A cost/effectiveness evaluation of lay therapy treatment for child abusing and high risk parents

This longitudinal investigation tested the effectiveness and cost-efficiency of a lay therapy treatment program in comparison with a standard social work treatment approach. A pretest-extended posttest research design was used to follow a group of child abusing and high risk mothers who received lay therapy (N = 27) and a randomized control group of similar clients (N = 28) over a 12-month period. Outcome data were obtained through interview and direct observation of the parents and children at six-month intervals. A variety of standardized instruments were used including Cattell's 16 Personality Factor Test, Coopersmith's Self-Opinion Form, and the Nurturance and Parent Observation Scales, adapted from Baumrind. Treatment success was defined as progression toward the mean scores of a matched comparison group (N = 21) obtained from the general population of the community during the pretest. The results indicated a trend toward improvement on the outcome measures for both treatment groups. The group receiving lay therapy treatment improved only slightly more than the group receiving standard treatment; however, there was also significantly less attrition with the lay therapy group. Analysis of time budget study data indicated that the lay therapists spent an average of 17.46 hours per month with each of their clients thus permitting the social workers to spend considerably less time with lay therapy clients. Analysis of the direct costs of the programs, based on time budget information, indicated that the lay therapy treatment involved more direct client contact than the standard treatment approach and was also substantially more costly. The high cost of the program was attributed to low caseloads and redundancy in supervision. This study presents several practical program and research recommendations.     

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.     

Screening for potential child maltreatment in parents of a newborn baby: The predictive validity of an Instrument for early identification of Parents At Risk for child Abuse and Neglect (IPARAN)

For preventive purposes it is important to be able to identify families with a high risk of child maltreatment at an early stage. Therefore we developed an actuarial instrument for screening families with a newborn baby, the Instrument for identification of Parents At Risk for child Abuse and Neglect (IPARAN). The aim of this study was to assess the predictive validity of the IPARAN and to examine whether combining actuarial and clinical methods leads to an improvement of the predictive validity. We examined the predictive validity by calculating several performance indicators (i.e., sensitivity, specificity and the Area Under the receiver operating characteristic Curve [AUC]) in a sample of 4692 Dutch families with newborns. The outcome measure was a report of child maltreatment at Child Protection Services during a follow-up of 3 years. For 17 children (.4%) a report of maltreatment was registered. The predictive validity of the IPARAN was significantly better than chance (AUC = .700, 95% CI [.567–.832]), in contrast to a low value for clinical judgement of nurses of the Youth Health Care Centers (AUC = .591, 95% CI [.422–.759]). The combination of the IPARAN and clinical judgement resulted in the highest predictive validity (AUC = .720, 95% CI [.593–.847]), however, the difference between the methods did not reach statistical significance. The good predictive validity of the IPARAN in combination with clinical judgment of the nurse enables professionals to assess risks at an early stage and to make referrals to early intervention programs.     

Parents in prison: A child abuse and neglect prevention strategy

Parents in Prison is an innovative family support service housed at the Tennessee State Prison for Men. Developed in response to inmates' recognition of the need for child abuse and neglect prevention services relevant to men who are in prison, the program model has potential for becoming a major service delivery strategy. Leadership for Parents in Prison is provided by an inmate committee which receives consultation and assistance from a community advisory board and an institutional sponsor. Program components--correspondence and classroom courses, monthly events featuring community guest speakers, and family-focused social activities and projects--address family needs during incarceration and upon return to community living. These diverse components and the flexible service delivery format permit widespread inmate participation not readily available in a prison setting. Parents in Prison successes demonstrate that the period of incarceration can be used to improve parental skills and knowledge and to strengthen family relationships. They also demonstrate the viability of a family support service which relies on inmate leadership, community volunteer participation, and institutional support. The future success of this model depends on replication in other prison settings, dissemination of the program products which have been and continue to be developed, and rigorous, systematic examination of the impact that participation has on child abuse and neglect problems associated with a father's incarceration.     

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

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

An evaluation of a support group for parents who have a sexually abused child

This study investigates the effectiveness of a parent support group for parents who have a child who has been sexually abused. The parents completed pre- and post-evaluation packages to assess the effectiveness of the group. The Louisville Behavior Checklist, the Parenting Stress Index, and a subjective evaluation using a rating scale and content analysis were used. The results indicated that there were significant decreases in some of the children's dysfunctional behaviors, and the parents found the group helpful and rated it highly stating that they learned coping skills and felt more confident as parents. The parents' stress levels did not change significantly. The implications of the results and suggestions for further research are discussed.     

Risk factors for child neglect: A meta-analytic review

Knowledge of risk factors and their effects is vital for successfully preventing and reducing child neglect. This study provides a meta-analytic update of research on risk factors for child neglect. A total of 315 effect sizes were extracted from 36 primary studies and classified into 24 risk domains. Effects of 15 risk domains were significant and ranged from small (r = .110) to large (r = .372) in magnitude. Most risks were found at the parental level, such as having a history of antisocial behavior/criminal offending (r = .372); having a history of mental/psychiatric problems (r = . 259); having mental/physical problems (r = .207); and experiences of abuse in own childhood (r = .182). The effect of mother-related risk factors was not significantly different from the effect of father-related risk factors. It is concluded that child neglect is determined by multiple risk domains and that especially parent-related risk factors are important in preventing and reducing child neglect. Implications of the results for clinical practice are discussed.     

Cumulative environmental risk in substance abusing women: early intervention, parenting stress, child abuse potential and child development

OBJECTIVE: To assess the relationship between cumulative environmental risks and early intervention, parenting attitudes, potential for child abuse and child development in substance abusing mothers. METHOD: We studied 161 substance-abusing women, from a randomized longitudinal study of a home based early intervention, who had custody of their children through 18 months. The intervention group received weekly home visits in the first 6 months and biweekly visits from 6 to 18 months. Parenting stress and child abuse potential were assessed at 6 and 18 months postpartum. Children's mental and motor development (Bayley MDI and PDI) and language development (REEL) were assessed at 6, 12, and 18 months postpartum. Ten maternal risk factors were assessed: maternal depression, domestic violence, nondomestic violence, family size, incarceration, no significant other in home, negative life events, psychiatric problems, homelessness, and severity of drug use. Level of risk was recoded into four categories (2 or less, 3, 4, and 5 or more), which had adequate cell sizes for repeated measures analysis. DATA ANALYSIS: Repeated measures analyses were run to examine how level of risk and group (intervention or control) were related to parenting stress, child abuse potential, and children's mental, motor and language development over time. RESULTS: Parenting stress and child abuse potential were higher for women with five risks or more compared with women who had four or fewer risks; children's mental, motor, and language development were not related to level of risk. Children in the intervention group had significantly higher scores on the PDI at 6 and 18 months (107.4 vs. 103.6 and 101.1 vs. 97.2) and had marginally better scores on the MDI at 6 and 12 months (107.7 vs. 104.2 and 103.6 vs. 100.1), compared to the control group. CONCLUSION: Compared to drug-abusing women with fewer than five risks, women with five or more risks found parenting more stressful and indicated greater inclination towards abusive and neglectful behavior, placing their infants at increased risk for poor parenting, abuse and neglect. Early home-based intervention in high-risk families may be beneficial to infant development.     

Behavioral intervention strategies with child abusive parents: A home intervention program

This article describes a therapeutic program for child abusive parents that is psychoeducationally based and is conducted through home visits by trained behavioral interventionists. The immediate goals of the intervention are to teach abusive parents effective child management procedures based on social learning therapy and to modify faulty or excessive expectations these parents have toward the behavior of their children. The general model is discussed as well as criteria for selection of parents for home intervention services, the differences between home intervention with abusive and non-abusive parents and the procedures used in home intervention services. A general discussion is also provided of the various goals and stages through which parents progress.     

Using and abusing rates of return: A critique of the world bank's 1995 education sector review

The World Bank's 1995 Education Sector Review relies very heavily on conventional rates of return to education (RORE) analysis in support of three (out of a total of six) key recommendations. This paper (i) critically examines how the Review draws on RORE research, (ii) shows that none of the alleged global RORE patterns exist; and (iii) more generally, questions the role of RORE analysis as an economic tool for education policy makers.     

Developmental effects of child abuse: A review

Most research investigating the effects of physical child abuse on children's development has been based on uncontrolled or poorly controlled studies having small samples, no long-term follow-up, and weak instrumentation. These studies, as well as some which have been more carefully designed, have generally suggested seriously detrimental developmental consequences in physical, intellectual, behavioral, and emotional areas. Some recent controlled follow-up studies challenge such a negative picture of abuse. In particular, a study by Elmer, which is probably the most carefully conducted study yet done, found that the harmful effects of abuse dissipated years after the abusive incident and that socioeconomic status (SES) and related factors may be more important than abuse in determining the course of child development. To improve the quality and clarity of future research on developmental effects of child abuse, this paper discusses, in four major areas, problems which plague the research. Definition: The extent, type, and frequency of abuse should be more carefully defined to allow studies to be compared. The types and amounts of social service interventions should also be specified. Generalization: Research should include more middle and upper SES children, more of the mildly and moderately abused, and more neglected children to allow generalization to the total population of maltreated children. Causality: Since developmental deficits may be the cause as well as the effects of abuse and because outside factors such as SES may lead to both the abuse and the deficits, there is a need for large-scale longitudinal studies which can untangle the cause and effect web of abuse by following children from birth and measuring many factors which might affect development (e.g., SES, birth abnormalities, abuse). Statistical Analysis: Future studies should always use statistical analysis and should obtain larger samples and utilize outcome and classification measures with demonstrated reliability and validity to increase statistical power.     

Treatment of parents who abuse their children: A literature review and implications for professionals

This article contains a review of the current treatment approaches to child abuse in terms of the following models: psychopathological, sociological, social-situational, family systems and social learning. The psychopathological model of child abuse emphasizes direct services. The services provided may consist of individual, group and lay treatment, volunteer companions, and self-help groups. The sociological model's approach to intervention emphasizes the need for wide-ranging changes in social values and structures. The socio-situational model's approach to treatment is based upon the assumption that the cause of child abuse lies not in the individual, but in the social situation, which may, in turn, be maintaining abusive patterns of behavior. The family systems approach to treatment resembles that of the socio-situational model in that it too emphasizes changing the family's pattern of interaction and behaviors. Finally, the social learning approach to treatment involves the identification of behavioral goals, specific techniques for achieving these goals, and the use of social reinforcers to facilitate this process. Data indicate that parents who abuse their children face multiple social and psychological difficulties. It has been suggested that the reason why treatment programs have not prodoced significant results in treating parents who abuse their children is that they focus on only one of the factors that operate to produce child abuse, i.e., lack of child management skills, marital dissatisfaction, or vocation or interpersonal skills dissatisfaction. It is logical that a treatment approach to abuse must view the problem as multi-determined and services should be structured in such a manner. Thus, the comprehensive treatment program should consist of the following; (1) Child Management Program; (2) Marital Enrichment Program; (3) Vocational Skills Enrichment Program; (4) Interpersonal Skills Enrichment Program. Programs to accomplish the acquisition of requisite skills in each of the four areas of emphasis are chosen from the technology of applied behavioral analysis. Each of the four program components is reviewed along with the rationale for a comprehensive program delivered through a behavioral group work approach. The article concludes with a discussion of the implementation and evaluation of the program.     

Parents,teachers and able readers in Key Stage 1: conversations with parents

This paper is a report of a series of semi‐structured interviews conducted with the parents of fifteen “precocious” readers during their child’s time in Key Stage 1. The parents were interviewed three times: once each academic year. The views expressed are those of the parents. There are important lessons to be learned from these parents. However, it has to be recognised that, as the parents of children with a precocious skill, their experiences may be atypical.     

Repeat reports among cases reported for child neglect: A scoping review

BackgroundIn the United States (US), child welfare policy prioritizes prevention of future harm (e.g., repeat reports) after a report of maltreatment. The majority of reports include some form of child neglect, but no prior review of the recurrence literature has focused on neglect.ObjectiveThis review sought to help guide future research, policy and practice by summarizing recurrence findings related to child neglect with attention to the broader ecological context in which maltreatment occurs.ParticipantsThe final review included 34 US studies of maltreatment recurrence. Twenty-eight studies compared child neglect with at least one other form of maltreatment and six studies examined recurrence among neglect cases.MethodsEleven online databases were searched to locate relevant empirical studies. This review attended specifically to contextualizing findings according to other modifiable factors as well as methodological variation. A scoping review approach was used to summarize findings.ResultsOf the 28 studies comparing neglect to other types of maltreatment, 14 found increased risk for neglect, 12 found no association, and two reported a lower risk. When significant, the effect size ranged from 10% to over three times higher risk for neglect. Poverty or material need was the most commonly included control (15 studies), with two thirds finding that lower resource families had higher risk.ConclusionMethodological variability across studies confounds current ability to guide practice or policy. More research is needed that can replicate and extend findings with comparable samples and model specifications that take into account the regional and policy context.     

Dispositional empathy in high- and low-risk parents for child physical abuse

OBJECTIVE: The present study was designed to investigate dispositional empathy in high-risk parents for child physical abuse, using self-report instruments. More specifically, the objective was to know if high-risk parents for child physical abuse, in comparison with low-risk parents, show deficits on main dimensions of dispositional empathy: empathic concern, role-taking, and personal distress. METHOD: Based on their scores on the Abuse Scale of the CAP Inventory (Milner, 1986), 36 high-risk and 38 low-risk for child physical abuse participants were selected from a total sample of 440 Basque Country (Spain) general population parents. Both groups were statistically matched on sociodemographic variables. The Interpersonal Reactivity Index (IRI, Davis, 1980), the Hogan Empathy Scale (HES, Hogan, 1969) and the Questionnaire Measure of Emotional Empathy (QMEE, Mehrabian & Epstein, 1972) were used to assess dispositional empathy. RESULTS: As expected, high-risk, relative to low-risk, parents showed lower total scores on the HES and QMEE measures and lower scores on the IRI "Empathic concern" dimension. Moreover, high-risk, relative to low-risk, parents showed higher scores on the IRI "Personal distress" dimension. No differences between groups were observed for the IRI "Perspective-taking" dimension. CONCLUSIONS: Findings of the present study supported the hypothesis that high-risk parents for child physical abuse show a deficit in dispositional empathy. High-risk parents reported less feelings of warmth, compassion and concern for others and more feelings of anxiety and discomfort that result from observing another's negative experience.