Predicting child maltreatment: A meta-analysis of the predictive validity of risk assessment instruments

Risk assessment is crucial in preventing child maltreatment since it can identify high-risk cases in need of child protection intervention. Despite widespread use of risk assessment instruments in child welfare, it is unknown how well these instruments predict maltreatment and what instrument characteristics are associated with higher levels of predictive validity. Therefore, a multilevel meta-analysis was conducted to examine the predictive accuracy of (characteristics of) risk assessment instruments. A literature search yielded 30 independent studies (N = 87,329) examining the predictive validity of 27 different risk assessment instruments. From these studies, 67 effect sizes could be extracted. Overall, a medium significant effect was found (AUC = 0.681), indicating a moderate predictive accuracy. Moderator analyses revealed that onset of maltreatment can be better predicted than recurrence of maltreatment, which is a promising finding for early detection and prevention of child maltreatment. In addition, actuarial instruments were found to outperform clinical instruments. To bring risk and needs assessment in child welfare to a higher level, actuarial instruments should be further developed and strengthened by distinguishing risk assessment from needs assessment and by integrating risk assessment with case management.     

An examination of trends in child sexual abuse investigations in Ontario over time

BackgroundChild sexual abuse (CSA) rates have been declining since the 1990s (Dunne et al., 2003; Finkelhor & Jones, 2004, 2012; Jones et al., 2001). Discrepancies in contexts and measures complicate comparing CSA rates across jurisdictions and studies, and there is limited literature about trends in CSA in Canada.ObjectiveUsing data from the Ontario Incidence Study of Reported Child Abuse and Neglect (OIS), the only source of provincially aggregated data in Ontario, Canada, that describes child welfare investigations, this paper provides information on reported and investigated CSA over the past 20 years.Participants and settingThe OIS uses a file review methodology; information is collected directly from investigating child welfare workers.MethodsA sample of child welfare agencies is selected for the study, and data are collected over a three-month period. Weights are applied to produce annual provincial estimates.ResultsThe rates of investigated CSA in Ontario decreased between 1993 and 2013, from 5.20 (95% CI [3.94, 6.47]) to 1.81 (95% CI [0.97, 2.66]) children per 1000. During this time, the rate of all child maltreatment-related investigations doubled, from 21.41 (95% CI [18.38, 24.42]) to 53.32 ([29.61, 77.03]) children per 1000.ConclusionsUnlike other forms of child maltreatment, the incidence of investigated CSA in Ontario declined since 1993. Substantiation rates for CSA investigations decreased more dramatically than the rate of all CSA investigations, which could indicate a true decline in rate or an inability to accurately identify cases of CSA.     

Development of a prediction model for child maltreatment recurrence in Japan: A historical cohort study using data from a Child Guidance Center

To develop a prediction model for the first recurrence of child maltreatment within the first year after the initial report, we carried out a historical cohort study using administrative data from 716 incident cases of child maltreatment (physical abuse, psychological abuse, or neglect) not receiving support services, reported between April 1, 1996 through March 31, 2011 to Shiga Central Child Guidance Center, Japan. In total, 23 items related to characteristics of the child, the maltreatment, the offender, household, and other related factors were selected as predictive variables and analyzed by multivariate logistic regression model for association with first recurrence of maltreatment. According to the stepwise selection procedure six factors were identified that include 9–13 year age of child (AOR = 3.43/95%CI = 1.52−7.72), <40 year age of the offender (AOR = 1.65/95%CI = 1.09−2.51), offender’s history of maltreatment during childhood (AOR = 2.56/95%CI = 1.31−4.99), household financial instability or poverty (AOR = 1.64/95%CI = 1.10−2.45), absence of someone in the community who could watch over the child (AOR = 1.68/95%CI = 1.16−2.44), and the organization as the referral source (AOR = 2.21/95%CI = 1.24−3.93). Using these six predictors, we generated a linear prediction model with a sensitivity and specificity of 45.2% and 82.4%, respectively. The model may be useful to assess the risk of further maltreatment and help the child and family welfare administrations to develop preventive strategies for recurrence.     

Families at risk of poor parenting: A descriptive study of sixty at risk families in a model prevention program

Sixty families assessed to be at risk of poor parenting were the subject of this study. These families were participants in a model multidisciplinary program designed for the secondary prevention of poor parenting and the extremes of child abuse and neglect. The model program consists of special medical, psychological, social and developmental services to families on an inpatient, outpatient, and in-home basis. Demographic information on these 60 families was tabulated. Each family was given a monthly rating on a simple measure of family function. Ratings over lime were observed, and families were characterized in terms of a family rating vector (up. up-plateau, plateau, fluctuating, and down). Families were also described in terms of the constellation of problems brought to the therapy situation. Problem lists for each family were subjected to factor analysis. Five factor constructs which made clinical sense emerged from the analysis. Each factor could be labeled as a “family type.” These types were: (I) Abusive Family. (II) Neglectful or Antisocial Family. (III) Family with an Emotionally Unstable Parent, (IV) Family with Cultural or intellectual Limitation, and (V) Family with Child-Rearing Difficulties. Approximately 20% of these families did not fit the typology. Families were then divided into two groups—those who were relatively long-term, ongoing recipients of services, and those who left the program in the observation interval. Families were categorized according to family function rating vector and “family type.” It was noted among long-term families, measured improvement in family function was most evident in families with transient situational crisis (who did not fit the typology) and those with intellectual and cultural deficits (Type IV). Among the families who dropped from the program. 15% were no longer at risk. Sixty-three percent of the remaining families were not improving. These techniques may be useful in determining which at risk families are more successful candidates for prevention efforts.     

The prevalence and impact of child maltreatment and other types of victimization in the UK: Findings from a population survey of caregivers,children and young people and young adults

Objectives

To measure the prevalence of maltreatment and other types of victimization among children, young people, and young adults in the UK; to explore the risks of other types of victimization among maltreated children and young people at different ages; using standardized scores from self-report measures, to assess the emotional wellbeing of maltreated children, young people, and young adults taking into account other types of childhood victimization, different perpetrators, non-victimization adversities and variables known to influence mental health.

Methods

A random UK representative sample of 2,160 parents and caregivers, 2,275 children and young people, and 1,761 young adults completed computer-assisted self-interviews. Interviews included assessment of a wide range of childhood victimization experiences and measures of impact on mental health.

Results

2.5% of children aged under 11 years and 6% of young people aged 11–17 years had 1 or more experiences of physical, sexual, or emotional abuse, or neglect by a parent or caregiver in the past year, and 8.9% of children under 11 years, 21.9% of young people aged 11–17 years, and 24.5% of young adults had experienced this at least once during childhood. High rates of sexual victimization were also found; 7.2% of females aged 11–17 and 18.6% of females aged 18–24 reported childhood experiences of sexual victimization by any adult or peer that involved physical contact (from sexual touching to rape). Victimization experiences accumulated with age and overlapped. Children who experienced maltreatment from a parent or caregiver were more likely than those not maltreated to be exposed to other forms of victimization, to experience non-victimization adversity, a high level of polyvictimization, and to have higher levels of trauma symptoms.

Conclusions

The past year maltreatment rates for children under age 18 were 7–17 times greater than official rates of substantiated child maltreatment in the UK. Professionals working with children and young people in all settings should be alert to the overlapping and age-related differences in experiences of childhood victimization to better identify child maltreatment and prevent the accumulative impact of different victimizations upon children's mental health.     

A study to define and assess severity of institutional abuse/neglect

The purpose of this paper is to examine results of an empirical study of judgments about the seriousness of situations of institutional child maltreatment. This study furthers the development of operational definitions of institutional abuse and neglect by examining the following issues: What is the relative seriousness of institutional child maltreatment events? Are judgments of seriousness made on the basis of caregiver behavior or negative consequences to the child? Are incidents of child maltreatment which occur in institutions judged differently than similar incidents which occur in an intrafamilial context? This paper presents data gathered on judgments made by 630 respondents regarding 24 situations of child maltreatment. Respondents in the study represented: children in care, direct caregivers, managers in institutions, public child welfare workers, facility board members, and foster parents. Respondents judged the situations to be harmful more readily than they judged them to be abuse/neglect. For the majority of events in this survey, the setting (out-of-home care vs. intrafamilial) did not appear to significantly affect the judgments of respondents in their assessment of harm or judgment as abuse/neglect. The presentation of a negative consequence for the child significantly (p < .05) increased the respondents' assessment of harm in 12 out of 24 events. The presentation of a consequence for the child significantly (p < .05) increased the respondents' assessment of harm in 12 out of 20 events. The presentation of a consequence for the child significantly (p < .05) increased the judgment of abuse/neglect in 8 out of 24 events.     

Predictors of variation in sate reported rates of psychological maltreatment: A survey of statutes and a call for change

BackgroundPsychological maltreatment (PM) is equivalent in harm to other forms of child maltreatment and yet it is not included in all US State child abuse statutes and past research using the National Child Abuse and Neglect Data System (NCANDS, 1998, 2007, 2008) identified 300-480-fold differences in substantiated cases across US States. This variation is inconsistent with the significance of the problem and the availability of reliable operational definitions.Participants and SettingUS State statutes were coded and compared with reported rates of four different forms of child maltreatment in the 2014 and 1998 NCANDS data sets.MethodsData were extracted from NCCANDS and State statutes were coded independently by the authors (kappa = .96).ResultsFor 2014, the difference in reported rates of PM between the State with the lowest rate and the State with the highest rate was 523-fold which was much higher than for physical (30-fold) and sexual abuse (20-fold) but not neglect (524-fold). Statutes still use the term “mental injury” from the original Child Abuse Prevention and Treatment Act (Child Abuse Prevention & Treatment Act, 1974) and two thirds did not define it. Reported rates of PM in NCANDS were not correlated with whether PM was defined in the statute but when a harm standard was present, reported rates were statistically lower. Almost 70% of statutes mentioned a current trend (e.g., sexual/human trafficking) demonstrating a willingness by States to amend statutes.ConclusionsA common, reliable definition of PM (and other forms of maltreatment) in CAPTA, NCANDS, and US State statutes is necessary for the US to have a surveillance system that allows for the assessment of the effects of policies on reported rates of all forms of maltreatment.     

Identifying child abuse and neglect risk among postpartum women in Japan using the Japanese version of the Kempe Family Stress Checklist

The aims of this study were to determine the rate of women who are high-risk for child abuse and neglect in a perinatal unit in Japan, and to identify the factors associated with risk level. To assess the potential risk for child abuse and neglect the Japanese version of the Kempe Family Stress Checklist (FSC-J) was used to guide interviews with postpartum women. FSC-J uses a three-point scale to score 10 categories, categorizing responses as “no risk = 0”, “risk = 5”, and “high risk = 10”. The range of FSC-J is 0–100. Using an established cutoff point of 25, subjects were divided into high and low risk groups. For both groups, relationships between factors were analyzed. Of the 174 subjects who agreed to participate, 12 (6.9%) scored high-risk, and 162 (93.1%) scored low-risk. Adjusted odds ratio identified three associated factors as important for predicting risk level: past mental illness (OR = 341.1), previous experience of intimate partner violence (OR = 68.0), and having a partner who was unemployed (OR = 14.5). Although this study was on a small sample of women in one hospital in Japan and a larger population would make this study much stronger, these results suggest that some 6.9% of postpartum women in Japan may be at high-risk for child abuse and neglect. It is critical, therefore, to develop a system for screening, intervention, and referral for such women and their children.     

Broken bonds: A meta-analysis of emotion reactivity and regulation in emotionally maltreating parents

BackgroundEmotional maltreatment is the most pervasive but least studied form of abuse.ObjectiveIn the present study, we examined the role of emotion reactivity and emotion regulation in emotional child maltreatment.MethodsWe identified nine studies that compared levels of parental emotion reactivity and regulation in emotionally maltreating families with levels in non-maltreating families.ResultsOur meta-analytic findings revealed that, in comparison to non-maltreating parents, parents who are emotionally maltreating their children report higher levels of negative affect, depression, verbal aggression, and anger. We also found that in comparison to non-maltreating parents, emotionally maltreating parents report lower levels of emotional control, emotion regulation, and coping strategies.ConclusionsWe outline the theoretical and practical implications of these results, and emphasize how research into the etiology of child maltreatment may provide the basis for more effective prevention, screening, and treatment practices designed to eradicate emotional maltreatment.     

Factor analysis and predictive validity of the Early Risks of Physical Abuse and Neglect Scale (ERPANS): A prospective study in Dutch public youth healthcare

Early detection of child abuse risk factors in families of new-born babies is an important task of the public youth health care system in the Netherlands. The Early Risks of Physical Abuse and Neglect Scale (ERPANS) was originally developed in Belgium as an observation scale for public child healthcare nurses. The present longitudinal study is an independent prospective validation of the ERPANS in a Dutch community sample (N = 1257) of families with a new-born. Results showed a commonality of underlying subsets of items belonging to the ‘Disturbed parent-child relationship’ and ‘Psychological problems’ factors, but the factor ‘Communication problems’ of the original ERPANS could not be replicated. We found that parental psychological problems were a significant predictor of family problems, including involvement of child protection authorities, at an average follow-up of 22 months. Parents who reported feeling unloved by their own parents were at higher risk of reports of serious concern to child protection authorities at 22 months after birth. These findings support the utility of at least a subset of the ERPANS items as a screening tool for child abuse risk in preventive public youth health care for new-born babies. Our research adds to a growing body of evidence which points to the importance of parental mental health problems and adverse childhood experiences as precursors to child abuse risk.     

Screening for potential child maltreatment in parents of a newborn baby: The predictive validity of an Instrument for early identification of Parents At Risk for child Abuse and Neglect (IPARAN)

For preventive purposes it is important to be able to identify families with a high risk of child maltreatment at an early stage. Therefore we developed an actuarial instrument for screening families with a newborn baby, the Instrument for identification of Parents At Risk for child Abuse and Neglect (IPARAN). The aim of this study was to assess the predictive validity of the IPARAN and to examine whether combining actuarial and clinical methods leads to an improvement of the predictive validity. We examined the predictive validity by calculating several performance indicators (i.e., sensitivity, specificity and the Area Under the receiver operating characteristic Curve [AUC]) in a sample of 4692 Dutch families with newborns. The outcome measure was a report of child maltreatment at Child Protection Services during a follow-up of 3 years. For 17 children (.4%) a report of maltreatment was registered. The predictive validity of the IPARAN was significantly better than chance (AUC = .700, 95% CI [.567–.832]), in contrast to a low value for clinical judgement of nurses of the Youth Health Care Centers (AUC = .591, 95% CI [.422–.759]). The combination of the IPARAN and clinical judgement resulted in the highest predictive validity (AUC = .720, 95% CI [.593–.847]), however, the difference between the methods did not reach statistical significance. The good predictive validity of the IPARAN in combination with clinical judgment of the nurse enables professionals to assess risks at an early stage and to make referrals to early intervention programs.     

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.     

Child maltreatment in the “Children of the Nineties:” deprivation, class, and social networks in a UK sample

Aim: To determine risk factors for child maltreatment within the socio-economic environment of a contemporary UK child population.Methods: The research is based on a large cohort study, the Avon Longitudinal Study of Parents and Children. Out of 14,256 children participating in the study, 115 have been identified as having been placed on local child protection registers prior to their 6th birthday. Data on the socio-economic environment of the families have been obtained from a series of questionnaires administered during pregnancy and the first 3 years of life. Risk factors have been analyzed using logistic regression analysis.Results: Four indicators of deprivation all showed significant relationships with registration. Adjusted odds ratios were 2.33 for paternal unemployment; 7.65 for council housing; 2.16 for overcrowding; and 2.33 for car ownership. There was a strong relationship between the number of indicators of deprivation and the risk of maltreatment. In a second model, maternal unemployment, high mobility (> 3 house moves in the previous 5 years) and a poor social network were also significant with odds ratios of 2.82, 2.81, and 3.09, respectively.Conclusions: This study confirms the importance of social factors in the etiology of child maltreatment. Social deprivation is an important determinant of child maltreatment, and encompasses a number of different aspects, including financial security, housing situation and material benefits; in addition, the job situation of the parents and the stability and richness of their social networks all have a significant impact on risk of maltreatment. Interventions at both an individual and a community level are important to support families and reduce the risk of maltreatment.     

Risk factors for fatal and non-fatal child maltreatment in families previously investigated by CPS: A case-control study

The objective of this study was to identify individual, family and caregiver risk factors for serious child maltreatment, resulting in hospitalization or death, among children and families investigated by Child Protective Services (CPS). We conducted a matched case-control study of 234 children who sustained fatal or serious nonfatal maltreatment due to physical abuse or neglect and whose mother was named in a CPS investigation between 1999 and 2013. A total of 702 children and their caregivers were included in the study with 234 cases matched 2:1,resulting in 468 controls. Data on potential risk factors were abstracted from three county administrative databases. Differences between cases and controls were calculated and multivariable conditional logistic regression was used to estimate risk models. Variables associated with increased risk for serious maltreatment included male child gender,younger caregivers, three or more children under the age of 5 living in the home, families in which a biologic child was not living with either parent, and scoring moderate or high on the Structured Decision Making Risk Tool^®. Caregiver involvement in intimate partner violence (IPV) and child enrollment in public health insurance appears to mitigate the risk of serious maltreatment.     

A prospective,longitudinal cohort study: The impact of child maltreatment on delinquency among South Korean youth in middle and high school

BackgroundCultural groups vary in how they understand child maltreatment and children's misbehavior and these cultural variations may impact the relationship between maltreatment and delinquency.ObjectiveThis study investigated the impact of maltreatment on delinquency among South Korean youth. Participants and Setting: Using Korean Children and Youth Panel Survey data, this study followed two cohorts of middle (n = 2,275) and high (n = 2,272) school youth for their first self-reported delinquency over 4 years.MethodDiscrete-time hazard model was used for the analyses.ResultsApproximately 19% of middle and 11% of high school youth engaged in delinquency for 4 years. Maltreatment is associated with delinquency only for high school youth (HR = 1.42). In both cohorts, male youth with high levels of aggression were more likely to engage in delinquency. Additional risk factors included high levels of depression (HR = 1.36) and negative attitudes toward school rules (HR = 0.68), father's education less than high school (HR = 0.63), low levels of self-control (HR = 0.63). Findings also identified culturally unique factors that place Korean youth at heightened risk of delinquency: mother's education more than high school (HR = 1.49) and higher family income (HR = 1.93).ConclusionPreventive interventions need to identify culturally specific risk factors for youth at increased risk of delinquency and thus these preventive interventions should be culturally tailored.     

Pilot study of a program delivered within the regular service system in Germany: Effect of a short-term attachment-based intervention on maternal sensitivity in mothers at risk for child abuse and neglect

This pilot study examined the effectiveness of a short-term attachment-based intervention, the Ulm Model, in a German population at risk for child abuse and neglect. The intervention used home visits and video feedback to promote maternal sensitivity, and was implemented by trained staff within the health care and youth welfare systems. Mothers in the control group (n = 33) received standard services only, while those in the intervention group (n = 63) additionally the Ulm Model intervention. The outcomes measured were maternal sensitivity, as assessed by the CARE-Index at pre-intervention, after the last session, and at about 6 and 12 months of age; and infant socio-emotional development, as assessed by the ET6-6 development test at about 6 and 12 months of age. The moderating effects on treatment outcomes of two variables were examined: risk for child abuse (moderate vs. high) and type of maternal attachment representation (secure vs. insecure). Among participants at moderate risk for child abuse, no differences were found between the intervention group and control group in either maternal sensitivity or infant development. Among those considered high risk, mothers in the intervention group showed a significant increase in maternal sensitivity from pre- to post-intervention; however, no group differences were seen at follow-up. There were some indications that infants of mothers in the intervention group showed better emotional development. The variable of maternal attachment representation was not a significant moderator for the intervention effect, but post hoc analysis indicated that the mean sensitivity of secure mothers was significant higher at the 6-month follow-up.     

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.     

Fatal and non-fatal child maltreatment in the US: An analysis of child,caregiver, and service utilization with the National Child Abuse and Neglect Data Set

The purpose of this study was to compare children who are fatally and non-fatally maltreated in the United States. In this first national-comparison study, we used the Child Abuse and Neglect Data Set of children and families who encounter/receive support from child welfare services. We found that children who were fatally maltreated were younger, were more likely to live with both their parents, and that their families experienced more financial and housing instability compared to non-fatally maltreated children. Overall, families in which children die use/receive fewer social services, as compared to families in which children live. We discuss the results with regard to child welfare practice and research.