Mothers in methadone treatment and their involvement with the child protection system: A replication and extension study

Objectives

Although a high level of involvement with the child protection system has been identified in families where parental substance use is a feature, not all such parents abuse or neglect their children or have contact with the child protection system. Identifying parents with substance-use histories who are able to care for their children without intervention by the child protection system, and being able to target interventions to the families who need them the most is important. This study interviewed a relatively large sample of mothers about their histories, their children and their involvement with the child protection system. We hypothesized that mothers in opioid pharmacological treatment who are involved with child protection services are different in characteristics to those mothers who are not involved.

Methods

One hundred and seventy-one women, with at least one child aged under 16 years, were interviewed at nine treatment clinics providing pharmacological treatment for opioid dependence across Sydney, Australia.

Results

Just over one-third of the women were involved with child protection services at the time of interview, mostly with children in out-of-home care. Logistic regression analyses revealed that factors which significantly increased the likelihood of the mother being involved with the child protection system were: (1) having a greater number of children, (2) being on psychiatric medication, and (3) having less than daily contact with her own parents.

Conclusions

This study replicates and extends the work of Grella, Hser, and Huang (2006) and the limited literature published to date examining the factors which contribute to some substance-using mothers becoming involved with the child protection system while others do not. The finding that mental health problems and parental supports (along with the number of children) were significantly associated with child protection system involvement in this study, indicates a need for improved interventions and the provision of treatment and support services if we are to reduce the involvement of the child protection system with these families.     

Discourses of education,protection, and child labor: case studies of Benin,Namibia and Swaziland

This article analyses discontinuities between local, national and international discourse in the fields of education, protection of children, and child labor, using Benin, Namibia and Swaziland as case studies. In Benin, child abuse and child labor are related to poverty, whereas in Namibia and Swaziland they are also interrelated with HIV/AIDS. In these countries, the notion of childhood is seen as continuous with adulthood, and the change from education to work is not abrupt and age-determined, but a smooth transition. The international discourse defines children in binary terms (child or adult), and promotes free and compulsory education for children, without recognizing the direct and indirect costs of education. Projects based on an international discourse may have little relevance in a poverty context where it is natural to make children work to ensure food safety. Local communities consider children from a logic of community survival; the external aid agencies consider them from a logic of individual children's rights. There is a need to find a bridge between these two interpretations of childhood.     

Pediatric response to a large-scale child protection intervention

Objective

In a rural area of the US state of Texas, in April 2008, the Texas Department of Family and Protective Services (DFPS) responded to evidence of widespread child abuse in an isolated religious compound by removing 463 individuals into state custody. This mass child protection intervention is the largest such action that has ever occurred in the United States. The objective of this paper is to characterize the burdens placed on the area's community resources, healthcare providers, and legal system, the limitations encountered by the forensic and public health professionals, and how these might be minimized in future large-scale child protection interventions.

Methods

Drawing on publicly available information, this article describes the child abuse investigation, legal outcomes, experiences of pediatric healthcare providers directly affected by the mass removal, and the roles of regional child abuse pediatric specialists.

Results

Because the compound's residents refused to cooperate with the investigation and the population of the compound was eight times higher than expected, law enforcement and child protection resources were insufficient to conduct standard child abuse investigations. Local medical and public health resources were also quickly overwhelmed. Consulting child abuse pediatricians were asked to recommend laboratory and radiologic studies that could assist in identifying signs of child abuse, but the lack of cooperation from patients and parents, inadequate medical histories, and limited physical examinations precluded full implementation of the recommendations.

Conclusions

Although most children in danger of abuse were removed from the high-risk environment for several months and some suspected abusers were found guilty in criminal trials, the overall success of the child protection intervention was reduced by the limitations imposed by insufficient resources and lack of cooperation from the compound's residents.

Practice implications

Recommendations for community and child abuse pediatricians who may become involved in future large child-protection interventions are presented.     

Bridge over troubled water: using implementation science to facilitate effective services in child welfare

To maximize benefits to children and their families, effective practices need to be used competently in child welfare settings. Since the 1990s, researchers and policy makers have focused attention on empirically supported interventions (ESIs). Much less attention has been paid to what is needed to implement these in a range of real-world settings. Without proper implementation, which includes an evaluation strategy from feasibility to fidelity to on-going work on moderators and mediators of program effects, established effective programs can be rendered ineffective in practical application. The paper will touch on progress, to date, of implementation science, its application to child welfare programs and practices, and will highlight a set of practical strategies for implementing empirically supported interventions in child welfare.     

Factors associated with child protection recurrence in Australia

The aim of the current research was to advance understanding of child protection in Australia by examining the factors associated with recurrence of child protection notifications to the formal child protection system. Extant research has been primarily undertaken in the USA and it is important to understand whether similar factors associated with recurrence actually hold in the Australian context. Administrative data were obtained for a sample of 9608 children first subject to a screened-in report in 2011–12. Children were followed for 12 months. Cox Proportional Hazard models were used to measure associations between 26 independent variables and four types of recurrence: subsequent reports, subsequent investigations, subsequent substantiations, and subsequent intervention. Factors associated with recurrence in Australia were broadly similar to those identified in other jurisdictions, including reports and substantiation for neglect, younger age, prior child protection involvement in the household, and parental characteristics including drug use, mental health problems, and history of maltreatment as a child. As in previous studies, post-investigative service provision was positively associated with recurrence. In prior US research, race did not predict recurrence. However, in the present study, Indigenous Australian children were significantly more likely to be subject to all types of recurrence measured. Future research on recurrence should aim to disentangle the complex relationships between child protection recurrence, child maltreatment, and service delivery. Recurrence is not a good proxy indicator of child safety. The findings have implications for the equity of recurrence-based risk assessment tools as they are applied to indigenous populations.     

Impact of child labor on academic performance: Evidence from the program “Edúcame Primero Colombia”

In this study, the effects of different variables of child labor on academic performance are investigated. To this end, 3302 children participating in the child labor eradication program “Edúcame Primero Colombia” were interviewed. The interview format used for the children's enrollment into the program was a template from which socioeconomic conditions, academic performance, and child labor variables were evaluated. The academic performance factor was determined using the Analytic Hierarchy Process (AHP). The data were analyzed through a logistic regression model that took into account children who engaged in a type of labor (n = 921). The results showed that labor conditions, the number of weekly hours dedicated to work, and the presence of work scheduled in the morning negatively affected the academic performance of child laborers. These results show that the relationship between child labor and academic performance is based on the conflict between these two activities. These results do not indicate a linear and simple relationship associated with the recognition of the presence or absence of child labor. This study has implications for the formulation of policies, programs, and interventions for preventing, eradicating, and attenuating the negative effects of child labor on the social and educational development of children.     

Psychological maltreatment: maltreatment of the mind: a catalyst for advancing child protection toward proactive primary prevention and promotion of personal well-being

Objective

Child protection, as primarily applied toward narrow corrective intervention, has been judged to be inadequate in dealing with the wide variety of forms and levels of physical, psychological and sexual violence to which children are subjected throughout the world. Concern about this state of affairs has grown as a part of a global increase in commitments and expectations for nations and their societies to be accountable to and for children, particularly in association with the requirements of the UN Convention on the Rights of the Child. A reconstruction of child protection is needed.

Method

Recently, a child rights approach to child protection has been gathering support to drive a transformation of child protection toward primary prevention capable of securing and promoting the rights, safety, well-being, health and development of children. This vision has been given concrete form by the UN Committee on the Rights of the Child through its recently adopted guide (General Comment 13) to fulfilling national obligations to the right of the child to freedom from all forms of violence.

Results/Conclusions

Here, it is argued that the desired transformation of child protection can be greatly facilitated by appreciation and application of knowledge about the psychological domain, in particular, psychological maltreatment, by promotion of an enlightened public health approach, and by giving high priority to determining the origins of violence and to establishing widespread commitment to full development of the uniqueness of each person.     

A scoping review of evidence-based interventions available to parents of maltreated children ages 0-5 involved with child welfare services

Parents referred to child welfare services for child maltreatment often struggle against chronic risk factors including violence, substance abuse, mental health concerns, and poverty, which impinge upon their ability to be sensitive caregivers. The first line of intervention within the child welfare context is to modify parenting behavior. This scoping review comprehensively surveyed all available literature to map the extent and range of research activity around the types of interventions available within a child welfare context to parents of infants and toddlers (0–5 years of age), to identify the facilitators and/or barriers to the uptake of interventions, and to check that interventions match the risk factors faced by parents. This scoping review engaged in stringent screening of studies based upon inclusion/exclusion criteria. Sixty-five articles involving forty-two interventions met inclusion criteria. Interventions generally aimed to improve parenting practices, the relationship between parent and child, and/or attachment security, along with reducing child abuse and/or neglect. A notable finding of this scoping review is that at present, interventions for parents of children ages 0–5 involved with the child welfare system are most frequently measured via case study and quasi-experimental designs, with randomized control trials making up 26.2% of included study designs.     

Developing a template for National Child Protection Index Reports

Objectives

What impact does the strengthening of child rights have on the experience and circumstances of children? CRC General Comment 13 emphasizes that defining measurable targets for improvements in child protection is a key element of efforts to strengthen child rights and well-being across the world. This paper describes an attempt to identify key domains relevant to such mapping of child protection indicators, and the feasibility of collecting data—from existing data sources or otherwise—to complete a “National Child Protection Index Report” summarizing achievements and concerns at a national level.

Methods

A process of inter-agency consultation was facilitated by the CPC Learning Network to establish a template for the Index Report. The template was modeled on that used for the “Countdown to 2015” maternal, neonatal and child health initiative, aiming to capture indices not only of key protection risks but also implementation and coverage of key protection measures. The work drew on indicator development and policy initiatives by a number of international child protection agencies. The template developed was used as a basis to pilot national data collection in Indonesia and, at a sub-national level, in northern Uganda.

Findings

The template provides a concise summary of protection issues of relevance to a broad range of constituencies, global and national. However, in the pilot settings, existing routine data collection was inadequate to effectively populate a large proportion of indicators. Mechanisms of collating findings from discrete assessments—another potential source of data for completion of the index report—were also generally underdeveloped.

Practice implications

In settings where state infrastructure allows the collection and analysis of routine data in such domains as health and economic activity, such efforts should be extended to the child protection sector. Discrete assessments by governmental or non-governmental agencies also provide significant potential for more effective sharing and collation of information. National Child Protection sub-clusters or equivalent structures can play an important role in facilitating both of these processes.     

Non-adult child supervision practices in Lao People’s Democratic Republic

Researchers have paid little attention to non-adult child supervision and the prevalence and factors influencing this practice in low-income countries. A better understanding of this phenomenon is needed to inform the development and implementation of policies and interventions to enhance child supervision in those settings. This study explores the prevalence and factors associated with young children being home alone or under the care of another young child in Lao People’s Democratic Republic. Using the 2011–2012 Lao Social Indicator Survey (N = 10,740 for the subsample of ‘child was home alone’ and N = 10,539 for the subsample of ‘child cared by another child < 10 years of age’), multi-level Poisson regressions were performed to determine the number of days children under five years of age were home alone or under the care of another child younger than 10 years of age. Large discrepancies across provinces and between urban and rural populations within each province were found. Children living in rural areas were more than five times more likely to be unsupervised than children living in urban settings (incidence rate ratio, IRR 5.2; 95% CI: 1.8–15.2), and children living in rural areas were nearly twice more likely to be under the care of another child than children living in urban settings (IRR 1.9; 95% CI: 1.3–2.8). Age was also a common factor in explaining variation in both dependent variables. Policies aimed at facilitating adequate child care and supervision should consider rurality to increase children’s protection.     

Kindergarten child care experiences and child achievement and socioemotional skills

Young children's experiences outside of both home and school are important for their development. As women have entered the labor force, child care has become an increasingly important context for child development. Child care experiences prior to school entry have been well-documented as important influences on children's academic and socioemotional development. However, less is known about the importance of non-parental, out-of-school care for young school-age children's development. Using a nationally representative sample of kindergartners (n = 16,888), this study examined the relationship between child care experiences during the kindergarten year and children's academic and socioemotional skills. Given that the amount of time available for child care is by definition related to the type of kindergarten a child attends, differences in the relationship between child care and child development were explored separately by full- and part-day kindergarten. Results showed that across both types of kindergarten, more hours of center care during the kindergarten year were associated with small improvements in math test scores for all children. Any center child care during the kindergarten year was associated with increased problem behavior and decreased prosocial skills, even after accounting for a large number of confounding factors. Differences by family income and child gender were also investigated. Implications for policy and practice are discussed.     

Redrawing the line: An exploration of how lay people construct child neglect

While there has been an increasing professional and political focus on the prevalence and harmfulness of child neglect, little has been done to explore what child neglect means outside child protection circles. This qualitative study explores lay constructions of child neglect by thematically analyzing focus group discussions between 46 self-defined ‘lay’ people in England.Participants viewed neglect as extremely damaging for children and as arising when children’s physical, emotional, training and supervisory needs were unmet due to abnormal parental behavior. Children with unmet needs were positioned as deprived, unloved, uncontrolled and escaping. They were only positioned as neglected when failure to meet their needs was attributable to a lack of parental knowledge and skill (clueless parents), a lack of appropriate parental disposition (underinvested parents) or both (unsuitable parents). ‘Normal’ parents – those with the appropriate parental disposition, skills and knowledge – who failed to meet their children’s needs were not seen as neglectful but rather as overburdened.As ‘normal parenting’ has fragmented in late modernity, society wide consensus on child neglect was felt by participants to have retreated to child protection definitions, alienating lay understandings. If child neglect really is ‘everybody’s business’, then it is important that lay people are included in forging new definitions of and responses to meeting the needs of children.     

Child protection assessment in humanitarian emergencies: case studies from Georgia, Gaza, Haiti and Yemen

Objectives

The paper reviews the experiences of conducting child protection assessments across four humanitarian emergencies where violence and insecurity, directly or indirectly, posed a major threat to children. We seek to identify common themes emerging from these experiences and propose ways to guide the planning and implementation of assessments that effectively identify, and suggest means of response to, threats to children's rights and well-being in emergency settings.

Methods

In the context of a field evaluation of an inter-agency resource kit, crisis settings where an inter-agency assessment of child protection had been considered in the period August 2008 to July 2010 were identified. Email correspondence, telephone-based structured interviews and documentary review collated information from child protection coordinating agencies from a total of twenty sites, the minority of which had proceeded to complete an assessment. This paper presents case studies of the experience in Georgia (following the conflict between Russian and Georgian forces in August 2008), Gaza (following the Israeli military incursion beginning in December 2008), Haiti (following the earthquake of January 2010), and Yemen (following the ceasefire agreement between the government and rebel forces in early 2010).

Case study findings

In each setting the context of the humanitarian emergency is outlined. The processes of the planning (and, where appropriate, implementation) of the child protection assessment is described. Where available, the findings of the child protection assessment and their use in shaping interventions are summarized.

Practice implications

Case studies document experience across humanitarian settings widely divergent in terms of the nature of the emergency, social–political context, and institutional capacity. Despite such differences, analysis suggests securing inter-agency coordination, preparation and capacity building, and means of ensuring timeliness of findings to be recurrent themes in the effective mobilization of an effective assessment able to inform programming.     

Data surveillance in child protection systems development: an Indonesian case study

Objectives

Successful implementation of child protection program interventions and child and family welfare services is contingent upon the availability and use of good quality information, as emphasized by the recent Convention on the Rights of the Child's General Comment 13. Yet, the role of information within child protection is not well understood, and ongoing efforts to strengthen child protection systems have not systematically examined this critical function. Recognizing these shortcomings, the Government of Indonesia and UNICEF commissioned a study to identify a “road map” for a national child protection information system.

Methods

The used desk review, semi-structured interviews, focus groups and site visits to identify existing data collection practices, and analyze the appropriateness and efficiency of information management mechanisms from the national down to the community level.

Results

The results show that the prevailing situation in Indonesia is characterized by a lack of accurate information on all necessary aspects of child care and protection including magnitude of problems, causality analysis and impact of programmatic responses. There is no lead actor for child protection at the national level, and there are no agreed upon data collection priorities, procedures or methods for a shared data collection system.

Conclusion

The study suggests a need to reframe the dominant language from a “child protection information management system” to a “child protection surveillance system” to promote clearer data collection objectives and activities. Identifying a government ministry to lead child protection efforts and to forge closer partnerships among relevant actors will be required to support a national surveillance system. Additionally, addressing obstacles that limit child protection incident detection at the community level is critical. In addition to strengthening Indonesia's system, this study's approach and findings have the potential to help to inform ongoing child protection system development initiatives in other countries as well.     

The intergenerational impact of trauma and family violence on parents and their children

BackgroundChildren who experience Child Abuse and Neglect (CAN) are at an increased risk of becoming a victim of Intimate Partner Violence (IPV) or a perpetrator of IPV or CAN. Moreover, maltreated children are at risk for developing long-lasting trauma symptoms, which can subsequently affect their own children’s lives. Understanding the mechanisms of the intergenerational transmission of violence and trauma is a prerequisite for the development of interventions.ObjectiveWe examine whether the relation between historical CAN and current trauma symptoms of mothers is mediated by current IPV. Furthermore, we investigate whether current CAN mediates the relation between current maternal trauma symptoms and child Post-Traumatic Stress Disorder (PTSD) symptoms. These mechanisms are compared for mothers and fathers.ParticipantsWe have recruited 101 fathers and 360 mothers (426 children, 50% boys, mean age 7 years) through child protection services.MethodsRespondents completed questionnaires about IPV, (historical) CAN and trauma symptoms.ResultsStructural equation models revealed that historical CAN of father and mothers was related to trauma symptoms. Only for mothers, this association was mediated by IPV. Trauma symptoms of both fathers and mothers were related to child PTSD symptoms. This effect was not mediated by current CAN.ConclusionIn violent families, maternal and paternal trauma can be transmitted over generations. However, intergenerational transmission of violence is found for mothers only. When family violence is reported, professionals should take the violence into account, as well as the history of parents and trauma symptoms of all family members.     

Child abuse and neglect: Training needs of student teachers

Increasing awareness of child abuse and neglect (CAN) raises questions about how well teachers are prepared for their role in child protection. This paper assesses and differentiates training needs of first-year students (n = 216) in Northern Ireland. Multiple-choice tests were used to assess knowledge of CAN statistics; recognising and reporting; policies, procedures, and legislative frameworks; and direct work with children. Considerable gaps in knowledge were found. Results between student groups varied and provide evidence of the need to develop pre-service child protection training. The importance of differentiation between student groups in terms of training content is emphasised.     

Why are suspected cases of child maltreatment referred by educators so often unsubstantiated?

School professionals have a unique vantage point for identifying child maltreatment and they are a frequent source of referral to child protective services. Disturbingly, past studies have found that maltreatment concerns reported by educators go unsubstantiated by child protective services at much higher rates than suspected maltreatment reported by other professionals. This study explores whether there are systematic differences in the characteristics of cases reported by educators as compared to other professionals and examines whether such variation might account for differences in investigation outcome. Analyses were based on 7,725 cases of suspected maltreatment referred by professionals to child protective services from the Canadian Incidence Study of Reported Child Abuse and Neglect – 2003 a national database on the characteristics of children and families investigated by child protective services. School professionals were responsible for 35.8% of professional referrals. Reports by educators were much more likely to be unsubstantiated (45.3%) than those by other professionals (28.4%) in subsequent child protective investigation. Cases reported by educators were found to contain significantly more child risk factors (e.g., child emotional and behavioural problems) and fewer caregiver and family risk factors (e.g., caregiver mental health problem, single parent family) than cases reported by other professionals. Even controlling for these differences, educator-reported concerns were still 1.84, 95% CI [1.41, 2.40] times as likely to be unsubstantiated as reports from other professionals. Contrary to the notion that educators are mostly reporting non-severe cases, suspected/substantiated cases reported by school professionals were more likely to be judged as chronic and more likely to involve families with a previous child protection history. Results are concerning for the capacity of the education and child protection systems to work together to meet their shared goal of promoting healthy child development. Additional research is needed on the way in which child risks and problems influence child protective service, particularly in the context of chronic abuse and neglect and lack of availability of child and family mental health interventions. Potential problems with credibility of school professionals as reporters of child maltreatment concerns also warrant further investigation.     

The complexity of child protection recurrence: The case for a systems approach

ObjectiveResearch on child protection recurrence has found consistent child, family, and case characteristics associated with repeated involvement with the child protection system. Despite the considerable body of empirical research, knowledge about why recurrence occurs, and what can be done to reduce it, is limited.MethodThis paper reviews the empirical literature and analyses the approaches of prior recurrence research. Four related conceptual challenges are identified: (1) a tendency to conflate child protection recurrence with repeated child maltreatment; (2) uncertainty about how best to operationalize and measure child protection recurrence in research; (3) inconsistency between prevailing explanations for the most frequently observed patterns of recurrence; and (4) difficulty in developing coherent strategies to address child protection recurrence based on research.ResultsAddressing these challenges requires a greater consideration of the effects of decision-making in the child protection system on recurrence. This paper proposes a methodology based in systems theory and drawing on existing administrative data to examine the characteristics of the child protection system that may also produce recurrence.     

Predictors of substantiated re-reports in a sample of children with initial unsubstantiated reports

Many children with unsubstantiated reports of child abuse and neglect repeatedly return to the child protection system, indicating that unsubstantiated reports may represent actual child maltreatment or risk for future maltreatment. Identifying patterns of re-reporting and predictors that may be associated with later substantiated re-reporting could help to identify children who are very likely to be maltreated. This knowledge may guide the development of policies and interventions to prevent further maltreatment and the risk for re-reports. The aims of this study were to: (1) measure the period between the time of the initial reports that were not substantiated and the time of first substantiated re-reports; and (2) identify factors associated with the risk of later substantiated re-reporting. The study analyzed secondary data from the Longitudinal Studies on Child Abuse and Neglect (LONGSCAN) through survival analysis. Of the 378 children with initially unsubstantiated reports, 81% were re-reported, of which almost two-thirds were substantiated. Children who were younger, non-white, and had caregivers with more depressive symptoms were at increased risk of a substantiated re-report. Among those that were later substantiated, 20% were substantiated within one year. Findings suggest that targeted preventative services should be developed and provided for families who are reported for the first time, even if not substantiated.