Louisiana's statewide interdisciplinary approach to diagnostic, protective and treatment services to abused and neglected children and their families

The provision of the most comprehensive funded statewide delivery of diagnostic, protective and treatment services to abused and neglected children and their families in the country has been made possible by the State of Louisiana and its concerned citizenry. The importance of obtaining a legislative mandate establishing and funding the statewide child protection concept by the Louisiana legislature was illustrated.We described how the medical and protective services components cooperate and coordinate at the state and local levels to provide the abused and neglected child and his family with the best possible services available. Throughout our presentation the use of the interdisciplinary team concept was emphasized as the best system known to enhance the reporting, investigation and diagnosis of child abuse and/or neglect cases as well as providing protective and treatment services to the child and his family.The Child Protection Center is the community agency serving as the “core” for the interdisciplinary approach to be successful. The role of each discipline employed by the center was reviewed and how interagency coordination is accomplished through their efforts.The interdisciplinary dispositional conference prior to a child's discharge from the hospital was considered as an excellent method to insure that several disciplines share in the definitive protective and treatment plans for the abused child.Several treatment modalities and their success rates for the child and his family were discussed. The accomplishments of the center were listed.Finally, a review of how the citizenry from the Baton Rouge Community responded overwhelmly by their involvement and commitments in an all out effort to combat a serious social symptom and disease — child abuse and neglect.     

Service needs of adolescent parents in child welfare: Is an evidence-based,structured, in-home behavioral parent training protocol effective?

SafeCare is an evidence-based behavioral parent training intervention that has been successfully implemented in multiple state child welfare systems. A statewide implementation in Oklahoma established the effectiveness of SafeCare with a diverse group of parents, which included adolescent parents under 21 years of age, a particularly at-risk group. The current study examined whether SafeCare is also effective for this subsample of 294 adolescent parents with regard to child welfare recidivism, depression and child abuse potential, and attainment of service goals. Post-treatment adolescent parent ratings of program engagement and satisfaction were also examined. Among the subsample of adolescent parents, the SafeCare intervention did not result in significantly improved outcomes in terms of preventing recidivism or reduction in risk factors associated with child abuse and neglect as compared to child welfare services as usual. Further, no significant differences in program engagement and satisfaction between SafeCare and services as usual were detected. These findings shed light on the potential differences in program effectiveness between adolescent and adult parents, and the need for future research to rigorously evaluate the effectiveness of behavioral parenting programs with adolescent parents.     

Impact of a Statewide Collaborative on Strengthening Families Through Early Care and Education

Research Findings: Research suggests that early care and education programs are most effective when they include strong components of family involvement. The Center for the Study of Social Policy recommended that early care and education programs build family-centered practices to strengthen families and reduce the incidence of child abuse and neglect. This article summarizes a statewide effort to implement this strategy, called Strengthening Families through Early Care and Education. We analyzed program self-assessments submitted by 186 early care and education programs. Analyses revealed that Head Start programs had better support systems in place for families than did “mainstream” (non–Head Start, non-accredited) early care and education programs. Results also showed that a small amount of state and local funding provided enough incentive for programs to improve their family-strengthening practices. Commitment and collaboration at the state level led to a sustainable impact by infusing “strengthening families” concepts into the early care and education field statewide.     

A survey of state efforts in gathering information on child abuse and neglect in handicapped populations

This paper reports the extent to which states assemble information on the incidence of abuse and neglect among handicapped populations. Data were collected from all states on the types of pre-existing disabilities cited on child abuse reporting forms and the perceived accuracy of this information. The study also sought to identify specific methods used to provide assistance to local agencies regarding the problems associated with abuse of the handicapped. Surveys were distributed to and completed by representatives of the designated child protection agencies within each state and the District of Columbia (n = 51). General findings were that although it is generally acknowledged in research that handicapped children represent a disproportionate number of abuse and neglect victims, nearly half of the states do not collect any information on “special characteristics.” Forms from the remaining states exhibited much variation in style and in the competency of collection techniques. These results suggest a significant lack of services specifically designed to improve the awareness of field representatives on the influence of exceptionalities in abusive cases. This information indicates that training and prevention programs will remain basically inadequate until the relationship between handicapped conditions and abuse/neglect is more clearly defined.     

Moving child abuse and neglect prevention programs forward: improving program evaluations

This paper focuses on evaluations of programs to prevent child abuse and neglect. It discusses the quality of the evaluations and offers suggestions for improvement to evaluators, program planners, and funders. Thirteen evaluations recommended by experts and published from 1978 through 1988 were reviewed. Using the true experiment as the standard of quality, we found evaluations frequently characterized by careful attention to methodologic detail. Evaluators describe eligibility criteria; half of the studies had control groups or followed progress. However, to learn more about prevention of abuse and neglect the caliber of evaluation research must improve. Evaluators do not define abuse or neglect; they accept reports of abuse. This has the effect of shifting the responsibility to others whose concerns and reporting standards differ. Lack of definition is reflected in a paucity of valid measurements; we could not assess the characteristics of families who benefit most from programs. Evaluators also omit important topics. Although seven evaluations studied health-related variables, no comprehensive analysis of the consequences and costs of medical neglect could be found; very little information on costs and benefits of any kind was available.     

Enrollment strategies in early home visitation to prevent physical child abuse and neglect and the "universal versus targeted" debate: a meta-analysis of population-based and screening-based programs.

OBJECTIVE: Seeking to discern optimal programmatic strategies and inform the "universal versus targeted" debate in early home visitation services to prevent physical child abuse and neglect, a meta-analysis was conducted examining enrollment approaches in early home visitation studies and their reported outcomes. METHOD: Quantitative meta-analytic techniques were used to compare effect sizes from 19 controlled outcome studies across screening-based and population-based enrollment strategies. Effect sizes were calculated on protective services data and on child maltreatment related measures of parenting. RESULTS: On protective services report data, population-based studies reported a weighted mean effect size attributable to early home visitation of +3.72%, in comparison to -.07% for screening-based studies. On child maltreatment related measures of parenting, population-based studies reported a weighted mean effect size (r) attributable to early home visitation of +.092, in comparison to +.020 for screening-based studies. CONCLUSIONS: The findings indicate that population-based enrollment strategies appear favorable to screening-based ones in early home visitation programs seeking to prevent physical child abuse and neglect. It may be that psychosocial risk screens serve to enroll higher proportions of families for which early home visitation services are less likely to leverage change, and to exacerbate a mismatch between early home visitation service aims and family needs.     

Mothers in substance abuse treatment: differences in characteristics based on involvement with child welfare services

PROBLEM: Greater awareness of the role of parental substance abuse in child maltreatment makes it imperative that the substance abuse treatment and child welfare systems coordinate services for these parents. Yet little is known about the characteristics of child-welfare involved parents (primarily mothers) who enter into substance abuse treatment. This paper compares the characteristics of mothers in substance abuse treatment who were and were not involved with child welfare services, and discusses the treatment implications of these differences. METHOD: Data were obtained from a statewide treatment outcome monitoring project in California. Clients were assessed at treatment admission using the Addiction Severity Index. Bivariate analyses and multivariate logistic regression were conducted comparing mothers who were (N=1,939) and were not (N=2,217) involved with child welfare. RESULTS: Mothers who were involved with child welfare were younger, had more children, and had more economic problems. They were more likely to be referred by the criminal justice system or other service providers, to have a history of physical abuse, and to be treated in outpatient programs. They had lower levels of alcohol severity, but did not differ with regard to psychiatric severity or criminal involvement. Primary users of methamphetamine were disproportionately represented among this group and had a distinct profile from primary alcohol- and opiate-users. CONCLUSION: Study findings suggest that mothers involved with child welfare enter substance abuse treatment through different avenues and present a clinical profile of treatment needs related to exposure to physical abuse, economic instability, and criminal justice involvement.     

Relationships between childhood abuse and neglect experience and HIV risk behaviors among methadone treatment drop-outs

OBJECTIVE: The purpose of this study was to examine the relationships between childhood abuse/neglect experiences (sexual abuse, physical abuse, emotional abuse, and child neglect) and adult life functioning among Methadone Maintenance Treatment Program (MMTP) drop-outs. METHOD: 432 subjects who dropped out of MMTP were recruited in New York City in 1997-1999. Adult life functioning was measured by HIV drug and sex risk behaviors, Addiction Severity Index (ASI) composite scores, and depression. The chi(2) tests, t tests, correlation, and multiple logistic regressions were performed to examine the relationships between abuse experiences and adult life functioning. RESULTS: The prevalence of child abuse/neglect history was high among MMTP drop-outs: sexual abuse-36%; physical abuse-60%; emotional abuse-57%; child physical neglect-66%; all four experiences-25%. As assessed via ASI composite scores, those who had been abused in childhood had significantly more medical, legal, relationship, and psychological problems than those who had not. Overall, several significant associations were found between the abuse experiences and HIV risk behaviors. Those who had experienced child neglect were more likely to be HIV positive. In multivariate analyses, childhood physical abuse was a significant predictor of having multiple sex partners while depression was significantly related to injection drug use in adulthood (p<.05). There were trends for the relationships between childhood sexual abuse and HIV sex risk behavior (p<.10) and between gender and injection drug use (p<.10). CONCLUSIONS: The findings support a need for drug treatment programs that include specialized therapies for those who suffered childhood abuse and neglect experiences.     

American Indian law on child abuse and neglect

A wide variety of American Indian tribal codes on child abuse and neglect are currently in effect. They range from anachronistic codes that were promulgated about fifty years ago and have never been revised to recently enacted codes that are innovative and incorporate the best practices in the field of protective services. The efforts, now underway, to collect and analyze Indian tribal codes on child abuse and neglect is supportive of the national interest to improve Indian child welfare services. The knowledge gained will be helpful to Indian tribes as they assess their own codes and will provide a new body of information on the laws in the U.S. on child abuse and neglect. In the past few years, increased national support in the United States has been focused on the protection of the best interest of Indian children with specific resources provided for the support of local Indian children and family programs operated by Indian tribal governments. Many Indian tribes are using these resources to develop and revise their child welfare codes, including those elements pertaining to child abuse and neglect. The momentum under way in the United States to improve Indian child welfare services can be expected to continue to include developments in Indian tribal codes on child abuse and neglect.     

Child sexual abuse and exploitation—A global glimpse

The view of what constitutes child abuse and neglect is dependent on the laws, cultural context, local thresholds and the availability. Since 1982, the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) has conducted surveillance of child maltreatment and child protection every two years, published in World Perspectives on Child Abuse. It is hoped that up to date information will inform the development of laws, policies and programs to better address child abuse and neglect. This article is based on data on child sexual abuse and exploitation from 73 countries gathered online in 2015-16 for the 12 edition of World Perspectives. Respondents were key informants who were knowledgeable professionals in the child protection field. They were encouraged to consult with colleagues so as to provide accurate information. Countries were grouped into different regions of the world and into income level categories. The findings focus on definitions of abuse and neglect, laws, policies and programs to address and prevent maltreatment and barriers to prevention. It is evident that there is considerable variability across regions and country income categories, and that programs and services need to be considerably strengthened, even in high income countries.     

The predictive impact of domestic violence on three types of child maltreatment

OBJECTIVE: This exploratory study investigated the co-occurrence of domestic violence and three types of child maltreatment: physical child abuse, psychological child abuse, and child neglect. METHOD: A sample of 2544 at-risk mothers with first-born children participated in a home-visiting child abuse prevention program. A longitudinal design using multiple data collection methods investigated the effect of domestic violence during the first 6 months of child rearing on confirmed physical child abuse, psychological child abuse, and child neglect up to the child's first 5 years. RESULTS: Logistic regressions revealed significant relationships between domestic violence and physical child abuse, psychological child abuse, and child neglect. These effects were significant beyond the significant effects of known risks of maltreatment, as measured by the Kempe Family Stress Inventory (KFSI). Domestic violence occurred in 59 (38%) of the 155 cases of confirmed maltreatment. Domestic violence preceded child maltreatment in 46 (78%) of the 59 cases of co-occurrence, as indicated by independent home observations and child protective service records. CONCLUSIONS: The findings indicate that domestic violence during the first 6 months of child rearing is significantly related to all three types of child maltreatment up to the child's fifth year. Domestic violence and risks factors measured on the KFSI continue to contribute to all three types of maltreatment up to the child's fifth year. Prevention programs would be wise to provide services to at-risk families until the child is at least 5 years old. Addressing concurrent problems during treatment may enhance intervention.     

From maltreatment report to juvenile incarceration: the role of child welfare services

OBJECTIVE: This study examined whether children who received child welfare services (e.g., in-home or out-of-home placement) were more or less likely to become incarcerated as serious and violent youthful offenders than those children who were investigated as victims of abuse and neglect but received no further child welfare intervention. METHOD: Administrative data on child abuse reporting, foster care, birth records, and juvenile corrections (CYA) were linked to prospectively examine the risk of incarceration as an adolescent following an investigation of abuse or neglect after age 6. The 10 county California sample included 159,549 school-aged children reported for abuse and neglect after 1990. RESULTS: About 8 per 1,000 children in the sample were later incarcerated in CYA. African American and Hispanic children who received in-home or foster care services after the index investigation event had a lower risk of incarceration than those whose cases were closed after the investigation. Among females, the rate of incarceration was highest for those who experienced foster or group care placements. Children initially reported for neglect were more likely to be incarcerated than those reported for physical or sexual abuse. CONCLUSIONS: Public child welfare services have rarely been assessed in terms of future negative child outcomes. This study finds that one serious negative outcome, CYA involvement, can only be understood when a number of factors are considered. The importance of understanding the differences between how different subpopulations respond to services is highlighted. Specifically, our findings suggest that more attention should be focused on children who are now receiving no services after an investigated child abuse and neglect report, on females, and on victims of child neglect.     

A descriptive survey of Swedish child health nurses' awareness of abuse and neglect. I. Characteristics of the nurses

OBJECTIVE: The objectives were to assess: (1) child health nurses' identification of abuse/neglect of children of preschool age in their districts; (2) overall prevalence of abuse/neglect according to the nurses; (3) determinants of nurse identification; (4) determinants of nurse-reported district prevalences; and (5) determinants of reporting to the child protection services (CPS). METHOD: Questionnaires were mailed to about 3,000 child health centers. RESULTS: Fifty-five percent responded. Of these, 22% identified no case and 33% at least one (mostly five or fewer). The overall prevalence was 1.4%. Identification correlated with general participation rate in the county. Other determinants of identification were acquaintance with the district, large district populations, and three variables assumed to reflect a personal interest. Determinants of prevalences were small district populations, regular contacts with the social services, and two personal interest variables. With large district populations, identification increased, whereas prevalences decreased. Only 30.3% had made a report to the CPS. Regular contacts with the social services correlated with reporting. Personal interest was a determinant of the decision to report, and acquaintance with the district a determinant of reporting rate. CONCLUSIONS: Abuse and neglect did not appear as priorities for the Child Health Services. The method probably led to an underestimation of the true prevalence. Personal interest and social services contacts emerged as important determinants. However, the assumed criteria of "interest" were not validated. For effective identification, no nurse should be responsible for more than 400 to 500 children. Implications for practice and research are discussed.     

Examining the effectiveness of home-based parent aide services to reduce risk for physical child abuse and neglect: Six-month findings from a randomized clinical trial

Objective

This study set out to carry out a feasible, real-world, randomized clinical trial to examine the benefits of home-based paraprofessional parent aide services in reducing physical abuse and neglect risk in high-risk parents.

Methods

Families were randomly assigned to receive either parent aide plus case management services (n = 73) or case management services only (n = 65), collecting in-home data on physical child abuse and neglect and proximal risk and protective factors, just prior to service initiation, and again after six months of services.

Results

Mothers receiving parent aide and case management services reported significant improvements from baseline to six-month follow-up in self-reported indicators of physical child abuse risk, as well as improvements on parental stress, mastery, depression, and anxiety, whereas mothers receiving only case management services did not. The slopes of such observed changes across groups, however, were not found to be statistically significantly different. No discernable improvements were found with regard to indicators of risk for child neglect.

Conclusions

As the first randomized clinical trial examining the effectiveness of parent aide services, this study provides the first controlled evidence examining the potential benefits of this service modality. This study suggests promising trends regarding the benefit of parent aide services with respect to physical child abuse risk reduction and related predictors, but evidence does not appear to suggest that such services, as they are presently delivered, reduce child neglect.

Practice implications

These findings support the continued use of parent aide services in cases of physical child abuse and also suggest careful consideration of the ways such services may be better configured to extend their impact, particularly with respect to child neglect risk.     

Family preservation and family support programs: child maltreatment outcomes across client risk levels and program types.

OBJECTIVES: This study evaluated client-level outcomes among an entire statewide group of Family Preservation and Family Support (FPFS) programs funded under PL 103-66. METHOD: A total of 1,601 clients (primarily low income, moderate to high risk with no current involvement in the child protection system) were assessed and followed over time for future child maltreatment events reported to Child Protective Services. The study compared program completers with program dropouts, compared recipients of more lengthy full-service programs with recipients of one-time services, and examined the effects of program duration, intensity, service site (center-based vs. home based) and service model/content. Effects were modeled using survival analysis and variable-exposure Poisson hierarchical models, controlling for initial client risk levels and removing failure events because of surveillance bias. Changes in lifestyle, economic and risk factors were also examined. RESULTS: A total of 198 (12.2%) participants had at least one defined failure event over a median follow-up period of 1.6 years. Controlling for risk and receipt of outside services, program completers did not differ from program dropouts or from recipients of one-time services, and there was no relationship between program intensity or duration and outcomes. Program types designed to help families meet basic concrete needs and programs using mentoring approaches were found to be more effective than parenting and child development oriented programming, and center-based services were found to be more effective than home-based services, especially among higher risk parents. CONCLUSIONS: The findings did not support the effectiveness of these services in preventing future maltreatment cases, and raised questions about a number of common family support assumptions regarding the superiority of home-visiting based and parent training services. A number of possible reasons for this are explored.