Identifying substance abusing delivering women: consequences for child maltreatment reports

OBJECTIVE: The major objective was to determine how and the extent to which SB2669, which requires the identification of substance abusing delivering women, affected the number of children reported for abuse or neglect in several California counties. METHOD: A monthly time-series model from April 1988 to December 1995 was constructed. The idea underlying the model was that month-to-month changes in the number of child maltreatment reports was a response to the presence of SB2669 in addition to various demographic, social, and economic factors. By separately estimating each county's number of reports, it was assumed that SB2669 did not necessarily affect each county's reports by the same amount, perhaps partially because of different counties' implementation strategies or general policies. Our sampling size consisted of seven high prevalence counties. RESULTS: The results suggest that the effects of SB2669 on the number of child maltreatment reports are mixed. On an aggregate level, all else constant, and at least for a few years after the passage of SB2669, SB2669 is associated with a decrease in child maltreatment reports in two of the participating counties. This decrease may be due to conscientious implementation of the legislation in these counties. This mixed finding is expected mainly because SB2669, although mandated, was never enforced. Moreover, from the process component of the study we learned that the implementation practices of this legislation vary substantially between and even within counties' hospitals. CONCLUSIONS/FUTURE DIRECTIONS: A decrease in maltreatment reports in the presence of SB2669 is not necessarily the most desirable outcome in the light of what we know about the relationship between substance abuse and child maltreatment. Law makers need to rethink the purpose of the law and provide the necessary language, tools and training to ensure that the goals of identifying substance abusing mothers and their families are met. Provisions also need to be made that somehow enforce this legislation. These provisions could lessen county-level and hospital-level variability in implementing the law.     

Differential responsiveness to a parenting intervention for mothers in substance abuse treatment

This study examines the relationship between levels of psychological distress in substance-dependent mothers and their differential response to a dyadic parent–child intervention. A sample of 66 mothers who were receiving treatment for substance abuse, as well as a simultaneous parenting intervention, were interviewed pre and post-treatment on measures of psychological distress, adult and child trauma history, parental reflective functioning, and child social–emotional development. Additionally, clinicians provided assessments of the parent–child relationships. As anticipated, trauma histories for mothers and children, children's social emotional development, and parental reflective functioning were associated with aspects of maternal psychological distress. Kruskal–Wallis and subsequent Wilcoxson signed rank tests revealed that women with highest levels of baseline psychological distress showed significant improvements in psychological functioning post-treatment while women with moderately elevated levels of psychological distress did not. Women who were most distressed at baseline showed increased levels of parental reflective functioning post-treatment while women with moderate and lower levels of baseline psychological distress showed improvements on clinician-rated assessments of parent–child relationships. Chi Square analyses showed that parents who endorsed the highest levels of distress at baseline reported that their children's risk status regarding social–emotional development decreased post-treatment. Despite similarities in substance dependence, mothers in this sample had different needs and outcomes in the context of this parenting intervention due to variation in mental health. Given this variation, parenting interventions for substance-dependent mothers need to account for the individual differences in levels of psychological distress.     

Treating child abuse-related posttraumatic stress and comorbid substance abuse in adolescents

OBJECTIVE: Child abuse is a risk factor for developing Posttraumatic Stress Disorder (PTSD) and subsequent Substance Use Disorder (SUD). The purpose of this review is to summarize current knowledge about effective treatments for adolescent abuse-related PTSD, SUD, and the co-occurrence of these conditions.METHOD: The literature on empirical treatment studies for these conditions in adolescence was reviewed, summarized, and synthesized.RESULTS: Randomized controlled studies of abuse-related PTSD and SUD in adolescents have supported the efficacy of cognitive behaviorally-based individual and family treatment components. Components overlap considerably in empirically supported treatments for each disorder. An integrated treatment approach is described for use in adolescents with abuse-related PTSD and SUD, with recommendations for optimizing services for this population and for future research.CONCLUSIONS: The available evidence on effective treatments suggests that integrated PTSD- and SUD-focused cognitive-behavioral and family treatment for adolescents with comorbid abuse-related PTSD and SUD may optimize outcomes for this population.     

Modeling risk for child abuse and harsh parenting in families with depressed and substance-abusing parents

Children with substance abusing parents are at considerable risk for child maltreatment. The current study applied an actor–partner interdependence model to examine how father only (n = 52) and dual couple (n = 33) substance use disorder, as well as their depressive symptomology influenced parents’ own (actor effects) and the partner's (partner effects) overreactivity in disciplinary interactions with their children, as well as their risk for child maltreatment. Parents completed the Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977), the overreactivity subscale from the Parenting Scale (Arnold, O’Leary, Wolff, & Acker, 1993), and the Brief Child Abuse Potential Inventory (Ondersma, Chaffin, Mullins, & LeBreton, 2005). Results of multigroup structural equation models revealed that a parent's own report of depressive symptoms predicted their risk for child maltreatment in both father SUD and dual SUD couples. Similarly, a parent's report of their own depressive symptoms predicted their overreactivity in disciplinary encounters both in father SUD and dual SUD couples. In all models, partners’ depressive symptoms did not predict their partner's risk for child maltreatment or overreactivity. Findings underscore the importance of a parent's own level of depressive symptoms in their risk for child maltreatment and for engaging in overreactivity during disciplinary episodes.     

Interpartner conflict and child abuse risk among African American and Latino adolescent parenting couples

OBJECTIVE: The goal of this study was to identify links between observed conflict interactions and risk for child abuse and harsh parenting among a multiethnic sample of adolescent mothers (14-19 years) and young fathers (14-24 years). METHODS: Prior to childbirth (T1), observation-based relationship data were collected from 154 expectant adolescent couples as well as information about physical aggression between partners. Two years after childbirth (T2), data relevant to harsh disciplinary practices and child abuse-prone attitudes were collected from both young mothers and fathers. Multiple regression analyses were run to examine the correspondence between (a) couples' relationship quality prior to childbirth and (b) subsequent risk for harsh and potentially abusive parenting practices. RESULTS: Findings indicated that interpartner violence prior to childbirth predicted physically punitive parenting behavior for fathers, but not for mothers. Young mothers and fathers observed to be more warmly engaged with each other during their pre-birth couple interactions (T1) reported lower rates of physically punitive parenting behavior with their children at T2. Couples' hostility at T1 predicted fathers' level of observed hostility toward his child during a structured play activity at T2. CONCLUSIONS: Results underscore the importance of addressing the quality of couples' relations as means of preventing dysfunctional parenting practices among adolescent mothers and their partners. Adolescent mothers and their partners are at heightened risk for engaging in dysfunctional parenting, including child abuse. Focusing on pregnant adolescents and their partners, this study sought to identify interpersonal predictors of child abuse risk. Although this study did not involve administering prevention or intervention services, the goal was to test hypotheses that would inform the development of programs for young at-risk couples. PRACTICE IMPLICATIONS: The decision to recruit young couples prior to childbirth was based on the presumption that this period of time could provide a window of opportunity to administer couple-based child abuse prevention programs. Consistent with previous research on marital relations and parenting, results of this study support the idea that efforts to develop and administer preventive-intervention programs targeting at-risk couples could help reduce the occurrence of harsh parenting behavior and abuse.     

Intergenerational transmission of child abuse: Predictors of child abuse potential among racially diverse women residing in domestic violence shelters

Parental risk for perpetrating child abuse is frequently associated with intergenerational patterns of abuse: being abused increases the risk for future abuse. Yet, the mechanisms of intergenerational abuse are unclear, and the risk factors for perpetrating child abuse are interrelated. Research suggests that history of childhood abuse, psychiatric distress, and exposure to intimate partner violence (IPV) are all related risk factors for perpetrating child abuse. We investigated these three risk factors using the developmental psychopathology framework in a racially diverse sample of high-risk women: women residing in domestic violence shelters. 211 mothers residing in domestic violence shelters completed measures of their own childhood abuse (defined narrowly in a 10-item self-report survey), exposure to and severity of IPV victimization, and structured interviews to diagnose psychiatric disorders. We utilized a hierarchical regression model to predict child abuse potential, accounting for risk factors in blocks roughly representing theorized temporal relationships: childhood abuse followed by psychiatric diagnoses, and then recency of exposure to IPV. Consistent with hypotheses, the strongest predictor of current child abuse potential was the psychiatric diagnosis of PTSD. Mediation tests further explicated that the relationship between maternal history of childhood sexual abuse and current potential for perpetrating child abuse is mediated by IPV-related PTSD symptoms. Results suggest that IPV-related PTSD symptoms, rather than exposure to abuse (i.e., childhood abuse or IPV), is most strongly associated with child abuse potential in recent IPV survivors. Interventions which can ameliorate maternal psychopathology and provide resources are recommended for these vulnerable families.     

The association between perceived injunctive norms toward corporal punishment,parenting support,and risk for child physical abuse

The use of corporal punishment (CP) is a strong risk factor for many poor outcomes for children including child maltreatment. The use of CP occurs within social contexts which are important to understand. Although it is known that perceived social norms regarding CP are related to its use, the specific role that a mother’s primary support person plays in influencing attitudes toward and use of CP remains unknown. The current study assessed linkages between maternal perceived social support in parenting and perceived injunctive norms of CP from her primary source of support, with maternal attitudes toward and use of CP. Survey data were collected from female primary caregivers (N = 436) of children age 2 to 7 years (mean age = 3.7) enrolled in Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clinics in Southeastern Louisiana. Most frequently, the biological father of the child (37.9%) and the maternal grandmother of the child (24.2%) were identified as the participant’s primary source of social support in parenting. Perceived injunctive norms of this support person toward CP use were significantly and positively associated with attitudes toward, AOR = 5.97, 95% CI = [4.04, 8.82], and use of CP, AOR = 3.77, 95% CI = [2.55, 5.59]. However, perceived social support was not associated with these outcomes and also did not moderate these associations. Findings suggest that efforts to reduce maternal risk for child physical abuse and use of CP must include the mother’s primary source of social support if they are to be successful.     

The roles of peritraumatic dissociation, child physical abuse, and child sexual abuse in the development of posttraumatic stress disorder and adult victimization

OBJECTIVE: Previous research has indicated that women who experience childhood physical abuse or childhood sexual abuse are at increased risk for posttraumatic stress disorder (PTSD) and adult victimization. Recently, peritraumatic dissociation (PD) has been suggested as another possible risk factor for PTSD and adult victimization. The purpose of the present study was to investigate the effects of childhood physical and sexual abuse and PD on PTSD and adult victimization. METHOD: A sample of 467 female college students completed questionnaires about childhood and adult sexual and physical abuse experiences, PD, and PTSD symptoms. RESULTS: The combined sexual and physical abuse (CA) and sexual abuse only (SA) groups reported significantly higher numbers of PTSD symptoms than the physical abuse only (PA) and no abuse (NA) groups. The CA and PA groups reported significantly more adult sexual and physical victimization than the SA and NA groups. Across all four groups, higher levels of PD were associated with higher levels of PTSD and adult sexual and physical victimization. CONCLUSIONS: The results of the current study suggest that different types of childhood abuse may lead to different adult problems. The results also indicated that PD may have a broad effect on PTSD development and adult victimization.     

Mindfulness and trauma symptoms predict child abuse potential in risk-exposed,men and women during pregnancy

BackgroundNearly a third of adults report childhood trauma in their youth and approximately 700,000 cases of child maltreatment were reported in 2016. Both history of childhood trauma and current trauma symptoms in adults are linked to child maltreatment, although many trauma-exposed individuals are warm and nurturing parents. Identifying resiliency factors in adults with risk factors for harsh parenting may illuminate new pathways to sensitive parenting. Mindfulness is reported to improve trauma and mental health symptoms but the relationship between mindfulness, trauma, and child abuse potential is not yet understood.ObjectiveThis cross-sectional study investigated the relationship between mindfulness, childhood trauma experiences, trauma symptoms and child abuse potential.Participants and settingOur participants were 102 expectant parents recruiting from obstetric clinics and agencies Detroit, MI (58.8% African American, 27.5% Caucasian).MethodBivariate correlations were examined using validated, self-report questionnaires. Significant variables were included in a hierarchical linear regression to identify predicting factors that contribute to child abuse potential scores.ResultsSignificant correlations between child abuse potential with current trauma symptoms (r = .53, p < .01) and mindfulness (r = −.32, p < .01) were found, but no link with past childhood trauma experiences and child abuse potential were identified. The model significantly predicts child abuse potential (ΔR² = .10, F(5, 96), = 12.48, p < .001). Trauma symptoms (B = .09, p < .001, 95% confidence interval [CI][−.40, −.07]) and mindfulness nonreactivity (B = −.24, p < .01, 95% CI[.05, .14]) predicted higher potential for child abuse scores.ConclusionFindings suggest increased mindfulness, especially nonreactivity to one’s own thoughts, may be an important factor to protect against child abuse potential. Interventions to increase parental mindfulness may reduce child abuse potential and improve child well-being, but further mechanistic research is needed to determine this.     

Childhood physical abuse, early social support, and risk for maltreatment: current social support as a mediator of risk for child physical abuse

OBJECTIVE: The study investigated whether perceptions of social support in adulthood partially mediated the associations between childhood experiences (i.e., receipt of physical abuse and levels of early social support) and adult risk for child physical abuse. METHOD: Participants included 598 general population adults who completed self-report measures designed to assess childhood physical abuse, perceptions of early and current social support, and risk factors for child physical abuse. Structural equation modeling was used to test and cross validate a model that included the direct effects of child physical abuse and early social support on child physical abuse risk, as well as mediated effects through an influence on adult perceptions of social support. RESULTS: Childhood physical abuse and early social support covaried, such that receipt of physical abuse was associated with lower levels of perceived early social support. Early support, but not child physical abuse, had an indirect effect (i.e., through current support) on child physical abuse risk. More specifically, levels of early support were directly related to adult perceptions of support, and adult perceptions of support were inversely associated with child physical abuse risk. Childhood physical abuse was directly related to child physical abuse risk. CONCLUSIONS: Low levels of early support may impact risk for child physical abuse by affecting perceptions of others as supportive in adulthood. The receipt of physical abuse in childhood, however, does not appear to impact perceptions of support in adulthood. Research is needed to identify additional factors that may explain the association between receipt of physical abuse in childhood and increased risk of child physical abuse in adulthood.     

Interagency collaboration: Strengthening substance abuse resources in child welfare

Supporting child welfare (CW) workers’ ability to accurately assess substance abuse needs and link families to appropriate services is critical given the high prevalence of parental substance use disorders (SUD) among CW-involved cases. Several barriers hinder this process, including CW workers’ lack of expertise for identifying SUD needs and scarcity of treatment resources. Drawing from theories and emergent literature on interagency collaboration, this study examined the role of collaboration in increasing the availability of resources for identifying and treating SUDs in CW agencies. Using data from the second cohort of families from the National Survey of Child and Adolescent Well-Being, study findings highlight a lack of SUD resources available to CW workers. On the other hand, the availability of SUD resources was increased when CW agencies had a memorandum of understanding, co-location of staff, and more intense collaboration with drug and alcohol service (DAS) providers. These results provide evidence to support efforts to improve collaboration between CW and DAS providers and showcase specific collaboration strategies to implement in order to improve service delivery.     

Perceptions of child protective services among pregnant or recently pregnant,opioid-using women in substance abuse treatment

Pregnant, opioid-using women represent a challenge to healthcare providers attempting to engage them in prenatal and substance abuse services. Limited, primarily international research suggests that child welfare clients have mixed feelings about Child Protective Services (CPS) and that fear of CPS may present a barrier to care. Understanding how pregnant opioid-using women in substance abuse treatment perceive CPS may be useful in encouraging substance abuse treatment initiation. Participants were currently or recently (within past 12 months) pregnant women with current or recent (within past 12 months) abuse/dependence of pharmaceutical opioids at a drug treatment facility. Participants were recruited by treatment staff to participate in a comprehensive study across multiple domains. Data for this analysis were collected using semi-structured qualitative interviews. Transcribed data were thematically analyzed using in vivo and interpretive coding by three coders for purposes of inter-rater reliability. Following 2, two-hour meetings, consensus was reached on primary themes and sub-themes. Two major themes and several sub-themes were identified: 1) Participants’ feelings and attitudes about CPS (positive and negative); 2) Interaction-based perceptions of CPS’ function and performance. Participants’ feelings toward CPS were often conditioned by their experiences with individual caseworkers. While many pregnant, opioid-using women identify legitimate, and even useful features of CPS, fear of CPS can be a barrier to care. Making substance abuse treatment accessible to this population requires recognition of their complex feelings toward CPS, and coordination among CPS case workers and substance abuse treatment providers.     

Relationships among parental beliefs in corporal punishment, reported stress, and physical child abuse potential.

OBJECTIVE: The present study examined the extent to which parental belief in the value of corporal punishment moderates the association between level of parenting stress and physical child abuse potential. Based on existing theory, it was expected that levels of parenting stress would be positively associated with physical child abuse potential among parents who reported high levels of belief in the value of corporal punishment. METHOD: Forty-one parents (25 general population and 16 at-risk parents) were assessed for belief in the value of corporal punishment, level of parenting stress, and physical child abuse potential using self-report measures. After removal of respondents due to response distortion or missing data, the final sample consisted of 31 parents with valid and complete protocols. Based on their responses on the study measures, respondents were categorized as either high or low on belief in corporal punishment and parenting stress. RESULTS: Level of parenting stress was positively associated with physical child abuse potential. As expected, the interaction of parenting stress and belief in the value of corporal punishment was significant. Level of parenting stress was positively associated with physical child abuse potential among parents who reported high levels of belief in the value of corporal punishment. In contrast, level of parenting stress was not associated with physical child abuse potential among parents who reported low belief in the value of corporal punishment. CONCLUSIONS: The present findings are consistent social information processing and stress and coping models of the etiology of physical child abuse, and underscore the importance of considering both parental cognitions and levels of parenting stress in assessing potential for physical child abuse.     

Chaos,poverty, and parenting: Predictors of early language development

Studies have shown that distal family risk factors like poverty and maternal education are strongly related to children's early language development. Yet, few studies have examined these risk factors in combination with more proximal day-to-day experiences of children that might be critical to understanding variation in early language. Young children's exposure to a chronically chaotic household may be one critical experience that is related to poorer language, beyond the contribution of SES and other demographic variables. In addition, it is not clear whether parenting might mediate the relationship between chaos and language. The purpose of this study was to understand how multiple indicators of chaos over children's first three years of life, in a representative sample of children living in low wealth rural communities, were related to child expressive and receptive language at 36 months. Factor analysis of 10 chaos indicators over five time periods suggested two factors that were named household disorganization and instability. Results suggested that after accounting for thirteen covariates like maternal education and poverty, one of two chaos composites (household disorganization) accounted for significant variance in receptive and expressive language. Parenting partially mediated this relationship although household disorganization continued to account for unique variance in predicting early language.     

Child abuse potential inventory and parenting behavior: Relationships with high-risk correlates

The primary purpose of this research was to examine the construct validity of the Child Abuse Potential Inventory by comparing maltreating and high-risk parents' CAP Inventory abuse scores to their behavior during interactions with their children. A second purpose was to determine the degree to which CAP Inventory scores and parenting behavior were related to several known correlates of abuse, as measured by parent and teacher reports. Participants (n = 41) included abusive and high-risk parents and their children referred to a treatment group. Correlational analyses revealed that CAP Inventory scores and observed parenting style yielded highly related findings, supporting construct validity of the CAP Inventory. However, the CAP Inventory and observed behavior index showed a different pattern of relationships to the risk correlates. Implications for assessment of risk status are discussed and recommendations are provided for continued research.     

Economic stress, parenting, and child adjustment in Mexican American and European American families

To assess the impact of economic hardship on 111 European American and 167 Mexican American families and their 5th-grade (M age=11.4 years) children, a family stress model was evaluated. Structural equation analyses revealed that economic hardship was linked to indexes of economic pressure that were related to depressive symptoms for mothers and fathers of both ethnicities. Depressive symptoms were linked to marital problems and hostile parenting. Paternal hostile parenting was related to child adjustment problems for European Americans, whereas marital problems were linked to child adjustment problems for Mexican Americans. Maternal acculturation was associated with both higher marital problems and lower hostile parenting. The utility of the model for describing the effects of economic hardship in Mexican Americans is noted.     

Parental perceptions of neighborhood processes,stress, personal control,and risk for physical child abuse and neglect

ObjectiveThis study set out to examine whether mothers’ individual perceptions of their neighborhood social processes predict their risk for physical child abuse and neglect directly and/or indirectly via pathways involving parents’ reported stress and sense of personal control in the parenting role.MethodsIn-home and phone interview data were examined cross-sectionally from a national birth cohort sample of 3,356 mothers across 20 US cities when the index child was 3 years of age. Mothers’ perceptions of neighborhood social processes, parenting stress, and personal control were examined as predictors, and three subscales of the Parent-To-Child Conflict Tactics Scale (CTS-PC) were employed as proxies of physical child abuse and neglect risk. Structural equation modeling (SEM) was employed to test direct and indirect pathways (via parenting stress and control) from perceived neighborhood processes to proxy measures of physical child abuse and neglect. Multiple group SEM was conducted to test for differences across major ethnic groups: African American, Hispanic, and White.ResultsAlthough perceived negative neighborhood processes had only a mild direct role in predicting risk for physical child abuse, and no direct role on child neglect, these perceptions had a discernable indirect role in predicting risk via parenting stress and personal control pathways. Parenting stress exerted the clearest direct role on both physical abuse and neglect risk. This predictor model did not significantly differ across ethnic groups.ConclusionsAlthough neighborhood conditions may not play a clear directly observable role on physical child abuse and neglect risk, the indirect role they play underscores the importance of parents’ perceptions of their neighborhoods, and especially the role they play via parents’ reported stress and personal control.Practice implicationsSuch findings suggest that targeting parents’ sense of control and stress in relation to their immediate social environment holds particular potential to reduce physical child abuse and neglect risk. Addressing parents’ perceptions of their neighborhood challenges may serve to reduce parenting risk via improving parents’ felt control and stress.     

Impact of child noncompliance on stress appraisals, attributions, and disciplinary choices in mothers at high and low risk for child physical abuse

OBJECTIVE: The study investigated the impact of repeated child noncompliance on stress appraisals, attributions, and disciplinary choices in high- and low-risk mothers. METHOD: Fifty (25 high-risk and 25 demographically, matched low-risk) mothers responded to questions related to stress appraisals, attributions, and disciplinary choices following presentations of a child engaging in repeated noncompliance. RESULTS: After repeated child noncompliance, high-risk, compared to low-risk, mothers perceived more threat and uncontrollability, rated child behaviors as more stressful, and reported higher levels of negative affect. High-risk mothers also reported more stable, global, and intentional attributions, with a trend toward more internal attributions, but did not differ in their evaluations of wrongness and seriousness of the child's behavior. After repeated noncompliance, a risk group difference was found in estimates of future child compliance but not in the use of power assertive discipline. CONCLUSIONS: Results support the view that high-risk, relative to low-risk, mothers are differentially responsive to stressful situations and differ in their attributions for negative child behaviors and in their expectations of future child compliance. However, since risk group differences in disciplinary choices were not also found, additional research is needed to demonstrate the process through which risk group cognitive and affective differences are related to differences in disciplinary behavior.