Predictors of placement for children who initially remained in their homes after an investigation for abuse or neglect

Objective

To examine the frequency and predictors of out-of-home placement in a 30-month follow-up for a nationally representative sample of children investigated for a report of maltreatment who remained in their homes following the index child welfare report.

Methods

Data came from the National Survey of Child and Adolescent Well-being (NSCAW), a 3-year longitudinal study of 5,501 youth 0-14 years old referred to child welfare agencies for potential maltreatment between 10/1999 and 12/2000. These analyses focused on the children who had not been placed out-of-home at the baseline interview and examined child, family and case characteristics as predictors of subsequent out-of-home placement. Weighted logistic regression models were used to determine which baseline characteristics were related to out-of-home placement in the follow-up.

Results

For the total study sample, predictors of placement in the 30-month follow-up period included elevated Conflict Tactics Scale scores, prior history of child welfare involvement, high family risk scores and caseworkers’ assessment of likelihood of re-report without receipt of services. Higher family income was protective. For children without any prior child welfare history (incident cases), younger children, low family income and a high family risk score were strongly related to subsequent placement but receipt of services and case workers’ assessments were not.

Conclusions/practice implications

Family risk variables are strongly related to out-of-home placement in a 30-month follow-up, but receipt of child welfare services is not related to further placements. Considering family risk factors and income, 25% of the children who lived in poor families, with high family risk scores, were subsequently placed out-of-home, even among children in families who received child welfare services. Given that relevant evidence-based interventions are available for these families, more widespread tests of their use should be explored to understand whether their use could make a substantial difference in the lives of vulnerable children.     

Evaluation of second step child protection videos: A randomized controlled trial

This randomized controlled trial (RCT) examined the effects of the Second Step Child Protection Unit videos on parents’ knowledge, motivation, and self-reported communication with their child about personal safety and childhood sexual abuse prevention. Parents of children between the ages of 3–11 years were randomly assigned to the intervention (watching the Second Step videos) or the control (watching videos on child obesity) groups. They completed measures assessing their knowledge of child sexual abuse (CSA), motivation to discuss CSA, self-reported discussions of CSA, child history of victimization, parent exposure to CSA, and comparable measures on topics of health and nutrition at pre-test. Participants viewed the videos one week later and immediately completed post-test 1, and then two months later completed the measures again. Multivariate Analyses of Covariance (MANCOVAs) and serial mediation analyses were conducted with the final sample of 438. The intervention group, compared to the control group, had significant increases in knowledge (specifically, less restrictive stereotype beliefs about CSA) and motivation to talk with their children about CSA both immediately after the intervention and at the two-month follow-up. Although the intervention did not have a direct effect on parent self-reported conversations with their children about CSA, it had a mediated effect. The intervention increased knowledge regarding CSA, which then predicted motivation, which in turn predicted conversations. The most pronounced effect was the intervention’s direct effect of increasing motivation immediately after the intervention, which then increased self-reported conversations with children about personal safety and CSA two months later.     

A treatment and education program for parents and children who are at-risk of abuse and neglect

A treatment program for families at-risk of abusive or neglectful parenting was described and evaluated. The program combined intervention strategies and concepts based on research on abuse, early intervention, education and social service. Treatment and education for the parent and child were provided in the three services of the program: Home-Based, Family School, and Neighborhood Peer Support Groups. At-risk families were identified by a high-risk stress index. Program evaluation was based on 46 families and their 74 preschool-age children. Data collected were: incidence of child abuse or neglect, family stresses, observations of parent-child interactions, family goal measurement, and developmental testing of the children. A significant reduction occurred in the number of children abused or neglected as compared to a similar high-risk, nonintervention sample. The family stresses were reduced, parent-child interactions improved, and the intellectual decline of the children was prevented. Families who participated in all three services gained the most from the program.     

Early identification and intervention for children with initial signs of reading deficits - A blinded randomized controlled trial

Early identification of reading disorder (RD) can prevent a “wait-to-fail” situation and can increase the efficacy of subsequent interventions. In this study we identified children in the middle of first grade of German elementary schools who were at risk for RD and evaluated a subsequent phonics intervention. We assessed 234 children and randomly allocated those performing below the 30^th percentile in a short standardized reading speed test to a six-week phonics (n = 29) or blinded motor control intervention (n = 26). Both interventions were implemented at school three times a week in small groups. Results showed that the first graders who had received the phonics instruction improved significantly in reading ability compared to the control group. Moreover, significantly more children in the control group exhibited RD than in the phonics group. This study provides the basis for developing school-based early identification and intervention programmes to remediate reading deficits and prevent RD.     

Effectiveness of specific factors in community-based intervention for child-witnesses of interparental violence: A randomized trial

A community-based intervention with specific factors for children and parents exposed to interparental violence (IPV) was compared with a control intervention based on non-specific factors. We hypothesized that participation in an intervention with specific factors, focused on IPV, parenting and coping, would be associated with better recovery. IPV exposed children and parents were group randomized over a specific factors- and control intervention. Baseline, posttest and follow-up measurements of 155 parents and children (aged 6–12 years, 55.5% boys) were fitted in a multilevel model. Outcomes were parent and teacher reported children's internalizing and externalizing problems (CBCL, TRF), child self-reported depressive symptoms (CDI) and parent and child reported children's post-traumatic stress symptoms (TSCYC, TSCC). Based on intention-to-treat and completer analyses, children in the specific factors intervention did not show better recovery than children in the control intervention. Children in both interventions decreased significantly in parent-reported children's internalizing and externalizing problems and post-traumatic stress symptoms. Children reported a decrease in their mean level of depressive and post-traumatic stress symptoms. Teachers reported a decrease in internalizing problems, but not in externalizing problems. No association between time since exposure and level and course of symptoms was found. Treatment differentiation was assessed and both programs were significantly different on hypothesized effective factors. Higher treatment adherence in both programs did not result in a larger difference in recovery. IPV exposed children improve over the course and after participating in a community-based child- and parent program, but specific factors in intervention may not carry additional benefits when implemented in community settings.     

Oral health-related quality of life in Brazilian child abuse victims: A comparative study

This study aims to assess and compare Oral Health-Related Quality of Life (OHRQoL) in child abuse victims and non-abused children in a Southern Brazilian city. The study compared two independent samples of children aged 8–10 years: 48 child abuse victims recruited from a centre for Child and Adolescent Psychological Support (NACA) for abused children, and 144 public and private school students. Data collection consisted of administration of the Child Perceptions Questionnaire 8–10 (CPQ_8-10) to measure OHRQoL (dependent variable), clinical examination (dental caries), and collection of socioeconomic and demographic information (age, sex, skin colour, family income, and type of school). Multiple linear regression models were used to assess the association between presence of abuse and OHRQoL and subscales. After adjustment for clinical and sociodemographic variables, child abuse victims were found to exhibit higher CPQ scores on the overall scale and on the oral symptoms and functional limitations subscales. In conclusion, child abuse victims have a higher impact on OHRQoL. Based on the results, it is possible to suggest that greater care should be taken of these children, not only in providing treatment for oral disorders, but also in providing interdisciplinary care.     

Exposure to violence,typology, and recidivism in a probation sample of domestic violence perpetrators

The present study investigated the predictive utility of self-reported domestic violence perpetrators’ exposure to violence in their family of origin and patterns related to this exposure through the use of longitudinal analyses on a sample of 228 men on probation in Lake County, Illinois. Differences in typology, recidivism, recidivism frequency, and violent behavior survival patterns in men with a history of domestic violence perpetration and with varying levels of family of origin violence exposure were examined. Findings suggest that those who witnessed interparental violence (either alone, or in combination with experiencing violence) were most likely to be classified as Generally Violent offenders (e.g., perpetrators who direct violence toward their family and others), compared to those who did not report experiencing or witnessing violence. In addition, results also indicate that men who experienced both witnessing interparental violence and receiving physical abuse in childhood were more likely to recidivate more frequently compared to those who did not report experiencing or witnessing violence. No significant findings for typology and recidivism were noted. Clinical and policy/practice implications are discussed.     

Child sexual abuse: A study of prevalence in Great Britain

Of 2019 men and women (aged 15 years and over) interviewed as part of a MORI Survey of a nationally representative sample of Great Britain, 10% reported that they had been sexually abused before the age of 16 (12% of females; 8% of males). There was no increased risk associated with specific social class categories or area of residence. For all types of sexual abuse, the mean age of victims when first abused was significantly lower for females. Subjective reports of the effects of sexual abuse indicated that the majority (51%) felt harmed by the experience, while only 4% reported that it had improved the quality of their life. We estimate that there are over 4.5 million adults in Great Britain who were sexually abused as children, and that a potential 1,117,000 children will be sexually abused before they are 15 years of age. At least 143,000 of these will be abused within the family. The social and mental health implications are enormous, and the authors suggest that an effective intervention and prevention policy is urgently required.     

A life course perspective of victimization,child welfare involvement,cumulative stress and mental health for mothers on probation and parole

Women involved in the criminal justice system experience multiple forms of adversity over their lifetimes. These events may include childhood abuse, involvement in the child welfare system as children, intimate partner violence victimization during adulthood, and punitive interactions with the child welfare system as mothers. Community supervision (e.g. probation or parole) entails particular stressors, such as obtaining basic needs and employment. A majority of women under community supervision also experience depression and anxiety. The current study used the Stress Process Model to investigate associations between childhood and adulthood stressors (including childhood abuse, intimate partner violence and child welfare system involvement), recent stressful life events, and symptoms of depression and anxiety for mothers (n = 348) on probation and parole. All of the mothers had experienced some form of childhood and/or adulthood victimization. Structural equation modeling was conducted to examine how childhood abuse, adulthood victimization, and child welfare system involvement as a child and a mother were associated with recent stressful life events and symptoms of depression and anxiety. Results indicated multiple direct and indirect relationships from childhood and adulthood stressors to mental health symptoms as women navigated probation and parole. For example, adverse childhood experiences were associated with elevated anxiety and depression symptoms via higher levels of recent stressful life events and adverse adulthood experiences. These findings highlight relationships between childhood abuse and adulthood factors and the mental health of mothers involved in the criminal justice system, with implications for theory, practice, and research.     

A small-scale randomized efficacy trial of Carescapes: Enhancing children’s social development in child care homes

The quality of the child care environment and caregiver practices can potentially have significant, lasting impact on children’s social development. This study involves the development and a small-scale efficacy trial of the Carescapes program, a video-based training program that focuses on promoting positive social development in young children attending family child care. Fifty-seven caregivers who provided child care in their homes were randomly assigned to immediate intervention or waitlist control groups. Random coefficients analyses showed significant increased use of effective behavior management practices and decreased overall children’s problem behavior for the intervention group. A mediation model demonstrated that increases in effective behavior management practices were associated with decreases in problem behavior. A medium intervention effect was found for caregiver’s monitoring and a small effect for use of positive attention. These effects declined 5 months following the intervention. Implications for future efficacy and effectiveness studies in family child care settings that involve strategies to facilitate maintenance are discussed.     

A cross-cultural examination of use of corporal punishment on children: a focus on Sweden and the United States

It appears that Sweden and the United States may be a study in contrasts regarding the sanction and use of corporal punishment on children. A 1979 study of American parents noted that 81% of them employed corporal punishment with children. A different study done in Sweden in 1978 noted that only 26% of parents used corporal punishment with children. What points to the differences in these parenting patterns within the two countries? In addition, a 1977 U.S. Supreme Court case entitled Ingraham vs. Wright ruled that “schools are empowered to carry out corporal punishment.” This court case involved two high school boys in Florida who had been repeatedly struck with wooden paddles. In contrast, Sweden had statutes which prohibited corporal punishment of children in their secondary schools as early as the 1920s. In 1957, the country passed a law which defined corporal punishment as unacceptable for small children in the schools. Then, in 1979, the Swedish government passed a statute prohibiting corporal punishment by parents. Are there differences in the way the two countries view law and its uses? Or, do the cultures sanction violence in general or just violence against children in different ways? This article examines some of the similarities and differences found in American and Swedish treatment of children and proposes what appear to be extreme differences in the way the countries and their people approach corporal punishment.     

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.     

A randomized controlled trial of a home-visiting intervention aimed at preventing relationship problems in depressed mothers and their infants

This study examined the effect of a mother–baby intervention on the quality of mother–child interaction, infant–mother attachment security, and infant socioemotional functioning in a group of depressed mothers with infants aged 1–12 months. A randomized controlled trial compared an experimental group ( n = 35) receiving the intervention (8–10 home visits) with a control group ( n = 36) receiving parenting support by telephone. There were assessments pre, post, and follow-up after 6 months. The intervention had positive effects on the quality of mother–infant interaction. Infants in the experimental group had higher scores for attachment security and for one aspect of socioemotional functioning, namely, competence. The intervention proved successful in preventing deterioration of the quality of mother–child interaction.     

Parenting intervention effects on reunification: A randomized trial of PMTO in foster care

Evidence-supported parenting interventions (ESPIs) have expanded into child welfare because a growing research base has demonstrated positive results among children with serious emotional and behavioral problems. Despite a clear federal policy emphasis on reunification, few randomized trials have tested ESPIs with biological families of children in foster care; even fewer studies have investigated the distal outcomes of ESPIs. The aim of the current study was to examine the effects of Parent Management Training, Oregon (PMTO) model on reunification. Children in foster care with emotional and behavioral problems were randomized to in-home PMTO (n = 461) or services as usual (SAU) (n = 457). Cox regression models tested whether children in the PMTO group achieved higher rates of reunification. We applied life tables data for integrals calculations to estimate days saved in foster care. Analyses were conducted as intent-to-treat (ITT), and per protocol analysis (PPA). ITT results showed reunification rates were 6.9% higher for the PMTO group (62.7%) than the SAU group (55.8%) with 151 days saved per typical child. PPA indicated that intervention completion strengthened effects as PMTO completers’ reunification rates (69.5%) were 13.7% higher than the SAU group (55.8%), and were 15.3% higher than non-completers (54.2%). Days saved were also greater for completers as compared to the SAU group (299 days) and non-completers (358 days). Overall, findings suggest that an in-home parenting intervention positively affected reunification as delivered to biological parents of children and youth in foster care with serious emotional and behavioral problems. Implications and future considerations for 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.     

Effects of a classroom management intervention on student selective attention: results from a randomized controlled trial

ABSTRACT

A main objective of classroom management (CM) is to raise students’ attention to their daily academic work by creating a classroom environment that supports academic and socioemotional learning. While studies have addressed CM effects on classroom-level behaviour or students’ academic outcomes, students’ attention skills been largely overlooked. This randomized controlled trial evaluates the effectiveness of a teacher-targeted CM intervention on students’ selective attention. Twenty-four primary schools were randomized into receiving the Inclusive And Appreciative Classroom Management (IACM) intervention (treatment) or a general information technology (IT) didactics course (control condition). All participating 1st-grade teachers and their students (N = 1,160) were followed for 1 year. Using repeated measurements of the d2 Test of Attention, we find that the IACM intervention improves students’ selective attention with .26 standard deviations. The effect is robust to the inclusion of student- and classroom-level characteristics. All analyses account for the variation across students, classrooms, and schools.     

Randomized controlled trial of a parenting program to reduce the risk of child maltreatment in South Africa

Parenting programs in high-income countries have been shown to reduce the risk of child maltreatment. However, there is limited evidence of their effectiveness in low- and middle-income countries. The objective of this study was to examine the initial effects of a parenting program in reducing the risk of child maltreatment in highly-deprived and vulnerable communities in Cape Town, South Africa. Low-income parents (N = 68) with children aged three to eight years were randomly assigned to either a group-based parenting program or a wait-list control group. Observational and parent-report assessments were taken at baseline and at immediate post-test after the intervention was delivered. Primary outcomes were parent-report and observational assessments of harsh parenting, positive parenting, and child behavior problems. Secondary outcomes were parent-report assessments of parental depression, parenting stress, and social support. Results indicated moderate treatment effects for increased frequency of parent-report of positive parenting (d = 0.63) and observational assessments of parent-child play (d = 0.57). Observational assessments also found moderate negative treatment effects for less frequent positive child behavior (d = −0.56). This study is the first randomized controlled trial design to rigorously test the effectiveness of a parenting program on reducing the risk of child maltreatment in sub-Saharan Africa using both observational and self-report assessments. Results provide preliminary evidence of effectiveness of reducing the risk of child maltreatment by improving positive parenting behavior. Further development is required to strengthen program components regarding child behavior management and nonviolent discipline strategies. Future research would benefit from a larger trial with sufficient power to determine program effectiveness.     

Feasibility study of the calm baby gently program: An educational baby book intervention on safe practices related to infant crying

BackgroundAbusive head trauma (AHT) is a preventable form of child abuse.ObjectiveThis project used a mixed method design to assess the feasibility of the Calm Baby Gently educational baby book intervention for promoting safe practices related to infant crying in an effort to prevent AHT.Participants and settingThree pediatric practices participated between June 2016 and January 2018, including 1045 caregivers who attended their infant’s 2-month well-child visit.MethodsPediatric providers gave the educational baby book to caregivers at the 1-month well-child visit. Caregivers completed a survey at the 2-month well-child visit on their use and satisfaction with the book and responses to infant crying. Thematic analysis of qualitative feedback was performed. Responses to infant crying were compared quantitatively between caregivers who had and had not read the book.ResultsOf the 819 caregivers (78%) who received the book, 92% (754) read it, and 51% (421) had another caregiver read it. Caregivers considered the book approachable, understandable, validating, and helpful for improving knowledge and skills related to infant crying. The book was rated more helpful by caregivers of younger age, male gender, and non-white race. Controlling for age, gender, and race, caregivers who read the book were more confident (p = 0.033) and had more knowledge on how to respond appropriately to infant crying (p = 0.019) than caregivers who had not read it.ConclusionsCalm Baby Gently is a feasible and well-received AHT prevention program. Randomized controlled trials are needed to better understand its impact on knowledge, behavior, and AHT rates.     

Homelessness in the child welfare system: A randomized controlled trial to assess the impact of housing subsidies on foster care placements and costs

Inadequate housing and homelessness among families represent a substantial challenge for child and adolescent well-being. Child welfare services confront housing that threatens placement into foster care with little resources and evidence to guide practice. The present study provides the first rigorous test of the Family Unification Program (FUP) – a federal program that offers housing subsidies for inadequately housed families under investigation for child maltreatment. A randomized controlled trial assesses program impact on foster care placement and costs.The experiment referred intact child welfare-involved families whose inadequate housing threatened foster placement in Chicago, IL to FUP plus housing advocacy (n = 89 families with 257 children) or housing advocacy alone (n = 89 families with 257 children). Families were referred from 2011 to 2013, and administrative data recorded dates and costs of foster placements over a 3-year follow-up. Intent-to-treat analyses suggested families randomly assigned for FUP exhibited slower increases in rates of foster placement following housing intervention compared with families referred for housing advocacy alone. The program generates average savings of nearly $500 per family per year to the foster care system. Housing subsidies provide the foster care system small but significant benefits for keeping homeless families together. Findings inform the design of a coordinated child welfare response to housing insecurity.     

Behavioral and musical characteristics of the children who are exposed to child maltreatment and poverty in South Korea: A survey

A preliminary survey was conducted on primary school aged children (N = 302) between seven to twelve years of age, who attend the local Community Child Centers (CCC) in the economically deprived areas of Jeollabukdo in South Korea for the purpose of identifying the children who have been exposed to on-going child maltreatment and poverty, and their needs. Both standardized and non-standardized self-report types of surveys were carried out and completed by both the children and the teachers of the CCC. As would be expected, emotional and behavioral problems are more pronounced by the children who are exposed to child maltreatment and poverty compared to the children who were not exposed to these adversities, or who were not poor. The more severely abused children in terms of frequency and co-occurrence of different abuses appear to display more behavioral problems than less severely abused children. Teachers reported that the children who were able to play a musical instrument and had arts therapy experiences appear to have less behavioral problems, particularly delinquent and aggressive behavior in comparison to the children who did not have such ability and experiences. Through the survey, it was possible to identify the children in need of therapeutic intervention and discover clinically relevant information. Clinical implications will be discussed further.