Fatal child maltreatment in England, 2005-2009

Objective

This paper presents comprehensive and up-to-date data covering 4 years of Serious Case Reviews into fatal child maltreatment in England.

Methods

Information on all notified cases of fatal maltreatment between April 2005 and March 2009 was examined to obtain case characteristics related to a systemic classification of 5 broad groups of maltreatment deaths (severe physical assaults; covert homicide/infanticide; overt homicide; extreme neglect/deprivational abuse; deaths related to but not directly caused by maltreatment).

Results

A total of 276 cases were recorded giving an incidence of 0.63 cases per 100,000 children (0-17) per year. 246 cases could be classified based on the data available. Of these the commonest specific group was those children who died as a result of severe physical assaults. Apparently deliberate overt and covert homicide was less common, while deaths as a direct consequence of neglect were rare. In contrast, some evidence of neglect was found in at least 40% of all cases, though not the direct cause of death.

Conclusions

Class characteristics differ between the different categories of death and may suggest the need for different strategies for prevention.     

Community interaction and child maltreatment

The way in which parents interact with their environment may have implications for their likelihood of abuse and neglect. This study examines the parent–environment relationship through community involvement and perception, using social disorganization theory. We hypothesize mothers who participate in their communities and have positive perceptions of them may be less likely to maltreat their children because of the potential protective capacity of neighborhood supports. Using information from the 5 year Fragile Families and Child Wellbeing Study (n = 2991), the mother's self-reported acts of psychological and physical maltreatment and neglect are measured. A mother's community involvement index is the number of community activities a mother was involved in, and community perception is measured by two five-item Likert scales assessing perception of community collective efficacy. We analyze the relationship between community variables and each of mother's maltreatment behaviors as well as the interaction between community factors using a series of nested logistic regressions. Higher levels of community involvement are associated with lower levels of psychological aggression. More positive perception of community social control is associated with lower levels of physical assault. A moderation effect of community perception suggests that a mother's perception of her community changes the relationship between community involvement and psychological child abuse. The results provide important policy and empirical implications to build positive and supportive communities as a protective factor in child maltreatment. Getting parents involved in their communities can improve the environment in which children and families develop, and decrease the likelihood that maltreatment will occur.     

The intergenerational transmission of child maltreatment: A three-level meta-analysis

A parental history of experiencing child maltreatment is an important risk factor in several etiological theories of child maltreatment. In the past, two reviews have been conducted on the available evidence for intergenerational continuity in child maltreatment, but were only qualitative in nature. Therefore, the present review aimed to provide a quantitative summary of the current knowledge on intergenerational transmission of child maltreatment. In our 3-level random-effects meta-analysis, we included 84 studies reporting on 285 effect sizes and found a medium summary effect of r = 0.289; 95% CI [0.257, 0.337], with significant variation in effect sizes within (level 2) and between (level 3) studies. This implies that in families of parents who experienced maltreatment in their own childhood, the odds of child maltreatment are almost three times the odds of child maltreatment in families of parents without a history of experiencing child maltreatment (OR = 2.990). However, as indications for bias were found, caution is warranted in interpreting this effect. Moderator analyses revealed that the effect of intergenerational transmission was the smallest in children who experienced physical abuse. Further, study quality was negatively associated with effect size magnitude. We highlight the need for an improvement in quality of primary research, and discuss implications of our findings for clinical practice.     

Identifying children at high risk for a child maltreatment report

Objective

To help professionals identify factors that place families at risk for future child maltreatment, to facilitate necessary services and to potentially help prevent abuse and neglect.

Method

The data are from a prospective, longitudinal study of 332 low-income families recruited from urban pediatric primary care clinics, followed for over 10 years, until the children were approximately 12 years old. Children with prior child protective services involvement (CPS) were excluded. The initial assessment included sociodemographic, child, parent and family level variables. Child maltreatment was assessed via CPS reports. Risk ratios (RRs) and their 95% confidence intervals (CIs) were estimated using Cox regression models.

Results

Of the 224 children without a prior CPS report and with complete data who were followed for an average of 10 years, 97 (43%) later had a CPS report. In a multivariate survival analysis, 5 risk factors predicted CPS reports: child's low performance on a standardized developmental assessment (RR = 1.23, 95% CI = 1.01-1.49, p = .04), maternal education ≤ high school (RR = 1.55, CI = 1.01-2.38, p = .04), maternal drug use (RR = 1.71, CI = 1.01-2.90, p < .05), maternal depressive symptoms (RR per one standard deviation higher score = 1.28, CI = 1.09-1.51, p < .01), and more children in the family (RR per additional child = 1.26, CI = 1.07-1.47, p < .01).

Conclusions

Five risk factors were associated with an increased risk for later maltreatment. Child health care and other professionals can identify these risk factors and facilitate necessary services to strengthen families, support parents and potentially help prevent child maltreatment.     

Experience by children and adolescents of more than one type of maltreatment: Association of different classes of maltreatment profiles with clinical outcome variables

Most victims of child abuse have experienced more than one type of maltreatment, yet there is a lack of understanding of the impact of specific combinations of types of maltreatment. This study aimed to identify meaningful classes of maltreatment profiles and to associate them with short-term clinical outcomes. A total of 358 German children and adolescents aged 4–17 with a known history of child maltreatment were included in the study. Through interviews and questionnaires, information was obtained from participants and their primary caregivers on history of maltreatment, sociodemographics, psychopathology, level of psychosocial functioning, and health-related quality of life. Types of abuse were categorized into six major groups: sexual abuse in general, sexual abuse with penetration, physical abuse, emotional abuse, neglect, and exposure to domestic violence. A latent class analysis (LCA) was performed to determine distinct multi-type maltreatment profiles, which were then assessed for their associations with the sociodemographic and clinical outcome variables. The LCA revealed that participants could be categorized into three meaningful classes according to history of maltreatment: (1) experience of multiple types of maltreatment excluding sexual abuse (63.1%), (2) experience of multiple types of maltreatment including sexual abuse (26.5%), and (3) experience of predominantly sexual abuse (10.3%). Members of Class 2 showed significantly worse short-term outcomes on psychopathology, level of functioning, and quality of life compared to the other classes. Three distinct profiles of multiple types of maltreatment were empirically identified in this sample. Exposure to multiple types of abuse was associated with poorer outcomes.     

How neighborhoods influence child maltreatment: a review of the literature and alternative pathways

OBJECTIVE: To review the literature on the relationships between neighborhoods and child maltreatment and identify future directions for research in this area. METHOD: A search of electronic databases and a survey of experts yielded a list of 25 studies on the influence of geographically defined neighborhoods on child maltreatment. These studies were then critically reviewed by an interdisciplinary research team. RESULTS: Numerous studies demonstrate that child maltreatment cases are concentrated in disadvantaged areas. A number of socio-economic characteristics of neighborhoods have been shown to correlate with child maltreatment rates as measured by official reports to child protective service agencies. Only a few studies examine direct measures of parenting behaviors associated with maltreatment, and these show a weaker relationship with neighborhood disadvantage. Moreover, the processes that link neighborhood conditions to either maltreatment reports or parenting behaviors are not yet confirmed by the research literature. Selection bias, neighborhood definitions and spatial influences are largely uncontrolled in the existing research. CONCLUSIONS: We propose a framework for pursuing further study of neighborhoods and child maltreatment that addresses the gaps in the current literature. Neighborhood-based strategies to prevent and reduce child maltreatment will be enhanced by research that provides a better understanding of how neighborhood conditions act as stressors or supports for families at risk of child maltreatment.     

The prevalence of child maltreatment in the Netherlands across a 5-year period

The prevalence of child maltreatment in the Netherlands was in 2005 first systematically examined in the Netherlands’ Prevalence study on Maltreatment of children and youth (NPM-2005), using sentinel reports and substantiated CPS cases, and in the Pupils on Abuse study (PoA-2005), using high school students’ self-report. In this second National Prevalence study on Maltreatment (NPM-2010), we used the same three methods to examine the prevalence of child maltreatment in 2010, enabling a cross-time comparison of the prevalence of child maltreatment in the Netherlands. First, 1,127 professionals from various occupational branches (sentinels) reported each child for whom they suspected child maltreatment during a period of three months. Second, we included 22,661 substantiated cases reported in 2010 to the Dutch Child Protective Services. Third, 1,920 high school students aged 12–17 years filled out a questionnaire on their experiences of maltreatment in 2010. The overall prevalence of child maltreatment in the Netherlands in 2010 was 33.8 per 1,000 children based on the combined sentinel and CPS reports and 99.4 per 1,000 adolescents based on self-report. Major risk factors for child maltreatment were parental low education, immigrant status, unemployment, and single parenthood. We found a large increase in CPS-reports, whereas prevalence rates based on sentinel and self-report did not change between 2005 and 2010. Based on these findings a likely conclusion is that the actual number of maltreated children has not increased from 2005 to 2010, but that professionals have become more aware of child maltreatment, and more likely to report cases to CPS.     

Emotion dysregulation as a mechanism linking child maltreatment exposure and self-harm behaviors in adolescents

Although child maltreatment exposure is a recognized risk factor for self-harm, mechanisms underlying this relationship remain unclear. Self-harm may function as a compensatory strategy to regulate distressing emotions. This cross-sectional study examines if emotion dysregulation mediates between the severity of maltreatment exposure and self-harm, adjusting for demographic variables and depressive symptoms. Participants were 108 adolescent patients recruited from a psychiatric hospital in Singapore (mean age 17.0 years, SD = 1.65; 59.3% female). Study measures included the Childhood Trauma Questionnaire (CTQ-SF), Functional Assessment of Self-Mutilation (FASM), Difficulties in Emotion Regulation Scale (DERS), and the Patient Health Questionnaire (PHQ-8). Path analysis was conducted to examine the direct and indirect effects of maltreatment exposure on self-harm via emotion dysregulation, controlling for demographic variables and depressive symptoms. Indirect effects were tested using bootstrapped confidence intervals (CI). Results showed that self-harm was highly prevalent in our sample (75.9%). Emotion dysregulation and depressive symptoms were found to be associated with higher self-harm frequency. In addition, results from path analysis showed that the association between the severity of maltreatment exposure and self-harm frequency was significantly mediated by emotion dysregulation B = 0.07, p < 0.05, 95% CI [0.02, 0.16]. Thus, emotion dysregulation may be a proximal mechanism linking maltreatment exposure and adolescent self-harm. Notably, self-harm may represent maladaptive attempts to manage emotion dysregulation that may have resulted from maltreatment. Findings from the study have implications for the prevention and treatment of self-harm in maltreated youth.     

Changes in the prevalence of child maltreatment in Vietnam over 10 years

ObjectivesIn the context of the shortage of studies on child maltreatment changes over time in limited resource settings, this paper explored the changes in the prevalence of multiple types of child maltreatment over a period of 10 years in Vietnam and tested the moderating role of some demographic characteristics in these changes.MethodsWe used data from two prevalence studies conducted in 2004 and in 2014 using similar methodologies. Both studies used self-report questionnaires which were completed by randomly selected students aged 12–17 years from different provinces in Vietnam. We also compared Hanoi subgroups to examine the trend using the most equivalent samples.ResultsWhile the prevalence estimates of sexual abuse and neglect were unchanged over 10 years, the prevalence of physical abuse and emotional abuse declined. The decrease in the prevalence of physical abuse was larger for younger adolescents and boys than for their counterparts. For sexual abuse, older adolescents reported an increase in the prevalence of sexual abuse. In the Hanoi sample comparison, only the prevalence of emotional abuse declined and this reduction was smaller for younger adolescents than for the older group.ConclusionDespite the reduction of emotional and physical abuse in the whole sample and emotional abuse in the Hanoi sample, all types of child maltreatment were still highly prevalent in Vietnam. We argue that interventions on all types of child maltreatment should be further implemented. Similar studies could be conducted to evaluate the effect of child protection policies on the prevalence of child maltreatment.     

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.     

Perinatal mental health and risk of child maltreatment: A systematic review and meta-analysis

BackgroundMental health problems in parents have been identified as a risk factor for child maltreatment. The perinatal period (from conception to 1 year) is a critical period but it is unclear whether perinatal mental health problems are also associated with increased risk.ObjectiveTo review evidence on perinatal mental health and risk of child maltreatment.MethodsSearches were conducted on six databases and 24 studies reported in 30 papers identified. Studies were conducted in seven countries, mainly the USA (n = 14). Sample sizes ranged from 48-14,893 and most examined mothers (n = 17). Studies were conducted in community (n = 17) or high-risk (n = 7) samples.ResultsThe majority of studies found a relationship between parental perinatal mental health problems and risk of child maltreatment, but inconsistent findings were observed between and within studies. The few studies that examined fathers (n = 6) all found a relationship between fathers’ mental health and risk of child maltreatment. Meta-analysis of 17 studies (n = 22,042) showed perinatal mental health problems increased risk of child maltreatment by OR 3.04 (95% CI 2.29–4.03). This relationship was moderated by type of sample, with larger effects for risk of child maltreatment in high-risk samples. The relationship was not moderated by type of mental illness, child maltreatment; methodological or measurement factors.ConclusionThe association between perinatal mental health and risk of child maltreatment is similar to that observed at other times during childhood. Methodological heterogeneity and inconsistent findings mean conclusions are tentative and need to be considered alongside other individual, family and social/cultural risk factors.     

Evidence for a relationship between child maltreatment and absenteeism among high-school students in Sweden

School absenteeism is a potent predictor of academic failure. Maltreated adolescents have been found to be more absent from school compared to their peers. However, it is scarcely studied in what degree a general population of students with high levels of school absenteeism has been exposed to child maltreatment. Furthermore, it is not known if maltreated school-absentees have specific characteristics compared to not-maltreated absentees. In this article, the first objective was to present and compare the prevalence of six types of child maltreatment in a general population of high school students reporting no, moderate or excessive absenteeism. The second objective was to compare maltreated and not-maltreated students who report absenteeism in respect to mental health, perceived school environment and peer victimization in school. Data from 667 girls and 649 boys (mean age 14.3) was used from the longitudinal multidisciplinary research program LoRDIA (Longitudinal Research on Development In Adolescence). Data was collected via self-report questionnaires in classroom settings. All six types of child maltreatment were overrepresented among absentees. Roughly 25% of absentees reported one subtype of maltreatment (16% in the total population) and a mean of 22% of absentees reported two or more types of maltreatment (11% in the total population). Maltreated absentees reported more mental health problems, personal harassment and worse relationship with their teachers than not-maltreated absentees. There might be specific correlates of school absenteeism among maltreated adolescents and professionals involved in preventing school-absenteeism should be made aware of the relationship between maltreatment and absenteeism.     

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.     

Media portrayal of a hidden problem: An analysis of Hong Kong newspaper coverage of child maltreatment in 2016

The news media plays a vital role in providing child protection information and resources, shaping the public’s understanding and perceptions of child maltreatment, and exposing system failures and setting policy agendas. To date, little is known about how child maltreatment is portrayed in the media in societies where these issues remain largely hidden and under-recognized. The purpose of the present study was to systematically examine newspaper coverage on child abuse and neglect in Hong Kong in order to assess how child maltreatment is currently presented and framed within public discourse.A total of 579 newspaper reports relevant to child maltreatment from four local newspapers in 2016 were reviewed. Similar to prior findings, cases involving sexual abuse received disproportionately more attention compared with other maltreatment types. The vast majority of news reports focused on specific cases or events, and seldom discussed child maltreatment as a broader social issue. Differences in reporting style and media framing were also compared by newspaper credibility, and for free versus paid newspapers.As a mass communication tool, more guidelines are needed to formulate public messages about child maltreatment that can improve individual, community, and structural capacities to prevent, identify, and respond to children who are victimized by abuse and neglect. This is especially important in jurisdictions where no mandatory reporting framework exists to help identify vulnerable children, and where the majority of child maltreatment is brought to the attention of authorities by families and those living within the child’s community.     

Childhood maltreatment and alcohol-related problems in young adulthood: The protective role of parental warmth

BackgroundAlcohol use among young adults is highly prevalent. Individuals exposed to childhood maltreatment are particularly vulnerable to alcohol use and alcohol-related problems. Few studies have examined family protective factors, such as parental warmth, that may mitigate the effects of childhood maltreatment on alcohol-related problems.ObjectiveThe current study seeks to examine the extent to which parental warmth reduces the effect of childhood exposure to maltreatment on alcohol-related problems in young adulthood.Participants and settingParticipants were young adults (N = 337; mean age = 21.7), who were recruited from an urban community and completed in-person interviews assessing childhood maltreatment, parental warmth, and alcohol-related problems.MethodsMultiple hierarchical linear regression models were used to examine whether maternal and paternal warmth reduced the impact of childhood exposure to maltreatment on alcohol-related problems in young adulthood. Common risk factors for alcohol-related problems, including psychological symptoms and peer and parental alcohol use, were also entered into the models.ResultsWe found a significant moderating effect of paternal warmth on the associations between childhood emotional abuse and alcohol-related problems (β= -0.29, p < .05). Specifically, the association between emotional abuse and alcohol-related problems was weaker among individuals with higher levels of paternal warmth. Moderating effects of maternal warmth on the maltreatment-problematic alcohol use relation were not supported.ConclusionThe results of this research suggest that parental warmth may not only relate to fewer alcohol-related problems among offspring, but may also modify the associations between childhood emotional abuse and alcohol-related problems during young adulthood.     

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.     

Adolescent risk factors for child maltreatment

We investigate adolescent risk factors, measured at both early and late adolescence, for involvement in child maltreatment during adulthood. Comprehensive assessments of risk factors for maltreatment that use representative samples with longitudinal data are scarce and can inform multilevel prevention. We use data from the Rochester Youth Development Study, a longitudinal study begun in 1988 with a sample of 1,000 seventh and eighth graders. Participants have been interviewed 14 times and, at the last assessment (age 31), 80% were retained. Risk factors represent 10 developmental domains: area characteristics, family background/structure, parent stressors, exposure to family violence, parent–child relationships, education, peer relationships, adolescent stressors, antisocial behaviors, and precocious transitions to adulthood. Maltreatment is measured by substantiated reports from Child Protective Services records. Many individual risk factors (20 at early adolescence and 14 at later adolescence) are significantly, albeit moderately, predictive of maltreatment. Several developmental domains stand out, including family background/structure, education, antisocial behaviors, and precocious transitions. In addition, there is a pronounced impact of cumulative risk on the likelihood of maltreatment. For example, only 3% of the youth with no risk domains in their background at early adolescence were involved in later maltreatment, but for those with risk in 9 developmental domains the rate was 45%. Prevention programs targeting youth at high risk for engaging in maltreatment should begin during early adolescence when risk factors are already at play. These programs need to be comprehensive, capable of addressing the multiple and interwoven nature of risk that is associated with maltreatment.     

The economic burden of child maltreatment in the United States, 2015

Child maltreatment incurs a high lifetime cost per victim and creates a substantial US population economic burden. This study aimed to use the most recent data and recommended methods to update previous (2008) estimates of 1) the per-victim lifetime cost, and 2) the annual US population economic burden of child maltreatment. Three ways to update the previous estimates were identified: 1) apply value per statistical life methodology to value child maltreatment mortality, 2) apply monetized quality-adjusted life years methodology to value child maltreatment morbidity, and 3) apply updated estimates of the exposed population. As with the previous estimates, the updated estimates used the societal cost perspective and lifetime horizon, but also accounted for victim and community intangible costs. Updated methods increased the estimated nonfatal child maltreatment per-victim lifetime cost from $210,012 (2010 USD) to $830,928 (2015 USD) and increased the fatal per-victim cost from $1.3 to $16.6 million. The estimated US population economic burden of child maltreatment based on 2015 substantiated incident cases (482,000 nonfatal and 1670 fatal victims) was $428 billion, representing lifetime costs incurred annually. Using estimated incidence of investigated annual incident cases (2,368,000 nonfatal and 1670 fatal victims), the estimated economic burden was $2 trillion. Accounting for victim and community intangible costs increased the estimated cost of child maltreatment considerably compared to previous estimates. The economic burden of child maltreatment is substantial and might off-set the cost of evidence-based interventions that reduce child maltreatment incidence.