Professionals' decision-making about out-of-home placements following instances of child abuse

OBJECTIVE: The goal of this research was to study how different groups of child welfare professionals prioritize and use information to make placement decisions following instances of child abuse. METHOD: A total of 90 juvenile court judges and guardians ad litem, Court Appointed Special Advocates (CASA), social workers, and mental health professionals responded to a detailed questionnaire describing four case studies of child physical abuse in which a parent was the perpetrator, the child was either 2 years or 6 years of age, and the abuse was either first time or chronic. Participants rated the impact of specific pieces of information regarding child, family, and system-level characteristics on their decision-making process. RESULTS: Analyses of reactions to these vignettes demonstrate that professional groups use different kinds of information when making decisions about foster care placements. Social workers and mental health providers rely on information about the severity and pattern of abuse and on information about services offered in the past and parental responses to those services. Judges and guardians ad litem rely more heavily on information about the likelihood of a reoccurrence of abuse and the child's ability to recount the abuse, whereas CASA volunteers rely on information about the stability of the family. CONCLUSIONS: Professional group membership, rather than factors such as age or ethnicity of the child or chronicity of abuse, accounts for different patterns of prioritizing and using information when making decisions about whether a child should remain in the home or be placed in foster care. The implications for community-based training and intervention efforts are discussed.     

Patterns of interactions in multidisciplinary child protection teams in New Jersey

OBJECTIVE: The objective of this study was to gain an understanding of how multidisciplinary team members in child protection worked together within the team, meeting to provide assessments of, and services to, children and families. METHOD: Fifteen multidisciplinary child-protection teams in New Jersey were observed during one meeting of each team. The interaction among team members was recorded and analyzed using a structured observation method, Bales' Interaction Process Analysis. RESULTS: There was a wide variation in participation among team members, with some contributing nothing to the meeting and others contributing a great deal. In some teams, participation by members was more equal than others. Some professional groups and agencies contributed very little to any meeting while others contributed a great deal to many meetings. CONCLUSIONS: Professionals are members of multidisciplinary teams because they are expected to contribute to the investigation of child maltreatment cases and to the planning for further work with cases. However, the findings from this study suggest that there is a considerable degree of inequality in levels of participation in multidisciplinary meetings. It is particularly noticeable that staff from the prosecutor's offices participate in every meeting and either the agency as a whole or individual members of it dominate many of the meetings.     

Hospital-based primary prevention strategy in child abuse: a multi-level needs addressment

The purpose of this study was to evaluate a primary prevention effort in child maltreatment, the focus of which was a community-wide endeavor (i.e., subjects were not prescreened for risk potential). Specific components of the planned intervention addressed four causal levels of maltreatment: individual, family, community, and cultural factors. That assessment was intended to build strengths in those parenting areas which are predictive of abusive or neglectful outcomes. Target areas included knowledge of child development, child-rearing attitudes, mother-infant interaction patterns, and parenting skills. A posttest-only control group design was employed. The control postpartum mothers received traditional or routine hospital services; experimental mothers received special in-hospital and after-care services by trained student nurse volunteers. These volunteers functioned in a dual educative/supportive role. Experimental mothers reported more realistic expectations of behavior, embraced more democratic child-rearing principles, providing more verbal stimulation to their infants (reflecting an increased sensitivity), and displayed increased problem-solving abilities.     

School programs to prevent intrafamilial child sexual abuse

The incidence of child sexual abuse would argue for the schools assuming a larger role in the development of preventive and educational programs. Because of the public school system's consistent and longitudinal contact with children and families it is perhaps the most promising institution for the delivery of preventive efforts. This article presents specific suggestions for school-based programs directed toward the prevention of intrafamilial child sexual abuse. Further, it is argued that for maximum effectiveness, the support of local parent-teacher organizations be elicited; that educational programs be presented separately for parents and children; and that a variety of programs in concert with the development level of participants be presented on topics related to child sexual abuse. Topics regarded as important for prevention efforts are factual information on sexual abuse, appropriate and inappropriate touch, the respective role responsibilities and rights of parents and children, and a sex education approach that stresses the values of nonexploitation and discrimination in the choice of whether to engage in sexual behavior and the choice of partners.     

Changes in reports and incidence of child abuse following natural disasters

OBJECTIVE: The aim of this research was to investigate if there is a higher incidence of child abuse following major natural disasters. METHODOLOGY: Child abuse reports and substantiations were analyzed, by county, for 1 year before and after Hurricane Hugo, the Loma Prieta Earthquake. and Hurricane Andrew. Counties were included if damage was widespread, the county was part of a presidential disaster declaration, and if there was a stable data collection system in place. RESULTS: Based on analyses of numbers, rates, and proportions, child abuse reports were disproportionately higher in the quarter and half year following two of the three disaster events (Hurricane Hugo and Loma Prieta Earthquake). CONCLUSIONS: Most, but not all, of the evidence presented indicates that child abuse escalates after major disasters. Conceptual and methodological issues need to be resolved to more conclusively answer the question about whether or not child abuse increases in the wake of natural disasters. Replications of this research are needed based on more recent disaster events.     

Impact of a statewide home visiting program to prevent child abuse

OBJECTIVES: To assess the impact of a voluntary, paraprofessional home visiting program in preventing child maltreatment and reducing the multiple, malleable psychosocial risks for maltreatment for which families had been targeted. METHODS: This collaborative, experimental study focused on 6 Healthy Families Alaska (HFAK) programs; 325 families were enrolled in 2000-2001, randomized to intervention and control groups, and interviewed to measure baseline attributes. Follow-up data were collected when children were 2 years old (85% follow-up rate). Outcomes included maltreatment reports, measures of potential maltreatment and parental risks, for example, poor mental health, substance use, and partner violence. HFAK records were reviewed to measure home visiting services. Home visitors were surveyed to measure perceived effectiveness and training adequacy. RESULTS: Parental risks were common at baseline, and one-sixth of families had a substantiated child protective services report in the child's first 2 years of life. There was no overall program effect on maltreatment reports, and most measures of potential maltreatment. Home visited mothers reported using mild forms of physical discipline less often than control mothers. The groups were similar in their use of more severe forms of physical discipline. There was no program impact on parental risks. There was no impact on outcomes for families with a 'high dose' of home visiting. Home visitors often failed to address parental risks and seldom linked families with community resources. Contradictions in the model compromised effectiveness. CONCLUSIONS: The program did not prevent child maltreatment, nor reduce the parental risks that had made families eligible for service. Research is needed to develop and test strategies to improve the effectiveness of home visiting.     

The handicapped child and child abuse

For a group of children with handicaps, growth and development are also affected by abuse or neglect. Our understanding of the problems of the abused, handicapped child emerges from experience with 37 children with cerebral palsy who have been maltreated, coupled with a review of the literature in related areas. We identify the following four problems as crucial to the study of abuse and neglect to the child with handicaps: (1) abuse that causes handicaps, (2) abuse that occurs to the handicapped child, (3) compromises in care that can occur when the handicapped child becomes involved with the medical and legal systems, and (4) arrangements for foster care or other out-of-home placement for the child with handicaps. We conclude that the very systems designed to protect and care for the child often fail, leaving the handicapped child without opportunity to reach developmental potential. In light of our observations, we recommend that the pediatrician not only be aware of the existence of abuse and neglect in the population of handicapped children, but also serve in the dual role of coordinator of services and advocate for these children.     

S.C.A.N. teams in Queensland—New legislation to combat child abuse

Queensland is a State of Australia of some 1.7 million square kilometers, with a population of only 2.2. million, half of whom reside in the southeast comer. Yet, it is the most decentralised State of Australia. Legislation introduced in 1980 endeavoured to make sure that child abuse was detected by medical practitioners and referred to S.C.A.N. teams organised on a regional basis. Members of the S.C.A.N. Team were authorized to take action after joint consultation. The organisation, the difficulties of implementation and the early results of the legislation are discussed. Problems with privacy of records and confidentiality are recognised. Public education was undertaken and the results, beneficial and adverse are highlighted. Notification of S.C.A.N. has increased public and professional awareness, and, in spite of difficulties of organisation in a large State of Australia, is providing increased and effective services to disadvantaged families.     

Stability of retrospective self-reports of child abuse and neglect before and after therapy for child abuse issues

OBJECTIVE: This study is a follow-up to a previously reported outcome study evaluating the efficacy of an emotionally focused therapy for adult survivors of childhood abuse. The present purpose was to evaluate the stability of self-reports of child maltreatment in the context of reduced psychopathology after therapy. The Childhood Trauma Questionnaire (CTQ; Bernstein et al., 1994) was used to measure the extent of child abuse and neglect. METHOD: The CTQ and measures of symptomatology, abuse resolution, and self-esteem were administered at pretreatment to 44 clients and after 6 months of therapy to 33 therapy completers. Post-treatment interviews also assessed changes in clients' perceptions of self and abusive and neglectful others. Analyses examined change on dependent measures, in interviews, and on the CTQ, as well as the test-retest and alpha reliabilities of CTQ factor scales, and the relationship of CTQ factor scales with pretreatment measures of distress. RESULTS: Analyses revealed significant reductions in psychopathology on all dependent measures and reduced self-blame, negatively biased memories, avoidance, and minimization of the abuse after therapy. Reports of abuse and physical neglect on the CTQ remained stable from pre- to post-therapy. All CTQ dimensions demonstrated good internal consistency and convergent validity with trauma-specific measures of distress. CONCLUSIONS: The stability of the CTQ in the context of significantly reduced psychopathology contributes to evidence supporting the accuracy of retrospective self-reports of childhood abuse.     

Maternal perinatal risk factors and child abuse

A retrospective matched pair study was designed to compare maternal perinatal factors such as abnormal pregnancy history and labor and delivery experience in families who subsequently were reported as physically abusive to one or more of their children as compared to non-abusive families. The study population consisted of the mothers of 532 children reported to the Baltimore (Maryland) Department of Social Services as physically abused during the years 1975-77. The comparison group was handmatched to the study group from State of Maryland birth certificates on the basis of the abused child's birth year and sex, maternal race, education and hospital of delivery. The study population was 67% black with a mean maternal education of 10.5 completed years. The abused children were 59% male with 48% less than 2 years of age. Results indicated that selected medical definitions of abnormal pregnancy, labor and delivery did not identify families at differential risk of maltreatment. However, mothers in maltreating families were younger, had shorter birth intervals, less prenatal care and were significantly more likely to have had a stillbirth or reported abortion or a prior child death. Study limitations are addressed as are suggestions for future research.     

Patterns of reported child abuse and neglect

Confirmed reports of abuse and neglect logged in a large state registry file from 1977 to 1984 are analyzed. Boys tend to sustain more frequent and more serious injuries. Victims of male perpetrators tend to sustain more serious injuries. A modest same-sex perpetrator/victim pattern is revealed for physical abuse; males are more likely to physically abuse boys while females are more likely to physically abuse girls. Among younger victims (aged 12 and younger) boys outnumber girls in all reporting categories except sexual abuse. Among adolescent victims, female victims greatly outnumber male victims in all reporting categories. Similarities between adolescent physical abuse and spouse abuse are noted; males are are the predominant perpetrators and females the predominant victims. As expected, victim age emerged as a strong predictor of severity of physical abuse injury. Several other factors including social isolation, mental health problems, lower income, and unemployment of the father are identified as modest predictors of severity.     

The nature and substantiation of official sexual abuse reports

A representative sample of 796 sexual abuse reports from New York State in 1985 was studied to explore factors associated with the decision to substantiate or unsubstantiate these reports. This study focused on the age, sex, and ethnicity of the subject child, and the source of the report as predictors of case substantiation. Substantiation rates tended to increase with the age of the child although this was more characteristic of reports involving female than male victims. Overall, reports involving female children were more likely to be substantiated than those involving male children. Ethnicity of the child showed no significant relationship to substantiation. Source of report, however, showed a strong relationship to case determination, with mandated reports found to be substantiated at a rate 13% higher than reports from non-mandated sources.     

Consistency in children's reports of sexual and physical abuse

OBJECTIVE: The goal of the present study was to investigate the consistency of children's reports of sexual and physical abuse. METHOD: A group of 222 children, ages 3-16 years, participated. As part of legal investigations, the children were interviewed twice about their alleged experiences of abuse. The consistency of children's reports of sexual and physical abuse was examined in the two interviews, in relation to age, type of abuse, gender, memory, suggestibility, and cognitive capabilities. RESULTS: Older children were more consistent than younger children in their reports of sexual and physical abuse. Children were more consistent when reporting sexual abuse than physical abuse. Girls were more consistent than boys in sexual abuse reports. Consistency in sexual abuse reports was predicted by measures of memory, whereas consistency in physical abuse reports was not. Cognitive abilities did not predict consistency in sexual abuse or physical abuse reports. CONCLUSIONS: Implications for understanding children's allegations of abuse are discussed.