The prevention of child abuse and neglect: A review of the literature with recommendations for application

Families at high risk for inadequate parenting can be identified during the perinatal period, or during later health care visits. Effective intervention can be implemented for these special families. During the maternity ward stay, intervention can include early delivery room contact, rooming-in arrangements, and increased teaching sessions on child care. The primary physician can provide frequent office visits, telephone contacts and helpful advice during acute illnesses and developmental phases which might precipitate child abuse. The physician can seek assistance from outreach workers such as public health nurses, lay health visitors, and child welfare caseworkers. Community prevention programs such as parenting classes, Parent's Anonymous groups, crisis nurseries and crisis hotlines should also be integrated into the family's treatment. When provided in concert, these actions can stabilize most dysfunctional families.     

Joining two social institutions to counter rural Alaskan child abuse

Change in social customs and institutions is usually a slow process. This seems particularly true in attitudes about child abuse. Two key elements for change are being utilized for child protection in a rural area of Alaska with a predominantly Caucasian population. First, application of an old church custom of "constructive gossip" by volunteers is changing this rural community attitude about children. Second, use of an innovative federal government health care delivery program has established this community's first obstetric and pediatric service. With the oil boom in Alaska, widespread family disruption with frequent child abuse and neglect has become commonplace. Despite the oil tax wealth, State of Alaska Child Protection Services are strained to keep up with family and community violence. Deliberate cooperation with local community, church and service organization leaders is helping keep up with child protection needs. The obstetric and pediatric specialists of the National Health Service Corps non-profit practice were co-leaders, along with community leaders, in starting a lay volunteer service called "Friends of Families." Working cooperatively with the state child protection office, 24 families have received assistance from parent aides of Friends of Families. The influence of these two key elements of change on rural community attitudes and institutions are described.     

Performance proficiency as a measure of learning needs

Level 2 evaluation often advocates that pretest and posttest measures be collected to assess learning gains. In many military organizations, learning per se is less relevant than whether graduates can proficiently perform the job tasks for which they were hired. The critical end is performance proficiency. Incorporating methods for measuring existing performance levels as part of a Level 2 evaluation process has helped the U.S. Coast Guard prove training success.     

Defining and Assessing Quality in Early Intervention Programs for Infants and Toddlers with Disabilities and their Families: Challenges and Unresolved Issues

Historically, child care quality research has focused primarily on typically developing children cared for in center-based programs. Findings from this research suggests that variations in quality of care have an effect on children's well-being and developmental outcomes. In this paper, we draw on child care quality research to inform our understanding of quality in early intervention services for infants and toddlers with disabilities and their families. Conceptual issues in defining quality and methodological challenges for assessing quality of early intervention services are presented. In the final sections of this paper, we discuss our efforts to design a measure of quality for early intervention programs and present some of the unresolved issues related to the assessment of quality in early intervention programs.     

Child care choices: A longitudinal study of children,families and child care in partnership with policy makers

Child Care Choices is an example of new early childhood research based on a relationship between policy makers and researchers. It is also an example of large-scale longitudinal team-based research into early childhood in Australia. The ongoing study addresses the professional problem for practitioners and policy makers of the increasing use of multiple care settings and changes to care arrangements in the early years and their possible impacts on child development. The project will follow an initial sample of 693 families with a child aged from birth to three years over a three-year period. An ecological framework is used to include the influences on child development of characteristics of the children and their families, their city or country location, as well as their childcare history and current care arrangements. Development is measured in terms of children’s health, motor development, social and emotional development, language and communication as well as emerging literacy and numeracy. The article discusses the unique features of the project in Australian early childhood research, its history, preliminary findings, and the potential of this kind of large-scale, longitudinal team-based research conducted in partnership with policy makers to contribute to policy as well as to theoretical debate.     

Cumulative and Differential Effects of Early Child Care and Middle Childhood Out-of-School Time on Adolescent Functioning

Effects associated with early child care and out-of-school time (OST) during middle childhood were examined in a large sample of U.S. adolescents (N = 958). Both higher quality early child care AND more epochs of organized activities (afterschool programs and extracurricular activities) during middle childhood were linked to higher academic achievement at age 15. Differential associations were found in the behavioral domain. Higher quality early child care was associated with fewer externalizing problems, whereas more hours of early child care was linked to greater impulsivity. More epochs of organized activities was associated with greater social confidence. Relations between early child care and adolescent outcomes were not mediated or moderated by OST arrangements in middle childhood, consistent with independent, additive relations of these nonfamilial settings.     

Depending on the kindness of strangers: current national data initiatives and developmental research

This article provides a brief review of current large-scale, longitudinal data collection initiatives focusing on children. These studies will be available for secondary data analyses in the twenty-first century. In addition to child outcome data, process-oriented information is being collected on child-parent interactions, quality of child care, elementary school teacher reports and classroom observations, accessibility and use of health, educational and social services, parental mental health, family violence, fathering, parental residence patterns, income and income sources, child support, employment patterns, and community characteristics. Several of these studies are randomized trials of the efficacy of early childhood intervention services and housing mobility programs. The usefulness of these efforts for exploring policy-relevant issues (child support enforcement, work requirements for welfare recipients, antipoverty strategies, housing subsidies and relocation, availability of child care, child-care subsidies) are discussed.     

Early childhood education and care educators supporting parent-child relationships: a systematic literature review

Building strong relationships between children and parents is vital for children’s social and emotional development. A majority of children attend early childhood education and care (ECEC) settings where they experience a range of relationships (educator–child, educator–parent, parent–child). Educators build relationships with children and parents, yet their influence on parent–child relationships is not well understood. Therefore, an evaluation of interventions/programs designed to promote parent–child relationships in ECEC settings (long day care, occasional care and preschool) and a range of settings (play groups, community groups and health centres) was conducted. The search revealed 21 peer-reviewed studies and seven interventions: two conducted in ECEC settings and five in a range of parent–child support settings. All studies reported intervention efficacy, yet none examined educators’ influence on parent–child relationships. Investigation into current educator practices is recommended to ensure educators are supported to promote and nurture parent–child relationships, consequently strengthening children’s social and emotional development.     

A pilot study of early childhood mental health consultation for children with behavioral problems in preschool

This study reports the findings of a pilot demonstration project called Together for Kids, which used a mental health consultation model to address the needs of young children with challenging behaviors who are identified in preschool classrooms. The study was conducted in four preschool programs and one Head Start program serving children ages 3–5, including both private-pay families and those using public subsidies. Rates of significant behavior problems as assessed by preschool teachers using a standardized scale were high, with 34% of all children enrolled in preschool classrooms in these sites over a 3-year period identified at-risk of externalizing or internalizing problems. Classroom teachers, as well as individual children and families identified as at-risk, were provided services, including, classroom observation and teacher training, individual child assessment and therapy, family assessment and support, and referrals for other family needs. Analysis of outcomes for 47 children and families with externalizing behavior problems who received individualized consultation, compared to 89 control children, and analysis of outcomes of a matched group of 19 intervention and 19 control children, revealed that the intervention was associated with significant improvements in classroom aggressive and maladaptive behavior, and growth in adaptive behavior. Improvements in child behavior were associated with total hours of individual child services provided, and with improvements in child developmental skills. Significant reductions in the rate of children suspended or terminated from child care programs were also found. Implications for further development of models of early childhood mental health consultation are discussed.     

Der Abbau von Bildungsbenachteiligung durch Kindertagesbetreuung für unter 3-Jährige – zwischen Wunsch und Wirklichkeit

Based on the assumption that children can benefit from early childhood education, the present paper investigates if the admission to day care and the selection of the type of day care (child care centers and home day care) is socially selective. In doing so, the paper analyzes how the socioeconomic and immigrant background of families influences which type of day care is used. For children under the age of three, the social background of families does influence if a child receives day care, but this influences diminishes the older the children get. The type of day care (child care centers and home day care) did not differ according to social background. The paper closes with a discussion of the challenges and potentials for development of educating children under the age of three.     

Families at risk of poor parenting: A model for service delivery,assessment, and intervention

The At Risk Parent Child Program is a multidisciplinary network agency designed for the secondary prevention of poor parenting and the extremes of child abuse and neglect. This model system of service delivery emphasizes (1) the coordination of existing community resources to access a target population of families at risk of parenting problems, (2) the provision of multiple special services in a neutral location (ambulatory pediatric clinic), and (3) the importance of intensive individual contact with a clinical professional who serves as primary therapist, social advocate and service coordinator for client families. Identification and assessment of families is best done during prenatal and perinatal periods. Both formal and informal procedures for screening for risk factors are described, and a simple set of at risk criteria for use by hospital nursing staff is provided. Preventive intervention strategies include special medical, psychological, social and developmental services, offered in an inpatient; outpatient, or in-home setting. Matching family needs to modality and setting of treatment is a major program concern. All direct services to at risk families are supplied by professionals employed within existing local agencies (hospital, public health department, state guidance center, and medical school pediatric clinic). Multiple agency involvement allows a broad-based screening capacity which allows thousands of families routine access to program services. The administrative center of the network stands as an independent, community-funded core which coordinates and monitors direct clinical services, and provides local political advocacy for families at risk of parenting problems.     

Medical neglect of a child: challenges for pediatricians in developing countries

OBJECTIVE: To conceptualize the underlying causes of the medical neglect of children in a developing country and to provide suggestions for the management of neglect by pediatricians. METHODS: A case history of a 4-year-old boy from Turkey with neglect of the required treatment for acute lymphoblastic leukemia is used to examine the causes and management of medical neglect. Results: Although epidemiological studies on child neglect are lacking, this case exemplifies how in DEVELOPING countries, reasons for neglect or non-compliance with medical recommendations and the roles and actions taken by the health care and the social service systems may differ from western populations. Common to both western and developing countries, the characteristics of the child, family, and society may be reasons for medical neglect. However, cultural fatalistic beliefs profoundly present in the developing world may also contribute to the medical neglect of a child. Identification of the neglect, a comprehensive, multidisciplinary assessment emphasizing the strengths within the family and the society, and the determination of the pediatric team to act in the best interest of the child may result in resolution of the neglect even in circumstances where resources within systems are not sufficient. CONCLUSIONS: In developing countries, increased emphasis on child neglect, its prompt recognition and management within the pediatric profession as well as at a health care and social service system levels are needed to address this prevalent and potentially fatal child health problem.     

The viability of pediatric hospices: a case study

This paper identifies the special characteristics needed by hospices caring for terminally ill children. It is based on a feasibility study conducted in 1979 for a pediatric hospital in New York City. From the analysis of statistical data and confidential interviews with health care professionals in the hospital and in the community, the study concludes that the needs of terminally ill children and their families are not being met currently and that the hospice is as appropriate for children as for adults. Three major differences in emphasis are noted, however. First, support of the family suffering the death of a child is of prime importance, because the grief is devastating and long lasting and because the number of family members affected is usually large. Second, the hospice emphasis on home care is even more imperative for children than for adults as it more significantly benefits both child and family; home care can be facilitated through supplementary care components such as day care. Third, there is a major need for both professional and public education in caring for terminally ill children and their families and in coping with childhood death. The author concludes that further research is needed in all aspects of pediatric terminal care.     

Who's minding the kids? Experimental evidence on the demand for child care quality

Despite the well-documented benefits of high-quality child care, many preschool-age children in the U.S. attend low-quality programs. Accordingly, improving the quality of child care is increasingly an explicit goal of government policy. However, accomplishing this goal requires a thorough understanding of the factors that influence parents’ child care decisions. This paper provides the first evidence on the demand for child care characteristics in the market for home-based care. Using a randomized audit design, we study three dimensions of caregiving: affordability (i.e., the hourly price of child care), quality (i.e., caregiver education and experience), and convenience (i.e., caregiver car ownership and availability). We find that while parents are extremely sensitive to the cost of child care, they also have strong preferences for quality, particularly caregivers’ educational attainment. Furthermore, we obtain mixed results on the convenience dimensions of child care, with parents valuing those owning a car but not those with more availability. Finally, we find significant heterogeneity in child care preferences according to families’ age of youngest child, race and ethnicity, and willingness-to-pay. Our findings are consistent with the notion that the problem of low-quality in the U.S. child care market may be explained by lack of affordability or the informational resources to identify high-quality care, rather than an undervaluation of such care by parents.     

Community characteristics associated with child abuse in Iowa

PROBLEM: Various demographic and community characteristics are associated with child abuse rates in national and urban samples, but similar analyses have not been done within rural areas. This study analyzes the relationships between reported and substantiated rates of child abuse and county demographic, health care resource and social services factors in a predominantly rural state in the US. METHODS: County-level data from Iowa between 1984-1993 were analyzed for associations between county characteristics and rates of child abuse using univariate correlations and multivariate stagewise regression analysis. Population-adjusted rates of reported and substantiated child abuse were correlated with rates of children in poverty, single-parent families, marriage and divorce, unemployment, high-school dropouts, median family income, elder abuse, birth and death rates, numbers of physicians and other healthcare providers, hospital, social workers, and number of caseworkers in the Department of Human Services. RESULTS: Rates of single-parent families, divorce and elder abuse were significantly associated with reported and substantiated child abuse in multivariate analysis, while economic and most health care factors were not. Reporting and substantiation rates differed across districts after adjustment for multiple factors including caseworker workload. CONCLUSIONS: In this rural state, family structure is more significantly associated with child abuse report and substantiation rates than are socioeconomic factors. The level of health care resources in a county does not appear to affect these rates.     

Costs and effectiveness of interventions in child maltreatment

There has been increasing awareness of the need to prevent child maltreatment at a time of limited public funds. As a result, cost-effectiveness has become important in the planning of health care and social services. Evaluations of child maltreatment interventions that have been analyzed for their cost-effectiveness are reviewed. There has been relatively little work in this area and much of it has serious methodological flaws. Nevertheless, research suggests that home health visitors, lay group counseling, and family and group therapy are promising interventions. Medical foster care has been shown to substantially reduce costs, but its effectiveness has not been determined. Current knowledge on the effectiveness of interventions in child maltreatment is limited, and this needs to be addressed in order to answer the question of cost-effectiveness. Recommendations are made for future research in the field.     

Context Matters: The Interrelatedness of Early Literacy Skills, Developmental Health, and Community Demographics

Whereas the great majority of literacy research has been focused at the child level, this study examined the relationship between early literacy rates, developmental health of the population, and demographics in 23 school communities. The results showed that school-level literacy scores were related to the physical, social, and emotional maturity of the kindergarten population, as well as community demographics, including the proportion of families in each school catchment area living below the low income cutoff, the proportion of single-parent families, and the community 5-year mobility rate. Furthermore, the proportion of children at risk for literacy difficulties varied systematically by school, ranging from 0% to 44%; this risk was strongly related to developmental health and to demographics of the school community. The implications for models of early identification and corresponding intervention programs for at-risk children are discussed.     

Approaches to Collaboration: Experiences of the Early Head Start-Child Care Partnerships

ABSTRACT

This study examined how partnerships between early care and education providers were developed and how they worked together to deliver comprehensive, high-quality services to infants and toddlers from low-income families. Survey data were collected from 220 Early Head Start (EHS) program directors and 386 child care center directors and family child care providers participating in EHS-child care partnerships. Research Findings: Nearly half of EHS programs chose partners with whom they had prior relationships, and most engaged them early (often before receiving the grant). Both EHS programs and child care providers described their relationships as mutually respectful and focused on similar goals. Through the partnerships, child care providers had access to professional development opportunities and offered children and families comprehensive services, such as health screenings. Practice or Policy: This study provided a nationally representative picture of EHS-child care partnerships. The findings suggest that strong relationships are foundational to the implementation of early care and education collaborations aimed at expanding access to high-quality care for infants and toddlers from low-income families. Collaborations are a potentially important policy lever that can help support the expansion of high-quality early care and education.     

Randomized trial of a statewide home visiting program: impact in preventing child abuse and neglect

OBJECTIVES: To assess the impact of home visiting in preventing child abuse and neglect in the first 3 years of life in families identified as at-risk of child abuse through population-based screening at the child's birth. METHODS: This experimental study focused on Hawaii Healthy Start Program (HSP) sites operated by three community-based agencies. From 11/94 to 12/95, 643 families were enrolled and randomly assigned to intervention and control groups. Child abuse and neglect were measured by observed and self-reported parenting behaviors, all hospitalizations for trauma and for conditions where hospitalization might have been avoided with adequate preventive care, maternal relinquishment of her role as primary caregiver, and substantiated CPS reports. Data were collected through annual maternal interviews (88% follow-up each year of all families with baseline interviews); observation of the home environment; and review of CPS, HSP, and pediatric medical records. RESULTS: HSP records rarely noted home visitor concern about possible abuse. The HSP and control groups were similar on most measures of maltreatment. HSP group mothers were less likely to use common corporal/verbal punishment (AOR=.59, p=.01) but this was attributable to one agency's reduction in threatening to spank the child. HSP group mothers reported less neglectful behavior (AOR=.72, .02), related to a trend toward decreased maternal preoccupation with problems and to improved access to medical care for intervention families at one agency. CONCLUSIONS: The program did not prevent child abuse or promote use of nonviolent discipline; it had a modest impact in preventing neglect. Possible targets for improved effectiveness include the program's implementation system and model.