neglect when examining the adjustment problems associated with a particular form of maltreatment. The association between ‘multi‐type maltreatment’ and adjustment was explored in the current study. Retrospective data were obtained on (a) the degree to which maltreatment types co‐occurred, (b) childhood family characteristics and (c) adjustment problems in adulthood in an Australian self‐selected community sample (N=175). As hypothesized, a large degree of overlap was reported in the experience of the five types of maltreatment. Family characteristics—particularly family cohesion and adaptability—discriminated between respondents reporting single‐type and multi‐type maltreatment. Greater adjustment problems were associated with reports of a larger number of different maltreatment types. Multi‐type maltreatment should be recognized as a crucial aspect of the nature and impact of child maltreatment and considered in the development of programmes for the prevention and treatment of child abuse and neglect. Copyright © 2000 John Wiley & Sons, Ltd.     

选择·整合·变质·审美——对草明20世纪50-70年代小说创作的再透视

作为一位曾经跻身主流且获得较高政治声誉的女作家,草明在20世纪50-70年代所做的人生之路和艺术之路的选择,自然无法避开那个时代的政治环境和极端价值判断的制约和围绕。然而,长期以来,研究界一直忽视了对草明工业题材小说的研究,以及她对中国工业题材小说创作的贡献,这也就造成了当代文学研究中新的遮蔽和盲点,并说明我们文学批评的生态环境尚处于“亚健康”的状态。