Parental substance abuse as a predictor of child maltreatment re-reports

This longitudinal study of child abuse and neglect cases closed after investigation examined the impact of parental substance abuse on family functioning and on subsequent referrals to child protective services. The findings support the hypothesis that parental substance abuse would have a negative impact on family functioning, which, in turn, would result in a higher rate of re-reports. As expected, substance abuse also had a direct impact on re-reports. It is critical that the child welfare system recognize and respond to parental substance abuse problems in these families through expanded and improved voluntary, and perhaps, mandatory services.     

The relationship between parental substance abuse and child maltreatment: findings from the Ontario Health Supplement

OBJECTIVE: This study examined the relationship between reported exposure to child abuse and a history of parental substance abuse (alcohol and drugs) in a community sample in Ontario, Canada. METHOD: The sample consisted of 8472 respondents to the Ontario Mental Health Supplement (OHSUP), a comprehensive population survey of mental health. The association of self-reported retrospective childhood physical and sexual abuse and parental histories of drug or alcohol abuse was examined. RESULTS: Rates of physical and sexual abuse were significantly higher, with a more than twofold increased risk among those reporting parental substance abuse histories. The rates were not significantly different between type or severity of abuse. Successively increasing rates of abuse were found for those respondents who reported that their fathers, mothers or both parents had substance abuse problems; this risk was significantly elevated for both parents compared to father only with substance abuse problem. CONCLUSIONS: Parental substance abuse is associated with a more than twofold increase in the risk of exposure to both childhood physical and sexual abuse. While the mechanism for this association remains unclear, agencies involved in child protection or in treatment of parents with substance abuse problems must be cognizant of this relationship and focus on the development of interventions to serve these families.     

Parental cognitive impairment and child maltreatment in Canada

Objectives

The aim of this study was to determine the prevalence of parental cognitive impairment in cases opened for child maltreatment investigation in Canada, and to examine the relationship between parental cognitive impairment and maltreatment investigation outcomes including substantiation, case disposition and court application.

Methods

The method was secondary analysis of the Canadian Incidence Study of Child Abuse and Neglect (CIS-2003) core-data, which is derived from a multi-stage stratified cluster sample of 11,562 child maltreatment investigations.

Results

Parental cognitive impairment was noted in 10.1% of sampled cases that were opened for child maltreatment investigation in 2003, and in 27.3% of sampled cases that resulted in child welfare court application. Neglect was the most common cause of concern. With child and case characteristics held constant, parental cognitive impairment predicted investigation outcomes. The data further suggest that the relationship between parental cognitive impairment and investigation outcomes was partially mediated by perceived parent non-cooperation, mental health issues and low social support.

Conclusions

The number of children who are living with a parent with cognitive impairment and who are referred for protective services is thought to be increasing. Building systems capacity to support parents with cognitive impairment and promote child wellbeing is therefore essential to containing the human and economic costs of maltreatment and out-of-home care.

Practice implications

A broad-spectrum approach is needed to support parents with cognitive impairment and their children. Equipping services with the knowledge, skills, and mandate they need to deliver evidence-based parent training is vital. However, strategies are also needed to tackle discrimination, alleviate family poverty, strengthen the social ties of parents with cognitive impairment and in turn, improve the life chances of their children.     

Mental health professionals' experiences reporting suspected child abuse and maltreatment

OBJECTIVE: The purpose of this study was to provide systematic data on the experiences of mental health professionals (e.g., psychiatrists, psychologists, and social workers) who reported cases of suspected child abuse and maltreatment concerning their clients. METHOD: Mail surveys were completed by 258 mental health professionals known to have reported a case of suspected child abuse and maltreatment to the New York State Central Register (NYSCR) in 1993. Subjects were asked to complete a survey describing their experience with making reports, referring to a specific case they reported. RESULTS: About 40% did not inform the client about the limits of confidentiality until reportable material came up. Most clinicians reported that informing clients about the limits of confidentiality did not deter them from entering treatment. Many clinicians learned about abuse/maltreatment after approximately 3 months into therapy. Even very experienced clinicians usually consulted with others before making the report. Clinicians most typically informed the client about the report directly and before it was made, but did not call the NYSCR in the presence of the client. Following the report, most clinicians performed additional activities such as calling clients and scheduling additional sessions. When clients evidenced resistance to continuing therapy, it usually dissipated after a brief period of time. In over 72% of the cases, making the report did not disrupt the relationship and in many instances it was helpful in the therapeutic process; about 27% were continuously resistant or terminated therapy shortly after the report was made. CONCLUSIONS: Implications for practice, training, program development, and research are discussed.     

Parental compliance to court-ordered treatment interventions in cases of child maltreatment

The authors reviewed 136 court cases representing 218 parents of children maltreated enough to warrant custodial transfer of the child from the parents to the state. The court's psychotherapeutic treatment orders were noted and parental compliance with those orders documented and analyzed. The court issued one or more specific treatment orders to 87.26% of all parents. The most common referrals were those for drug or alcohol treatment (61.9%), individual psychotherapy (60.6%), and family treatment (29.4%). Treatment compliance was significantly lowered in those parents presenting with substance abuse. Compliance was also significantly lower among those parents who sexually and/or physically maltreated their children than among parents who neglected but did not physically or sexually maltreat their children.     

Measuring child maltreatment in the United Kingdom: a study of the prevalence of child abuse and neglect

OBJECTIVE: To provide reliable measures of the prevalence of all forms of child maltreatment in the UK that will be robust in the context of social and cultural differences due to social class, ethnicity and, region. METHODS: Two thousand eight hundred sixty-nine (2,869) young adults aged 18=-24, obtained by random probability sampling throughout the UK, were interviewed face to face by trained interviewers. Maltreatment was defined using a post hoc assessment of a range of experienced behaviors and treatments while the respondents were aged 16 or under. RESULTS: Over 90% of respondents reported that they came from a warm and loving family background. Maltreatment (both intra and extrafamilial) was experienced by 16% of the sample. Serious maltreatment was experienced by 7% of respondents for physical abuse, 6% for emotional abuse, 6% for absence of care, and 5% for absence of supervision, and 11% reported sexual abuse involving contact. Attitudes to maltreatment were explored through the examination of respondents' views of different behaviors and experiences that children may have been exposed to. CONCLUSION: The maltreatment of children in the UK today remains an extensive social problem. Prevalence data reveal that children are most at risk in the home for physical and emotional abuse and neglect. They are at greater risk of sexual abuse outside the home, particularly in dating relationships.     

Domestic violence,parental substance misuse and the decision to substantiate child maltreatment

Families that experience domestic violence and parental substance misuse are disproportionately involved with the child welfare system. Prior research suggests that child protective services (CPS) caseworkers are more likely to substantiate maltreatment allegations when domestic violence and parental substance misuse are identified during the investigation, pointing to one possible mechanism for this disproportionate involvement. While previous studies have relied on nationally representative data sets, the current study used administrative records from a large Midwestern child welfare agency that accounts for state-level variation in child welfare policy and practice. A total of 501,060 substantiation decisions made between 2009 and 2013 were examined to assess the influence of caseworker-perceived domestic violence and parental substance misuse on the decision to substantiate reported maltreatment. Results from multilevel modeling suggest that the identification of domestic violence and parental substance misuse during an investigation significantly increased the probability that an allegation would be substantiated. The implication of these findings for child welfare practice are considered in light of the fact that many child welfare agencies do not consider exposure to domestic violence and parental substance misuse in and of themselves to constitute child maltreatment.     

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.     

Fatal child maltreatment: Characteristics of deaths from physical abuse versus neglect

This study examined victim, family, and alleged perpetrator characteristics associated with fatal child maltreatment (FCM) in 685 cases identified by child welfare services in the state of Oklahoma over a 21-year period. Analyses also examined differences in child, family, and alleged perpetrator characteristics of deaths from abuse versus neglect. Case information was drawn from child welfare investigation records for all FCM cases identified by the state Department of Human Services. Fatal neglect accounted for the majority (51%) of deaths. Children were primarily younger than age 5, and parents were most frequently the alleged perpetrators. Moreover, most victims had not been the subject of a child welfare report prior to their death. A greater number of children in the home and previous family involvement with child welfare increased children's likelihood of dying from neglect, rather than physical abuse. In addition, alleged perpetrators of neglect were more likely to be female and biologically related to the victim. These results indicate that there are unique family risk factors for death from neglect (versus physical abuse) that may be important to consider when selecting or developing prevention efforts.     

Child maltreatment and risk patterns among participants in a child abuse prevention program

The relationship between risk factors and Child Protective Services (CPS) outcomes in families who participate in home visiting programs to prevent abuse and neglect and who are reported to CPS is largely unknown. We examined the relationship between parental risk factors and the substantiation status and number of CPS reports in families in a statewide prevention program. We reviewed CPS reports from 2006 to 2008 for families in Connecticut's child abuse prevention program. Six risk factors (histories of CPS, domestic violence [DV], mental health, sexual abuse, substance abuse, and criminal involvement) and the number of caregivers were abstracted to create risk scores for each family member. Maltreatment type, substantiation, and number of reports were recorded. Odds ratios were calculated. Of 1,125 families, 171 (15.6%) had at least one CPS report, and reports of 131 families were available for review. Families with a substantiated (25.2%) versus unsubstantiated (74.8%) first report had a high number of paternal risk factors (OR = 6.13, 95% CI [1.89, 20.00]) and were more likely to have a history of maternal DV (OR = 8.47, 95% CI [2.96, 24.39]), paternal DV (OR = 11.23, 95% CI [3.33, 38.46]), and maternal criminal history (OR = 4.55; 95% CI [1.32, 15.60]). Families with >1 report (34.4%) versus 1 report (65.6%) were more likely to have >3 caregivers, but this was not statistically significant (OR = 2.53, 95% CI [0.98, 6.54]). In a prevention program for first-time families, DV, paternal risk, maternal criminal history, and an increased number of caregivers were associated with maltreatment outcomes. Targeting parental violence may impact child abuse prevention.     

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.     

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.     

Predicting child maltreatment recurrences during treatment.

The primary purpose of the child protective services system is to protect children from the recurrence of child maltreatment. Understanding more about what predicts recurrence may help us more adequately target interventions to reduce the risk of future maltreatment. OBJECTIVE: The specific objective of this study was to identify correlates of recurrence during CPS intervention for families who were provided continuing intervention following a confirmed index report of physical abuse or neglect. METHOD: This nonconcurrent prospective study selected 446 subject families who met study eligibility requirements from 1,181 families randomly selected from the 2,902 families who had experienced a substantiated report of child abuse or neglect during the sampling year. Data were collected and coded from archival sources for 5 years following the index report. Each record was coded by two research analysts to increase inter-rater reliability. Data were analyzed with survival analysis methods: (1) Kaplan Meier and (2) the Cox Proportional Regression Model. RESULTS: Predictors of recurrence were child vulnerability, family stress, partner abuse, social support deficits, and an interaction between family stress and social support deficits. CONCLUSIONS: Implications of this and earlier research suggest that increasing social supports may help families cope with life events that increase stress and the risk of continued child maltreatment; that collaborations between CPS and domestic violence agencies are needed; and that screening maltreated children for mental health problems and other disabilities and assuring that children with these needs and their families get effective treatment may reduce the likelihood of continued maltreatment.     

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.     

Measuring the severity of child maltreatment

OBJECTIVE: The purpose was to identify different operational definitions of maltreatment severity, and then to examine their predictive validity. METHOD: Children and their primary caregivers participating in a consortium of ongoing longitudinal studies were interviewed when they were approximately 4 and 8 years of age to assess behavior problems, and developmental and psychological functioning. Four different severity definitions were identified and applied to 519 children who were reported for alleged maltreatment between Birth and the Age 8 interview. A taxonomy for defining maltreatment characteristics (Barnett, Manly, & Cicchetti, 1993) was applied to Child Protective Service records to define severity as (a) Maximum Severity within each of five maltreatment types, (b) Overall Maximum Severity across the five types, (c) Total Severity or the sum of the maximum severity for each of five types, and (d) Mean Severity or the average severity for those types of maltreatment alleged, during each of two time periods-Birth to Age 4, and Age 4 to Age 8. RESULTS: Regression analyses that controlled for socio-demographic factors, early maltreatment (Birth to Age 4), prior functioning (Age 4), and site revealed that (a) all four severity definitions for maltreatment reports between Age 4 and Age 8 predicted Age 8 behavior problems, (b) Maximum Severity by Type and Mean Severity predicted adaptive functioning at Age 8, and (c) only Maximum Severity by Type was related to anger, at Age 8. Follow-up regression analyses indicated that only Maximum Severity by Type, specifically physical abuse, accounted for outcomes, beyond maltreatment occurrence versus non-occurrence. CONCLUSION: The results suggest that maltreatment severity definitions that preserve ratings within types of maltreatment may be the optimal approach to measure the severity of children's experiences.     

Childhood history of abuse and child abuse screening.

Although a childhood history of abuse is related to parental child abuse, many parents with a history of abuse are not abusive. To determine the effects of a childhood history of abuse on adult child abuse potential, a modified Conflict Tactics Scale (CTS) and the Child Abuse Potential (CAP) Inventory were administered to matched groups of physically abusive mothers with a childhood history of abuse, nonabusive comparison mothers with a childhood history of abuse, and nonabusive comparison mothers without a childhood history of abuse. The modified CTS asked about childhood events and was used to confirm a childhood history of abuse. As expected, the CTS verbal and violence scales were higher for the abusive and nonabusive mothers with a childhood history of abuse. None of the CTS scores were different for the abusive and nonabusive mothers with a childhood history of abuse. In contrast, the CAP abuse scores distinguished between all three study groups. However, on the CAP factor scales, only the rigidity and unhappiness factors discriminated between abusive and nonabusive mothers with a childhood history of abuse. Nonabusive mothers with a childhood history of abuse were less rigid in their child expectations and were happier in their interpersonal relationships than abusive mothers with a childhood history of abuse.