Web-based training in child maltreatment for future mandated reporters

OBJECTIVE: The purpose of this study was to determine the effectiveness of providing Web-based information about child maltreatment to undergraduate education and graduate counseling students. The goal was to determine, via an objective test, whether students would gain information about abuse signs and symptoms and reporting laws. METHODS: One hundred and five education and counseling students enrolled in a large, urban, ethnically diverse, university participated in the Web-based training tutorial. Their participation was part of their course requirements. They logged into the Web site using their university identification number and password. The pre and post-tests could only be taken once. Completion of the tutorial took on average 1 hour. RESULTS: Findings indicated that students' post-test scores were significantly higher than pretest scores on an examination measuring knowledge of child maltreatment signs, symptoms, and reporting procedures. Participants rated their knowledge of child maltreatment significantly higher after taking the tutorial and reported enjoying the self-paced learning of the Web format. CONCLUSION: Overall, this study demonstrated the effectiveness of a brief on-line tutorial to disseminate information related to child abuse identification and reporting to future mandated reporters. In approximately 1 hour of on line training, participants gained an increase in knowledge of reporting procedures. Utilization of Web-based training is proposed as an effective and convenient method of instruction particularly for child abuse issues.     

Does the gender of parent or child matter in child maltreatment in China?

Child maltreatment is a public health problem worldwide, and China is no exception. However, the pattern of child maltreatment remains unknown, including whether the gender of children and their parents has an impact on the occurrence of maltreatment. This study aims at examining the rates and frequency of child maltreatment, including physical abuse, psychological abuse and neglect perpetrated by mothers and fathers. We also test whether the interaction between parents’ gender and their child's gender affects the occurrence of child maltreatment in China. 997 children from the China Jintan Child Cohort Study participated in the present study and reported their maltreatment experience perpetrated by their mothers and fathers using the questionnaire, Parent–Child Conflict Tactics Scale (CTSPC_CA). Generalized linear model analyses show that boys were more likely than girls to report physical abuse, and, in particular, boys were more likely than girls to be physically abused by their fathers. On the other hand, mothers were more likely than fathers to exhibit psychological aggression and use corporal punishment for both boys and girls. There was no difference based on the child's or parent's gender in the occurrence of neglect. The findings present empirical evidence that enhances the understanding of the pattern of child maltreatment in China, provide implications for social workers and health professionals to identify children at risk of child maltreatment, and shed light on future research studies.     

Identification and reporting of child maltreatment by Head Start personnel: attitudes and experiences

A two-part questionnaire was administered to 143 Head Start personnel in order to determine how personal characteristics of the Head Start workers and the characteristics of the families they serve, affect the identification and reporting of child maltreatment. Of additional interest was whether some forms of maltreatment, once identified, would be more likely to be reported than other forms of maltreatment. The results support the efficacy of educational programs in child maltreatment for increasing the identification and reporting of maltreatment by workers. They also indicate that there are complex interactions between certain characteristics of the reporter (e.g., educational level) and prior training in maltreatment identification. Finally, neglect, although more frequently identified by the workers, appears to be least likely of all forms of maltreatment to be reported to official sources. Results are discussed in light of their implications for future research and practical application.     

Pediatricians' knowledge, attitudes and experience regarding child maltreatment in Kuwait

OBJECTIVES: This cross-sectional survey was conducted to evaluate the awareness and actual professional experience of pediatricians in Kuwait regarding child maltreatment, a topic rarely explored in this part of the world. METHODS: Data were obtained from all pediatricians in public hospitals with pediatric emergency services using a structured detailed self-completed questionnaire. RESULTS: The experience of child neglect was more common than that of child abuse in the clinical practice of surveyed pediatricians. Fifty percent of 117 pediatricians (69% of all eligible) reported having encountered at least 1 case of abuse and up to 3 cases of neglect in the past year. Women and younger doctors more commonly recognized hypothetical situations as maltreatment, and believed child abuse and neglect as being common or very common in Kuwait. Other demographic or professional variables did not affect recognition of maltreatment. Participants would most likely alert social workers about suspected maltreatment cases. More than 80% did not know whether there is a legal obligation to report or which legal authorities should receive reports of suspected cases. DISCUSSION AND CONCLUSIONS: National ethical guidelines regarding reporting suspected cases of maltreatment must be established. Laws protecting maltreated children and reporting physicians must be immediately enacted. Additional training is required to help pediatricians, especially expatriates from other cultures, to diagnose with certainty cases of child maltreatment in their practice in Kuwait.     

Which maltreated children are at greatest risk of aggressive and criminal behavior? An examination of maltreatment dimensions and cumulative risk

This paper explores the well-documented relationship between child maltreatment and aggressive and criminal behavior, specifically examining several dimensions of maltreatment and cumulative child and family risk. Using data from the provincially representative Ontario Incidence Study of Reported Child Abuse and Neglect (OIS-2013), this paper utilizes a developmental lens to examine whether maltreatment dimensions and cumulative risk can differentiate maltreated young people who exhibit aggressive and criminal behaviors and those who do not.A total unweighted sample of 1837 substantiated maltreatment investigations was examined in this analysis using chi-square, t-test, and logistic regression. The findings indicate that 13% of maltreated children and youth served by the Ontario child welfare system exhibited aggression and 6% of maltreated adolescents were involved in the youth justice system. Aggressive children and youth were more likely to experience severe and co-occurring forms of maltreatment and to experience higher levels of cumulative child risk. In adolescence, youth exhibiting aggressive and/or criminal behavior commonly were investigated because of neglect, specifically because their caregivers were no longer willing or able to remain in a caregiving role. Implications for child welfare policy and practice are discussed.     

Parent–child interaction therapy: A manualized intervention for the therapeutic child welfare sector

Children who have experienced maltreatment can often display behavioral difficulties; their parents may lack disciplinary knowledge, be less sensitive to their children, and engage in coercive parenting practices. Parent–child interaction therapy (PCIT) is a well-known, evidence-based treatment (EBT) for child behavior problems and within the last decade has garnered significant evidence to suggest its utility for parents engaged in child maltreatment. This article uses a case example to describe PCIT treatment phases and PCIT research within the child maltreatment sector is synthesized with particular focus on treatment modifications. Successful augmentations and modifications include a motivation component, keeping therapeutic time shorter rather than longer, and whether to incorporate individual counseling and in-home PCIT are also considered. Practical strategies from both a therapeutic and research experience are discussed.     

A survey of pediatricians' attitudes and experiences with court in cases of child maltreatment

OBJECTIVES: To explore pediatricians' attitudes and experiences with the court system in child maltreatment cases. DESIGN: An anonymous, cross-sectional survey of a random sample of pediatricians registered with the North Carolina Medical Board. RESULTS: The response rate of the study was 60% (N=270). Few pediatricians (10%) reported that they had "ever" suspected maltreatment but decided not to report it. Pediatricians were equally likely to recall positive and negative experiences in court for child abuse cases. Pediatricians with negative court experiences were more likely to view reporting as time-consuming and were more than twice as likely not to report suspected cases of maltreatment (OR 2.4, 95% CI 1.04, 6.0). Seventy-five percent of pediatricians felt that court is harmful or distressing for children. CONCLUSIONS: The majority of pediatricians report suspected cases of child maltreatment. Pediatrician's court experiences play a role in the response to child maltreatment cases, influencing attitudes towards the legal system and the process of caring for maltreated children. Future research efforts should address physicians' concerns about the impact of court on children, ways to improve the working relationship between the legal system and physicians, and the training needs of physicians in child maltreatment, including testifying and understanding the court process.     

Providing Quality Early Care and Education to Young Children Who Experience Maltreatment: A Review of the Literature

The current paper highlights the few studies that examine the role of early care and education on the developmental and early academic outcomes of children who experience maltreatment. First, we argue that children who experience maltreatment are at significant risk for poor developmental outcomes as a result of the chronic exposure to stress that is typical of this population. Recent evidence emphasizing the effects of stress on brain development is discussed. Next, the role of quality early care and education (ECE) experiences for children receiving services from child protective agencies are explored, underscoring three particular studies that examine the early educational experiences of children who receive child protective services as a result of maltreatment or exposure to violence. Finally, we focus on current approaches to improve the outcomes of children who experience maltreatment, within the context of ECE, and the implications for future research. Overall, this review serves as a call for international research efforts to explore the role of ECE on the developmental and early educational outcomes of this vulnerable population of children.     

Child Maltreatment and Children's Developmental Trajectories in Early to Middle Childhood

Associations between experiencing child maltreatment and adverse developmental outcomes are widely studied, yet conclusions regarding the extent to which effects are bidirectional, and whether they are likely causal, remain elusive. This study uses the Fragile Families and Child Wellbeing Study, a birth cohort of 4,898 children followed from birth through age 9. Hierarchical linear modeling and structural equation modeling are employed to estimate associations of maltreatment with cognitive and social‐emotional well‐being. Results suggest that effects of early childhood maltreatment emerge immediately, though developmental outcomes are also affected by newly occurring maltreatment over time. Additionally, findings indicate that children's early developmental scores predict their subsequent probability of experiencing maltreatment, though to a lesser extent than early maltreatment predicts subsequent developmental outcomes.     

Child maltreatment: social representation of the general population and the professionals working with children in the Caribbean area of Colombia

OBJECTIVE: The main objective was to know social representations about child maltreatment (severity, etiology, and intervention strategies) of the general population and the professionals working with children in the Caribbean area of Colombia. METHOD: Sample was composed for 402 participants. From this pool of participants, 111 of them were working in child protection, 95 worked with children but not in the child protection system and 196 pertained to the general population. All participants answered to a questionnaire composed by 86 items. The questionnaire was developed to assess (1) the perceived severity of different typologies of child abuse, (2) opinions about risk factors for child maltreatment and sexual abuse, and (3) opinions about the most adequate ways of intervention with perpetrator of child abuse. RESULTS: Sexual abuse is considered as the most severe typology of child maltreatment and emotional abuse is considered as more severe than physical abuse. No differences between groups were found in perceived severity of typologies of child maltreatment. Differences in the social representation about the etiology of child maltreatment were found. Professionals working in the child protection system give more value to characteristics of parents and to the socio-economic and familiar environment in the etiology of child maltreatment than participants from the general population. Prevention and treatment programs for abusers were considered as the more relevant strategies against child maltreatment. DISCUSSION: Findings of present study suggest that social representations about child maltreatment of general population and professionals from the Caribbean area of Colombia are similar than social representation observed in other regions and countries. It is important to take into account that child labor and child poverty were considered as non-severe typologies of child maltreatment. Moreover, findings suggest that people from general population in the Caribbean area of Colombia have a relevant knowledge about agencies working for child protection.     

Re-reporting of child maltreatment: does participation in other public sector services moderate the likelihood of a second maltreatment report?

OBJECTIVE: This study uses administrative data to track the first re-reports of maltreatment in a low-income, urban child welfare population (n=4957) while controlling for other public service involvement. Service system involvement is explored across the following sectors: Child Welfare, Income Maintenance, Special Education, Juvenile Court, and various forms of Medicaid-reimbursed medical or mental health care. This study builds knowledge by adding the services dimension to an ecological framework for analyses and by following recurrence for a longer period of time than prior investigations (7.5 years). METHOD: We model the re-reporting of a child for maltreatment as a function of child, caregiver, service, and neighborhood characteristics using data from birth records, child welfare, income maintenance, Medicaid, adult corrections, juvenile court, special education, law enforcement, and census sources. Bivariate and multivariate analyses are presented, the latter using Cox regression with a robust sandwich covariance matrix estimate to account for the intracluster dependence within tracts. RESULTS: Key results across bivariate and multivariate analyses included a lower rate of re-reporting among children with parents who were high school graduates and/or permanently exited from the first spell on AFDC (p<.0001); and for children in families that received less intensive in-home services compared to those not receiving services, receiving intensive in-home, or foster care services (p<.0001). Higher rates of re-reporting were found for children with Medicaid mental health/substance abuse treatment records (p<.0001) and special education eligibility for emotional disturbance (p<.005). CONCLUSIONS: Caretaker characteristics and non-child welfare service use patterns had a strong association with the likelihood of a child being re-reported to the child welfare agency and should be more heavily attended to by child welfare workers. High rates of service sector overlap suggest that interagency ties and cooperation should be strengthened. The lower risk associated with less intensive in-home services compared to un-served cases may indicate under-identification of in-home service eligibility following a first report of maltreatment.     

Commitment,confidence, and concerns: Assessing health care professionals’ child maltreatment reporting attitudes

Given that childhood maltreatment is a significant international public health problem contributing to all major morbidity and mortality determinants, there is need to explore current practices and readiness of health care professionals (HCPs) to assess maltreatment, identify maltreatment risk factors, and complete mandated reporting. HCPs (N = 114) completed a child maltreatment mandated reporting measure to assess level of comfort with mandated reporting, commitment to the reporting role, and confidence in the child protection system to take action as needed. Additional questions explored comfort discussing maltreatment and risk factors for maltreatment in a medical setting and knowledge of community resources. Results indicated that HCPs were committed to their mandated reporting role and did not perceive substantial potential negative consequences of reporting. However, there were concerns regarding lack of confidence in the system’s ability to respond sufficiently to reports. Despite commitment to the reporting role, results showed that large proportions of HCPs do not routinely screen for maltreatment, feel uncomfortable discussing maltreatment history, and lack knowledge about community resources. Additional training efforts must be prioritized in health care systems to improve short- and long-term health outcomes.     

Opinions among mandated reporters toward child maltreatment reporting policies

OBJECTIVE: This study investigates the opinions of social workers, pediatricians, and physician assistants in their support for the existing child maltreatment mandated reporting policy and an alternative reporting policy. Differences in professional training, age, gender, reporting behavior, attitudes towards reporting, and level of certainty needed to report were considered in determining which group of mandated reporters was most likely to support either the existing or an alternative policy. METHOD: A total of 382 social workers, pediatricians, and physician assistants in Connecticut and Massachusetts completed a self-report questionnaire. This sample represented an overall adjusted response rate of 76%. RESULTS: There was slightly more support for the existing reporting policy compared to the alternative policy. After controlling for age, attitudinal variables, and reporting behavior, social workers were significantly more likely to favor an alternative child maltreatment reporting policy than pediatricians or physician assistants. Also, those mandated reporters who had not consistently reported all suspected cases of maltreatment were significantly more likely to favor the alternative policy than consistent reporters. CONCLUSIONS: Because the majority of mandated reporters do not consistently report all suspected cases of maltreatment and support for an alternative reporting policy varies among different groups, consideration of alternative strategies and policies that address the concerns of different types of professionals may be appropriate.     

Classification of maltreatment-related mortality by Child Death Review teams: How reliable are they?

Accurate estimation of the incidence of maltreatment-related child mortality depends on reliable child fatality review. We examined the inter-rater reliability of maltreatment designation for two Alaskan Child Death Review (CDR) panels. Two different multidisciplinary CDR panels each reviewed a series of 101 infant and child deaths (ages 0–4 years) in Alaska. Both panels independently reviewed identical medical, autopsy, law enforcement, child welfare, and administrative records for each death utilizing the same maltreatment criteria. Percent agreement for maltreatment was 64.7% with a weighted Kappa of 0.61 (95% CI 0.51, 0.70). Across maltreatment subtypes, agreement was highest for abuse (69.3%) and lowest for negligence (60.4%). Discordance was higher if the mother was unmarried or a smoker, if residence was rural, or if there was a family history of child protective services report(s). Incidence estimates did not depend on which panel's data were used. There is substantial room for improvement in the reliability of CDR panel assessment of maltreatment related mortality. Standardized decision guidance for CDR panels may improve the reliability of their data.     

Teachers' attitudes toward and knowledge of child maltreatment

OBJECTIVE: The purpose of this study was to determine teachers' self-reported knowledge of the signs and symptoms of child maltreatment, reporting procedures, legal issues surrounding child abuse and their attitudes toward corporal punishment. In addition, a factor analysis was performed on the Educators and Child Abuse Questionnaire (ECAQ) (Kenny, 2001a). METHOD: Two hundred teachers, who work in the southeast region of the US in a large, ethnically diverse school system, were administered the ECAQ which contains questions on knowledge concerning: (1) signs and symptoms of child abuse, (2) laws, and (3) procedures for reporting child abuse as well as number of reports filed. RESULTS: Most teachers reported being unaware of the signs and symptoms of child maltreatment, as well as reporting procedures. They also felt administration would not be supportive and were in disagreement with their legal role as mandated reporters. The ECAQ was found to be a reliable measure with four factors: (1) Awareness of signs and symptoms of child abuse, (2) Knowledge of reporting procedures, (3) Attitudes toward discipline, and (4) Seriousness of child abuse. CONCLUSIONS: In general, teachers reported a lack of awareness of the signs of child abuse and reporting procedures, which may affect their ability to report cases of suspected abuse. There is a need for standardized training in child maltreatment for all teachers as well as clear, concise institutional guidelines for reporting child abuse and support for teachers confronted with suspected victims.     

The relationship between attitudes toward corporal punishment and the perception and reporting of child maltreatment.

OBJECTIVE: This study examined the effect of workers' attitudes toward corporal punishment on the workers' perception and reporting of child maltreatment. Three hundred twenty-five (325) potential entry level workers participated in this study. METHOD: Responding to vignettes in multi-item scales, study participants 1) rated their approval of parental discipline involving corporal punishment; 2) rated the seriousness of incidents of probable maltreatment; and 3) indicated whether or not they would report the incidents of maltreatment to child protective services. Data were analyzed using correlation analyses and multiple regression procedures. RESULTS: 1) Respondents with higher scores for approval of corporal punishment were less likely to perceive maltreatment; 2) respondents with higher scores for approval of corporal punishment were less likely to report maltreatment; 3) the likelihood that a respondent would report maltreatment was a joint function of the respondent's perception of the seriousness of an incident and approval of corporal punishment. CONCLUSION: Attitudes about corporal punishment are important predictors of reporting behavior. Social service agencies face a challenge to provide workers with training which will enable them to detect and report maltreatment despite workers' individual beliefs about discipline and punishment.     

Educational program on evaluation of alleged sexual abuse victims

Increased awareness of the problem of child sexual abuse has resulted in increasing numbers of children presenting to professionals for the evaluation of possible sexual victimization. A multidisciplinary project to develop professionals' knowledge and skills in the identification and evaluation of possible victims is described. The program focused on the child as a victim and emphasized developmental perspectives with regard to identification, interviewing children, the medical examination, and children in the legal system. Fifty-one medical and social work professionals from ten Indiana counties attended the program and responded to questionnaires about their experience and knowledge. Of 40 (78%) respondents, 63% had had no previous training in the medical evaluation for child sexual abuse. Child protective workers referred alleged victims primarily to the child's regular physician (37%) or emergency room (31%) for medical examination. Knowledge about child sexual abuse improved significantly at two weeks postsymposium (p = .001) and remained improved at six months postsymposium (p less than .02). These original participants have subsequently organized similar multidisciplinary programs in their local communities for medical, social, law enforcement, and legal professionals; thus, they have been "seeds" for further educational and cooperative efforts throughout the state.     

The psychosocial adjustment of maltreated children: methodological limitations and guidelines for future research

Several empirical studies on the impact of maltreatment on children's psychosocial adjustment were recently reviewed in this journal [1]. Following a brief overview of the findings from that article, the present paper summarizes the methodological limitations of the studies reviewed and discusses guidelines for future research in this area. In order to advance knowledge of child maltreatment sequelae, we suggest future studies should include the following: precise operational definitions of maltreatment; adequate verification of the absence of maltreatment in the control groups; identification and control of maltreatment covariates; and consideration of subjects' age in group assignment. Future investigations should also employ more longitudinal research designs and give more attention to the treatment needs of the child.     

Developmental effects of child abuse: recent findings

This paper summarizes the pre-1982 research findings on the developmental effects of child abuse and reviews recent contributions to this area. While some of the recent research continues to demonstrate deleterious developmental consequences of child maltreatment, others are pointing to a complex relationship between child maltreatment and development. Mediating variables such as the child's individual characteristics, environmental resources, and the quality of personal interactions the child is exposed to may interact with negative experiences like maltreatment and may be just as important in predicting outcome than maltreatment alone. Recent research has also been concerned with specifying the possible differential effects of different patterns of maltreatment. This has led to a clearer separation between the effects of abuse and neglect, particularly in language development. Despite the methodological improvements in recent research, there is still the need for longitudinal prospective studies on the developmental effects of child abuse, taking into account possible mediating variables.     

What's in a name? A comparison of methods for classifying predominant type of maltreatment

OBJECTIVE: The primary aim of the study was to identify a classification scheme, for determining the predominant type of maltreatment in a child's history that best predicts differences in developmental outcomes. METHOD: Three different predominant type classification schemes were examined in a sample of 519 children with a history of alleged maltreatment. Cases were classified into predominant maltreatment types according to three different schemes: Hierarchical regression analyses examined whether the HT, SFT, and EHT type classifications contributed to prediction of child behavior problems, trauma symptoms and adaptive functioning. RESULTS: After controlling for demographic factors, the HT definitions predicted four outcomes, while the SFT definitions predicted three, and the EHT classifications contributed to the prediction of five child outcomes. The co-occurrence of multiple types of maltreatment was robustly related to outcomes. However, the HT and SFT classifications predicted outcomes even after accounting for the co-occurrence of multiple maltreatment subtypes. CONCLUSION: A classification scheme that differentiates between type combinations and single maltreatment types may have the greatest predictive validity. Over and above knowing about co-occurrence of maltreatment sub-types, it is important to understand what type, or constellation of types, of maltreatment have been alleged in a child's history.