National survey of hospital child protection teams in Japan

This study aimed to investigate the penetration rate of child protection teams (CPTs) in medical institutions and associations between CPT functions and hospital services. We collected data in October of 2015 from 377 hospitals in Japan offering pediatric organ transplantation. The questionnaire included questions regarding the existence of a CPT, the number of child maltreatment cases discussed and reported per year, CPT functions including 21 items about staffing, manuals, meeting, prevention, education, and collaboration, and the services provided by the hospital. Of the 377 institutions, 122 (32.4%) answered the survey. There were significant associations between CPT functions and the number of pediatric beds (r = .27), number of pediatricians (r = .27), number of outpatients (r = .39), number of emergency outpatients (r = .28), and emergency medical care (p = .009). In a multiple regression analysis, CPT functions were significantly associated with the number of CPT members, pediatric outpatient numbers, and pediatric emergency outpatient numbers. Japan has no CPT guidelines that outline what CPTs should offer in terms of structure, staffing, functions, and systems. Hospitals with many pediatric and emergency outpatients are expected to play major roles in providing services such as specialty care, intensive care, and education. They are also expected to play a role in detecting and managing child maltreatment, and have, by their own initiative, improved their capacities to achieve these goals.     

Patterns of interactions in multidisciplinary child protection teams in New Jersey

OBJECTIVE: The objective of this study was to gain an understanding of how multidisciplinary team members in child protection worked together within the team, meeting to provide assessments of, and services to, children and families. METHOD: Fifteen multidisciplinary child-protection teams in New Jersey were observed during one meeting of each team. The interaction among team members was recorded and analyzed using a structured observation method, Bales' Interaction Process Analysis. RESULTS: There was a wide variation in participation among team members, with some contributing nothing to the meeting and others contributing a great deal. In some teams, participation by members was more equal than others. Some professional groups and agencies contributed very little to any meeting while others contributed a great deal to many meetings. CONCLUSIONS: Professionals are members of multidisciplinary teams because they are expected to contribute to the investigation of child maltreatment cases and to the planning for further work with cases. However, the findings from this study suggest that there is a considerable degree of inequality in levels of participation in multidisciplinary meetings. It is particularly noticeable that staff from the prosecutor's offices participate in every meeting and either the agency as a whole or individual members of it dominate many of the meetings.     

Mental health training and the hospice community: a national survey

This article summarizes a national survey of the hospice community. Respondents provided detailed information in the following areas: (a) What formal mental health training is provided for staff members? (b) Who conducts this training? (c) What areas are covered and where would more training be useful? (d) How is the training conducted--what formats and teaching materials are used? and (e) How much training do staff members receive? The results of the survey indicate that the hospice community is making a concerted effort to meet the mental health training needs of its paid staff members and volunteers. However, more than half of the hospices surveyed expressed a need for further training in 26 of the 33 issues and skills covered in the questionnaire, and many reported a need for a more systematic and comprehensive mental health curriculum. The findings point to several areas of particularly great need and provide a basis for the development of future mental health training in the hospice community.     

Outpatient mental health services for children in foster care: a national perspective

OBJECTIVE: To determine factors influencing the use of outpatient mental health services provided by mental health professionals (OMHS) for children in foster care using a national probability sample in the United States. METHOD: As part of the National Survey of Child and Adolescent Well-being, detailed survey data were collected on 462 children, ages 2-15, who had been in out-of-home care for approximately 12 months at the time of sampling. A multivariate logistic regression model was used to determine how clinical need, as measured by a Total Problem, Externalizing, or Internalizing Scale T-score of 64 or greater on the Achenbach Child Behavior Checklist (CBCL), and non-clinical factors affected OSMHS use. RESULTS: Over half of the children in the sample received at least one OMHS. Need, older age, and history of sexual abuse history all positively predicted OMHS. A history of physical neglect negatively predicted OSMHS. African-Americans used fewer services than children of Caucasian ancestry at all values on the CBCL. This finding was particularly salient at lower levels of CBCL scores; at higher levels, the discrepancy in the use of services diminished but the proportion of children receiving services remained lower for African-American children. CONCLUSIONS: This national study confirms previous findings regarding the use of mental health services based on regional data. Limitations in the use of services imposed by non-clinical factors, specifically, age, race/ethnicity and type of abuse, need to be examined in order to address implicit and explicit policies and practices that may result in inequitable distribution of services.     

Factors associated with nurses' intention to report child abuse: a national survey of Taiwanese nurses

OBJECTIVE: The objectives were to determine the experiences of Taiwanese nurses with a new child abuse reporting law and to assess attitudinal correlates of nurses' intention to report. METHOD: A stratified quota sampling technique was used to select registered nurses working in pediatric, psychiatric and emergency care units in Taiwan. A total of 1400 (return rate 88%) questionnaires from 1617 nurses were used. The questionnaire includes demographic information, attitudes toward and knowledge of child abuse and reporting laws, and eight vignettes of child abuse. RESULTS:Most nurses (86%) said they had never reported a child abuse case; 21% said they had failed to report a suspected case of child abuse. Most (80%) had never had any child abuse education. About 75% felt their nursing education and in-service training was inadequate or absent. Most had an inadequate knowledge of the reporting law (mean score: 60% correct). Nurses only answered 17-43% of the law-related questions correctly. The majority accepted the professional responsibility to report. There were some differences among pediatric, psychiatric and emergency care nurses. In general, these Taiwanese nurses had negative attitudes toward corporal punishment and toward parents who abuse their children. The study also identified a variety of attitudes related to intention to report relevant to the Theory of Planned Behavior. CONCLUSIONS:Nurses accept responsibility for reporting but they believe their professional preparation for reporting is inadequate. There is a strong need for in-service and pre-service education about child abuse among nurses in Taiwan.     

Reported contact with child protection services among those reporting child physical and sexual abuse: results from a community survey

OBJECTIVE: This study uses results from a large community survey to examine the relationship between a history of child maltreatment and self-reports of contact with Child Protection Services (CPS). METHODS: The Ontario Health Supplement was a province-wide, probability-based survey of household dwellings in the province of Ontario, Canada. A random sample of residents aged 15 and older participated in the Ontario Health Supplement (N=9953). A face-to-face interview included a question about contact with Child Protection Services (CPS), and the Child Maltreatment History Self-Report, a self-administered questionnaire, was used to assess history of child physical and sexual abuse. RESULTS: Only a very small percentage of respondents with a history of child abuse reported contact with CPS; 5.1% of those with a history of physical abuse, and 8.7% of those with a history of sexual abuse. Contact with CPS was associated with younger age of respondent for both types of abuse and female gender for physical abuse. In the case of sexual abuse, younger respondents whose parental employment classification was in the lower socioeconomic group were more likely to have contact with CPS. CONCLUSIONS: Interventions that target only those who come in contact with CPS will not reach most persons exposed to child abuse.     

Predicting the decisions of hospital based child protection teams to report to child protective services,police and community welfare services

This study examines judgments made by hospital-based child protection teams (CPTs) when determining if there is reasonable suspicion that a child has been maltreated, and whether to report the case to a community welfare agency, to child protective services (CPS) and/or to the police. A prospective multi-center study of all 968 consecutive cases referred to CPTs during 2010–2011 in six medical centers in Israel. Centers were purposefully selected to represent the heterogeneity of medical centers in Israel in terms of size, geographical location and population characteristics. A structured questionnaire was designed to capture relevant information and judgments on each child referred to the team. Bivariate associations and multivariate multinomial logistic regressions were conducted to predict whether the decisions would be (a) to close the case, (b) to refer the case to community welfare services, or (c) to report it to CPS and/or the police. Bivariate and multivariate analyses identified a large number of case characteristics associated with higher probability of reporting to CPS/police or of referral to community welfare services. Case characteristics associated with the decisions include socio-demographic (e.g., ethnicity and financial status), parental functioning (e.g., mental health), previous contacts with authorities and hospital, current referral characteristics (e.g., parental referral vs. child referral), physical findings, and suspicious behaviors of child and parent. Most of the findings suggest that decisions of CPTs are based on indices that have strong support in the professional literature. Existing heterogeneity between cases, practitioners and medical centers had an impact on the overall predictability of the decision to report. Attending to collaboration between hospitals and community agencies is suggested to support learning and quality improvement.     

Funding realities: child abuse diagnostic evaluations in the health care setting.

OBJECTIVE: This study examines staffing, funding sources, reimbursement, and financing of medically-oriented child protection teams. METHOD: A 16-item questionnaire on the composition, size, and services of the team, program costs, revenue sources, reimbursement rates, and perceptions of funding stability was mailed to a sample of 118 medically-oriented child protection teams. RESULTS: After excluding 10 programs, an overall response rate of 68% was obtained. Teams varied in configuration, services, charges, and funding. Over 50% identified funding as being important, yet, demonstrated varying levels of awareness of budget and reimbursement issues. Many generally relied on patient care reimbursement from health care and government payers. Some programs seemed to be doing well financially while others were struggling. Approximately one-third of the respondents indicated that funding was unstable. CONCLUSIONS: Many programs are innovatively knitting together patch-works of funding and support to serve children and families in need. Team leaders should increase their knowledge of fiscal issues in order to be effective advocates at the institutional level for continued team support. A potential way of accomplishing this would be to utilize the existing structure of a national professional association and its national meeting to provide a forum for relatively successful programs to showcase their "ideal models" of team financing.     

Adverse childhood experiences among youth reported to child welfare: Results from the national survey of child & adolescent wellbeing

The negative influence of adverse childhood experiences (ACEs) on social, emotional, and behavioral (SEB) outcomes are well documented. However, no research to date has examined the effect of ACEs on SEB outcomes in youth who received mental health services after reporting to the child welfare system. This study's analyses of data from the National Survey of Child and Adolescent Well-Being II revealed that the most prevalent ACEs included hospitalization for a medical condition, neglect, and exposures to domestic and community violence. Logistic regression of this data showed that the odds of being diagnosed with internalizing problems increased with age and when sexual abuse was reported. The results also showed that compared to Caucasian youth, Latinos were less likely to be diagnosed with externalizing behaviors, even when sexual abuse had been reported. Contrary to one of this study's hypotheses, mental health service use within the past 18 months increased the odds of being diagnosed with SEB problems. These findings highlight the persistence of SEB problems despite receipt of mental health services. Future research should assess the impact of interventions that aim to mitigate poor SEB outcomes due to ACEs, especially sexual abuse.     

Connectedness and suicidal ideation among adolescents involved with child welfare: A national survey

Using data from the National Survey of Child and Adolescent Well-Being, this study examined the relationship between connectedness in major social domains (i.e., caregiver, peers, deviant peers, and school) and suicidal ideation among adolescents (11–17 years old) investigated by child welfare agencies (N = 995). Weighted logistic regression models were used to evaluate the relationships between connectedness variables and suicidal ideation, after adjusting for covariates. Youths with a stronger connection to caregivers were much less likely to report suicidal ideation, whereas youths with stronger deviant peer relationships were significantly more likely to report suicidal ideation. Significant associations found between primary caregiver and deviant peer connectedness and suicidal ideation highlight the need for attentive consideration of these relationships when working with this highly vulnerable population. Identifying domain-specific connectedness factors related to suicidal ideation presents an opportunity for the development of targeted early intervention for child welfare-involved youths.     

A USA national survey of program services provided by child advocacy centers

OBJECTIVE: Child Advocacy Centers (CACs) are designed to improve the community collaborative response to child sexual abuse and the criminal justice processing of child sexual abuse cases. CACs, in existence for 16 years, now have standards for membership developed by the National Children's Alliance (NCA) that include nine core components. And yet no systematic examination of the CAC model exists. The purpose of this paper was to assess the variations within these core components as they exist in the field. METHOD: Using a stratified random sampling design, 117 CAC directors were interviewed using a semi-structured interview that was based on the NCA's standards for membership. The eight core components of the CAC model examined in this study include: a child-friendly facility, a multidisciplinary team, an investigative child interview, a medical examination of the child, provision of mental health services, victim advocacy, case review, and case tracking. RESULTS: Results reveal the CAC model has been widely adopted by both member and nonmember centers, although variations in implementation exist. CONCLUSIONS: Future developments in the CAC model must include evaluation of the model.     

Disentangling the effect of out-of-home care on child mental health

BackgroundChildren in out-of-home care are consistently found to have poor mental health compared to children in the general population. However, UK research has so far failed to disentangle the impact of the care system on children’s mental health outcomes from the effects of the adverse circumstances that led to their admission to care.ObjectiveThis research investigated the association between care placement and the presence of child mental health problems after controlling for children’s pre-care experiences. It also identified factors associated with mental health problems among children in care.Participants and SettingThe sample comprised three groups of children involved with child welfare services due to maltreatment, including children in out-of-home care (n = 122), reunified children (n = 82) and those who had never been in care (n = 159).MethodsThe mental health of the children in the three groups was compared, using information collected from their parents/foster carers and social workers.ResultsThe odds of a child in out-of-home care having a mental health problem were not significantly higher than those of a child who had never been in care (AOR = 1.24; p = 0.462). However, the odds of a child in out-of-home care having reactive attachment disorder (RAD) were significantly higher than those of a child who had never been in care (AOR=1.92; p = 0.032).ConclusionsThese findings make an important contribution to international debates about whether placing children in care is beneficial or detrimental to their wellbeing, and highlight a range of inter-linking factors associated with the mental health of children in out-of-home care.     

Cumulative teen birth rates among girls in foster care at age 17: An analysis of linked birth and child protection records from California

This study used linked foster care and birth records to provide a longitudinal, population-level examination of the incidence of first and repeat births among girls who were in foster care at age 17. Girls in a foster care placement in California at the age of 17 between 2003 and 2007 were identified from statewide child protection records. These records were probabilistically matched to vital birth records spanning the period from 2001 to 2010. Linked data were used to estimate the cumulative percentage of girls who had given birth before age 20. Birth rates and unadjusted risk ratios were generated to characterize foster care experiences correlated with heightened teen birth rates. Between 2003 and 2007 in California, there were 20,222 girls in foster care at age 17. Overall, 11.4% had a first birth before age 18. The cumulative percentage who gave birth before age 20 was 28.1%. Among girls who had a first birth before age 18, 41.2% had a repeat teen birth. Significant variations by race/ethnicity and placement-related characteristics emerged. Expanded data and rigorous research are needed to evaluate prevention efforts and ensure parenting teens are provided with the needed services and supports.     

The role of the health care provider with the gifted child

The health care provider functioning in an organized pre‐school setting can play a vital role in the early identification of the gifted child. Early recognition and intervention with the child and family is important in meeting the special needs as well as challenges the gifted child presents. The health professional can make a unique contribution in this area as well as being alert for the potential health problems the child may have.     

The role of managed mental health care in counseling gifted children and families

This study examined the role of managed mental health care in the counseling of gifted children and families. When gifted children and their families experience difficulties resulting from giftedness, they have the option of choosing a private provider, although cost is often prohibitive. Moreover, when insurance is used to offset the cost, most mental health insurance policies have a managed care component. One requirement of managed care is that services be medically necessary to alleviate a recognized mental illness diagnosis. Problems resulting from giftedness may not be recognized as a mental illness. As a result, insurance may not pay for these counseling costs. However, this does not have to be the case because of the flexibility managed care case managers have to make judgments. 40 managed care case managers were surveyed to address this issue. 14 of the case managers consented to individual interviews. The results indicate that some case managers would approve reimbursement and others would not. The study describes criteria and conditions that need to be met for reimbursement.     

At the heart of child care: Predictors of teacher sensitivity in center-based child care

This study examined the extent to which characteristics of early childhood teachers and settings predicted observed teacher sensitivity. Participants included 41 head teachers at child care centers located in Northern California. Accreditation status, center size, and program quality were uniquely associated with teacher sensitivity. Accreditation was also associated with a number of other teacher (training, ethnic minority status, and depression) and setting characteristics (program quality, subsidies, and child ethnic minority enrollment). Other unique predictors included more teacher training, smaller center size, and perceived organizational health. Having a greater number of depressive symptoms or working in a larger center were identified as risks to teacher sensitivity, and were moderated by higher levels of teacher training and observed program quality The current study provides preliminary support for the importance of examining the ways that teacher and setting characteristics are related to teacher interactions with young children.     

Factors of Programme Choice in Public Television: a national survey

The differing audience objectives of public and commercial television in the United States pose significant issues relative to how programmes are chosen for broadcast. Factors which influence the selection of programmes on public television (the chief broadcast outlet of educational programmes in America) warrant the scrutiny of media scholars, for such factors may prove influential in determining the nature of broadcast educational programmes. A survey of US public television programmers, conducted to examine factors perceived as important in making programme decisions, identified 11 factors, but about 70% of the total variance was explained by the first five factors: (1) audience measures, (2) personal feedback, (3) programme strategy, (4) station resources and (5) intuition. The audience measure factor explained the largest proportion of the variance (30%). Several factors were comparable with those used in an earlier study of commercial TV programme decision‐making. The findings suggest that perhaps internal constraints (station budget) cause public and commercial programmers to be similar in their perceptions about factors regarded as influential in programme selection     

Subsidizing child care: How child care subsidies affect the child care used by low-income African American families

To evaluate the type and quality of child care used by low-income families who were either receiving or not receiving subsidized child care, we interviewed 111 African American parents from a randomly selected sample of low-income families. We inquired about their child-care use, satisfaction with care, work stress, and employment history. Using standardized assessment instruments, independent observers in the children's child-care setting evaluated the quality of the care and characteristics of the providers. We found that families using subsidized child care were more likely to use center care and other more formal types of care, while families not using subsidized child care were more likely to use a relative in the relative's home. Families using subsidized care tended to use licensed and registered child-care arrangements more than non-subsidized families. Also, subsidized families spent approximately half as much out-of-pocket money for child care. However, we found no evidence that the care used by families using subsidized care was of any higher quality than that used by non-subsidized families. We examine the possibility that child-care subsidy programs may not be adequately designed or funded to increase the availability of quality child care to low-income families. Educators and policy makers may want to consider additional means of increasing access to quality care in low-income families.     

The relationship between child protection contact and mental health outcomes among Canadian adults with a child abuse history

Despite being a primary response to child abuse, it is currently unknown whether contact with child protection services (CPS) does more good than harm. The aim of the current study was to examine whether contact with CPS is associated with improved mental health outcomes among adult respondents who reported experiencing child abuse, after adjusting for sociodemographic factors and abuse severity. The data were drawn from the 2012 Canadian Community Health Survey-Mental Health (CCHS-2012), which used a multistage stratified cluster design (household-level response rate = 79.8%). Included in this study were individuals aged 18 years and older living in the 10 Canadian provinces (N = 23,395). Child abuse included physical abuse, sexual abuse, and exposure to intimate partner violence (IPV). Mental health outcomes included lifetime mental disorders, lifetime and past year suicidal ideation, plans, and attempts, and current psychological well-being and functioning and distress. All models were adjusted for sociodemographic factors and severity of child abuse. For the majority of outcomes, there were no statistically significant differences between adults with a child abuse history who had CPS contact compared to those without CPS contact. However, those with CPS contact were more likely to report lifetime suicide attempts. These findings suggest that CPS contact is not associated with improved mental health outcomes. Implications are discussed.     

Continuity of caregiver for infants and toddlers in center-based child care: Report on a survey of center practices

The purposes of this mail survey were to describe the extent to which child care programs use continuity of caregivers with infants and toddlers, the factors influencing decisions to move infants and toddlers to new classes, the practices used to prepare them for such moves, and the extent to which respondents agreed with the concept of providing continuity of caregivers. Child care programs accredited by the National Association for the Education of Young Children and those that were not accredited were selected randomly from existing data bases. Results indicate that (a) relatively few programs use continuity of caregivers for infants and even fewer use it for toddlers; (b) the majority of programs consider children’s attainment of developmental milestones, their age, and the space available in the next class when deciding when to transition infants and toddlers to new classes; (c) most centers used a number of practices to prepare infants and toddlers to move to new classes; and (d) more respondents report agreement with using continuity of caregivers than practice it. Relatively few differences were noted across accredited and nonaccredited centers on these issues.