Child abuse reporting: teachers' perceived deterrents

OBJECTIVE: There are three general objectives: First, to determine the number of reports of abuse made by teachers, their knowledge of child abuse laws and reporting procedures, and their perceived deterrents in reporting abuse; second, to determine if there were gender or ethnic differences in reporting; and third, to evaluate teachers responses to case vignettes. METHOD: A survey of 197 teachers was conducted. They were given a questionnaire that included demographic information, knowledge of child abuse laws and procedures, and two scenarios of legally reportable child abuse. RESULTS: Seventy-three percent of this sample reported that they had never made a report of child abuse, while those who had made reports made an average of one report. Only 11% of teachers reported that there were instances in which they believed abuse may have occurred, but failed to report. Additionally, these teachers felt that their pre- and post-service training did not adequately prepare them for abuse reporting. The most common reasons cited for not reporting abuse were fear of making an inaccurate report, feeling as though child protective services do not help families, and no apparent physical signs of abuse. There were no gender differences in reporting. The teachers' responses to the case vignettes were not consistent with their previous reports. CONCLUSIONS: In general, most teachers reported having never made a child abuse report. Although only a small percentage of teachers reported failing to report abuse, when presented with legally reportable case vignettes, many failed to report. The majority of teachers report receiving inadequate training in child abuse signs, symptoms, and reporting procedure. There is an obvious need for more education for teachers that addresses their perceived deterrents and aids them in feeling more confident in making reports of child abuse.     

Substance abuse and serious child mistreatment: prevalence, risk, and outcome in a court sample

This study examined the prevalence and specific types of substance abuse in a sample of 206 cases of serious child abuse or neglect brought before a metropolitan juvenile court on care and protection petitions. In 43% of the cases, at least one of the parents had a documented problem with either alcohol or drugs, a figure which rose to 50% when alleged instances of substance abuse were included. Alcohol, cocaine, and heroin were the three most frequently mentioned abused substances. Parents with documented substance abuse were significantly more likely than nonsubstance-abusing parents to have been referred previously to child protective agencies, to be rated by court investigators as presenting high risk to their children, to reject court-ordered services, and to have their children permanently removed. When the two factors of court investigator high risk ratings and presence of parental substance abuse were combined, it was possible to obtain even higher levels of prediction of which parents would reject services and have their children permanently removed. Results suggest (1) the importance of increased screening, evaluation, and treatment of parental substance abuse in cases of serious child mistreatment; and (2) the possibility of adopting a predictive approach as to which families will be able to respond to court-ordered treatment requests and have their children returned.     

Professionals' decision-making about out-of-home placements following instances of child abuse

OBJECTIVE: The goal of this research was to study how different groups of child welfare professionals prioritize and use information to make placement decisions following instances of child abuse. METHOD: A total of 90 juvenile court judges and guardians ad litem, Court Appointed Special Advocates (CASA), social workers, and mental health professionals responded to a detailed questionnaire describing four case studies of child physical abuse in which a parent was the perpetrator, the child was either 2 years or 6 years of age, and the abuse was either first time or chronic. Participants rated the impact of specific pieces of information regarding child, family, and system-level characteristics on their decision-making process. RESULTS: Analyses of reactions to these vignettes demonstrate that professional groups use different kinds of information when making decisions about foster care placements. Social workers and mental health providers rely on information about the severity and pattern of abuse and on information about services offered in the past and parental responses to those services. Judges and guardians ad litem rely more heavily on information about the likelihood of a reoccurrence of abuse and the child's ability to recount the abuse, whereas CASA volunteers rely on information about the stability of the family. CONCLUSIONS: Professional group membership, rather than factors such as age or ethnicity of the child or chronicity of abuse, accounts for different patterns of prioritizing and using information when making decisions about whether a child should remain in the home or be placed in foster care. The implications for community-based training and intervention efforts are discussed.     

Knowledge and management strategies in incest cases: A survey of physicians, psychologists and family counselors

A questionnaire was mailed to all 255 psychologists, psychiatrists, pediatricians, and family counselors listed in the 1983 telephone directory. Of the 108 private practitioners who responded, over one-half had treated a child or adult incest victim in the past year; 86% requested more training in this area. Practitioners had a high level of general knowledge about intrafamilial child sexual abuse. Nevertheless, one-third stated they would not refer to protective services a child who had first made, but then retracted, an incest allegation. While most pediatricians would recommend physical examination of a child who had retracted, only half of other professionals would do so. Women practitioners were more realistic about the high frequency of actual father-daughter incest and were more likely to report the hypothetical case of the retracted allegation.     

Protecting seriously mistreated children: time delays in a court sample.

The study examined the progress through the child protective system of a sample of 206 severely abused and/or neglected children brought before the Boston Juvenile Court (BJC) on Care and Protection (C & P) petitions. Overall, children were in the system an average of 5 years from the filing of the first official report of mistreatment to the resolution of their cases. The families had been known to the state child protective service agency for an average of more than 2.5 years before the current court involvement. Once arraigned in juvenile court on the C & P, the average case took almost 1.5 years to reach a disposition. After disposition, children permanently removed from parental custody required, on average, an additional year and a half in Probate Court to reach a permanent placement. Of the more than twenty variables examined, including severity of mistreatment, protective service history, and parental mental illness, no meaningful pattern emerged which could predict delays. Our findings characterize the delays experienced by many abused and neglected children, and highlight the necessity of closer monitoring of the progress of cases through the protective and court systems.     

Survivors of institutional abuse in long-term child care in Scotland

BackgroundThe Scottish Child Abuse Inquiry (SCAI) commissioned the research project to document the outcomes of institutional abuse in long-term child care in Scotland.ObjectiveTo profile the experiences of survivors abused in long-term child care in Scotland, and to develop a model which linked maltreatment, risk and protective factors, and outcomes.Participants and Setting225 survivors of historical institutional abuse in Scotland, who made witness statements to SCAI.MethodsData were extracted from witness statements using a coding frame developed through a thematic analysis of a subsample of 52 statements.ResultsSurvivors had been in care in predominantly Catholic and non-religious residential institutions in Scotland for an average of 8 years, having entered at an average age of 6.8 years. They had suffered multiple forms of maltreatment. Maltreatment rates were: physical abuse, 95.6%; emotional abuse, 85.3%; sexual abuse, 60.4%; emotional neglect, 51.1%; and physical neglect, 37.3%. Across the lifespan survivors had negative outcomes in psychosocial adjustment (96%), mental health (84%), and physical health (43%). The effect of maltreatment in care on psychosocial problems was mediated by both risk and protective factors; and on mental health was mediated by risk factors, but not protective factors. Maltreatment in care had a direct effect on physical health which was not mediated by risk or protective factors. The effects of the cumulative number of risk factors on adverse mental health and psychosocial outcomes was greater than that of maltreatment, and protective factors had a limited impact on adverse outcomes.ConclusionsEvidence-based child protection policies and practices should be implemented to prevent institutional abuse and treat child abuse survivors in Scotland.     

Child maltreatment in the "children of the nineties" a longitudinal study of parental risk factors.

OBJECTIVE: To identify and validate factors within the parental background affecting risk of child maltreatment. METHOD: A nested case-control study based on the Avon Longitudinal Study of Parents and Children ("Children of the Nineties"), a cohort of children born in Avon in 1991 through 1992. Data on the childhood and psychiatric histories of the parents, along with other data on the social and family environments, have been collected through postal questionnaires from early antenatal booking onwards. RESULTS: Out of 14,138 participating children, 162 have been identified as having been maltreated. Using logistic regression analysis, significant risk factors within the mothers' backgrounds were age < 20; lower educational achievement; history of sexual abuse; child guidance or psychiatry; absence of her father during childhood; and a previous history of psychiatric illness. Significant factors in the fathers' backgrounds were age < 20; lower educational achievement; having been in care during childhood; and a history of psychiatric illness. Significant factors on univariate, but not multivariate analysis included a parental history of childhood physical abuse; divorce or separation of the mother's parents; a maternal history of having been in care, or separated from her mother; parental alcohol or drug abuse; and a maternal history of depression. CONCLUSIONS: This study, the first of its kind in the UK, supports the findings of others that parental age, educational achievement, and a history of psychiatric illness are of prime importance in an understanding of child maltreatment. With the exception of maternal sexual abuse, a history of abuse in childhood is not significant once adjusted for other background factors. The study suggests that psychodynamic models are inadequate to explain child maltreatment, and wider models incorporating other ecological domains are needed.     

Social history: A qualitative analysis of child abuse pediatricians’ consultation notes

BackgroundChild abuse pediatricians (CAPs) are often consulted for injuries when child physical abuse is suspected or when the etiology of a serious injury is unclear. CAPs carefully evaluate the reported mechanism of the child’s injury and the medical findings in the context of the child’s family and social setting to identify possible risk and protective factors for child abuse and the need for social services. It is unknown what population risk indicators along with other social cues CAPs record in the social history of the consultation notes when assessing families who are being evaluated for child physical abuse.Participants and settingThirty-two CAPs representing 28 US child abuse programs.MethodsParticipants submitted 730 completed cases of inpatient medical consultation notes for three injury types: traumatic brain injury, long bone fracture, and skull fracture in hospitalized children 4 years of age and younger. We defined a priori 12 social cues using known population risk indicators (e.g., single mother) and identified de novo 13 negative (e.g., legal engagement) and ten positive social cues (e.g., competent parenting). Using content analysis, we systematically coded the social history for the social cues.ResultsWe coded 3,543 cues resulting in a median of 7 coded cues per case. One quarter of the cues were population indicators while half of the cues were negative and one quarter positive.ConclusionsCAPs choose a wide variety of information, not always related to known population risk indicators, to include in their social histories.     

What predicts injury from physical punishment? A test of the typologies of violence hypothesis

OBJECTIVE: This study examined the power of child, perpetrator, and socio-economic characteristics to predict injury in cases of reported child physical abuse. The study was designed to assess the validity of the assumption that physically injurious incidents of child physical abuse are qualitatively different from those that do not result in injury, that their generative factors are distinctive, and that the quality of caregiving in these two types of incidents is different. METHOD: A weighted, nationally representative sample of 8,164 substantiated punishment abuse cases in Canada was used. Various models were constructed and evaluated through logistic regression. RESULTS: Of six potential predictors - child age, perpetrator sex, child functioning, parent functioning, economic stress, and social stress - none predicted injury to the child. CONCLUSIONS: The findings suggest that injurious and non-injurious physical abuse cannot be distinguished on the basis of the personal characteristics or circumstances of the child or perpetrator. PRACTICE IMPLICATIONS: A common criterion for child welfare intervention into cases of suspected physical abuse is injury or risk of injury. This criterion assumes that injurious and non-injurious assaults are qualitatively different phenomena, predicted by different risk factors. In the present study an attempt was made to differentiate between injurious and non-injurious cases of punitive physical abuse on the basis of characteristics of the child, perpetrator, family, and social context. None of these factors explained the likelihood of injury, suggesting that the prediction of injury as an intervention criterion may be questionable.     

The incidence of severe physical child abuse in Wales

OBJECTIVES: The purposes of this study were: (1) to ascertain the incidence and nature of severe physical child abuse in Wales; (2) to ascertain the incidence of all physical abuse in babies under 1 year of age; and (3) to determine whether child protection registers (CPR) accurately reflect the numbers of children who are physically abused. METHODS: This is a population-based incidence study based in Wales, UK, for 2 years from April 1996 through March 1998. Children studied were under the age of 14 with severe physical abuse consistent with the criminal law level of Grievous Bodily Harm. This included seven categories of injury (death; head injury including subdural hemorrhage; internal abdominal injury; physical injury in Munchausen Syndrome by Proxy including suffocation; fracture; burn or scald; adult bite). Cases were ascertained by a pediatrician surveillance reporting system (WPSU). A criterion for inclusion was multidisciplinary agreement that physical abuse had occurred (at case conference, strategy meeting, or Part 8 Review). The incidence of all babies under 1 year of age with physical abuse was also studied. Ascertainment of babies under the age of 1 year was undertaken from CPR as well as the WPSU. RESULTS: Severe abuse is six times more common in babies [54/100,000/year (95% CI +/- 17.2)] than in children from 1 year to 4 years of age [9.2/100,000 (95% CI +/- 3.6)]. It is 120 times more common than in 5- to 13-year-olds [0.47/100,000 (95% CI +/- 0.47)]. This is mainly because two types of serious abuse (brain injury including subdural hemorrhage and fractures) are more common in babies under the age of 1 year than older children. Using data from two sources (the WPSU and CPRs), the incidence of physical abuse in babies is 114/100,000 (CI 114 +/- 11.8) per year. This equates to 1 baby in 880 being abused in the first year of life. The largely rural Health Authority area in Wales had incidence figures for abuse in babies that were 50% of the three other predominantly urban Health Authority areas. Boys throughout the series were more at risk of being severely abused than girls (p < .025). Only 29% of the babies under 1 year of age on the CPR had actually been injured. Thirty percent of abused babies under the age of 1 year and 73% of severely abused children over the age of 1 year had caused previous concern to health professionals regarding abuse or neglect. Conclusions: Physical abuse is a significant problem in babies under the age of 1 year. Very young babies (under 6 months old) have the highest risk of suffering damage or death as a result of physical abuse. Severe abuse, in particular subdural hematoma and fracture, is much more common in babies than in older children. There is evidence of failure of secondary prevention of child abuse by health professionals, with a greater need to act on concerns regarding abuse and neglect. Interagency child protection work in partnership with parents should focus more on protecting babies under age 1 year from further abuse than on maintenance of the infant within an abusive home. The CPR is not intended as an accurate measure of children suffering abuse. It is a record of children requiring a child protection plan and must not be used as a measure of numbers of abused children.     

Parental alienation,coaching and the best interests of the child: Allegations of child sexual abuse in the Family Court of Australia

BackgroundAllegations of child sexual abuse provide complex challenges to family court systems.ObjectivesDespite being highly criticised in the academic research, this analysis examined whether and how the gendered concepts of parental alienation syndrome or parental alienation more broadly are still being used to rebut allegations of child sexual abuse in family court cases in Australia. Parental Alienation is broadly understood as the deliberate actions of one parent to disrupt and prevent children’s ongoing relationships with their other parent, in this case through allegations of abuse.MethodsWe examined 357 publicly available judgements of the Family Court of Australia between 2010 and 2015. Judgements were analysed qualitatively for key themes using N-VIVO software.ResultsFive themes emerged in the data, including use of the concept of parental alienation, coaching, mothers as manipulative, mothers as mentally ill, and impact of the best interest of the child.ConclusionsResults indicate that judgements made in the Family Court of Australia are both similar and divergent from those made in other jurisdictions internationally. The complexity of responding to allegations of child sexual abuse for parents is discussed.     

Identified spouse abuse as a risk factor for child abuse

CONTEXT: There are limited data on the extent to which spouse abuse in a family is a risk factor for child abuse. OBJECTIVE: To estimate the subsequent relative risk of child abuse in families with a report of spouse abuse compared with other families. DESIGN: Cohort study. SETTING: Analysis of a centralized US Army database PARTICIPANTS: Married couples with children with at least one spouse on active duty in the US Army during 1989-95. MAIN OUTCOME MEASURES: The US Army Family Advocacy Program's Central Database was used to identify child and spouse abuse. The exposure was an episode of identified spouse abuse and the main outcome was a substantiated episode of subsequent child abuse.RESULTS: During the study period of an estimated 2,019,949 person years, 14,270 incident child abuse cases were substantiated. Families with an incident case of spouse abuse identified during the study period were twice as likely to have a substantiated report of child abuse compaired with other military families, rate ratio, 2.0, (95% confidence interval [CI] 1.9-2.1). Young parental age had the highest rate ratio, 4.9 (95% CI 4.5-5.3) in the subgroup analysis controlling for rank. Identified spouse abuse was associated with physical abuse of a child, rate ratio 2.4 (95% CI 2.2-2.5), and with sexual abuse of a child, rate ratio 1.5 (95% CI 1.3-1.7). Identified spouse abuse was not associated with child neglect or maltreatment, rate ratio, 1.0 95% CI 0.9-1.1) CONCLUSION: An identified episode of spouse abuse in a family appears to be associated with an increased risk of subsequent child abuse and serves as an independent risk factor. Therefore. care providers should consider the potential risk to children when dealing with spouse abuse.     

Cross-cultural comparisons of child-reported emotional and physical abuse: rates, risk factors and psychosocial symptoms

OBJECTIVES: This study was designed to assess the incidence of child emotional and physical abuse, associated risk factors and psychosocial symptoms in a cross-cultural comparison between post-communist bloc countries. Method: One-thousand one-hundred forty-five children ages 10-14 from Latvia (N = 297), Lithuania ( N = 300), Macedonia (N = 302), and Moldova (N = 246) participated in the study. They completed questionnaires assessing their experience of emotional or physical abuse, and provided information about family risk-factors and psychosocial symptoms, including PTSD-related symptoms. RESULTS: Incidence rates of maltreatment differed by country, as did levels of reported psychosocial symptoms. Incidence of emotional and physical abuse differed by region, with higher levels of abuse reported in the rural regions. In all four countries, a similar association between emotional/physical abuse and psychosocial symptoms was found, with the uniformly largest correlation between emotional abuse and anger. When examining the combined scores of emotional and physcial abuse, even higher correlation's were found, particularly in relation to anger and depression. In all four countries, parental overuse of alcohol was associated with emotional and/or physical abuse. CONCLUSIONS: Findings show differences by country in child-reported levels of emotional and physical abuse, but similar patterns of correlation with psychosocial symptoms and the risk factors of parental alcohol overuse and living in a rural area.     

How are parental functioning and single parenthood associated with court outcomes? An analysis of child protection cases

Impaired parental functioning and single parenthood are considered risk factors for child maltreatment and being involved in the child protection context. Past research has shown that an impaired mental functioning and being a single parent are indicators of limited parenting resources. These risk factors are likely to be considered by family judges, which might lead to more intrusive court decisions concerning parental custody. To date, court data have rarely been investigated. The present study examined parental mental health and single parenthood using data from family law proceedings. The role of the fathers has been understudied and the few existing studies yielded contradictory results with respect to fathers’ involvement as risk or protective factor. Therefore, the study included both fathers’ data and mothers’ data. A total of 220 child protection court files with 343 affected children were coded using a category system. Parental mental health was coded as parental functioning in daily life and was significantly associated with the court outcome. Multilevel mediation analyses showed a significant indirect effect of maternal functioning on the intrusiveness of the court decisions via child maltreatment. Single motherhood moderated the effect: The indirect effect was more pronounced for single mothers. This study contributes to a better understanding of the population getting before court and the judicial process. Psychological attributes do play a role in the decision-making of judges; and taking the role of the fathers into account is necessary.     

Gender differences in the risk for delinquency among youth exposed to family violence

OBJECTIVE: The purpose of this research was to illuminate gender differences in adolescent delinquency against a backdrop of childhood exposure to both marital violence and physical child abuse. Specifically, analyses were performed to trace the unique effects of exposure to either form of family violence (marital or child) on the violent and nonviolent delinquency of boys and girls. METHOD: This is a prospective study of 299 children who were interviewed with their mothers in 1991 about forms of abuse in the family. Approximately 5 years later a search of juvenile court records was performed for these same children. Details on the nature of the crimes were collected. Outcome variables included: (1) whether there was ever an arrest; and (2) whether there was ever an arrest for a violent crime. RESULTS: Preliminary analyses indicated no gender differences in overall referral rates to juvenile court, although boys were more likely than girls to be referred for property, felony, and violent offenses. Exposure to marital violence in childhood predicted referral to juvenile court. Girls with a history of physical child abuse were arrested for violent offenses more than boys with similar histories, but the context of violent offenses differed dramatically by gender: Nearly all referrals for a violent offense for girls were for domestic violence. CONCLUSIONS: Although boys and girls share similar family risk factors for delinquency, girls are more likely than boys to be arrested for violent offenses in the aftermath of child physical abuse. These findings suggest that it takes more severe abuse to prompt violence in girls than is necessary to explain boys' violent offending.     

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.     

Analog of parental empathy: Association with physical child abuse risk and punishment intentions

Objectives

Current research has been inconsistent in corroborating that parents’ compromised empathy is associated with elevated physical child abuse risk, perhaps in part because of an emphasis on dispositional empathy rather than empathy directed at their own children. Research has also relied on self-reports of empathy that are susceptible to participant misrepresentation. The present study utilized an analog task of parental empathy to investigate the association of parental empathy toward one's own child with physical child abuse potential and with their tendency to punish perceived child misbehavior.

Methods

A sample of 135 mothers and their 4–9 year old children were recruited, with mothers estimating their children's emotional reactions using a behavioral simulation of parental empathy. Mothers also provided self-reports on two measures of child abuse potential, a measure of negative attributions and expected punishment of children using vignettes, as well as a traditional measure of dispositional empathic concern and perspective-taking.

Results

Findings suggest that parental demonstration of poorer empathic ability on the analog task was significantly related to increased physical abuse potential, likelihood to punish, and negative child attributions. However, self-reported dispositional empathy exhibited the pattern of inconsistent associations previously observed in the literature.

Conclusions

Parental empathy appears to be a relevant target for prevention and intervention programs. Future research should also consider similar analog approaches to investigate such constructs to better uncover the factors that elevate abuse risk.     

Occult abusive injuries in children brought for care after intimate partner violence: An exploratory study

Children in homes with intimate partner violence (IPV) are at increased risk for physical abuse. We determined the frequency and injury patterns in children who underwent child abuse consultation after IPV exposure by retrospectively analyzing the "Examination of Siblings To Recognize Abuse" cohort of children referred for physical abuse. Children were selected who presented after IPV exposure. Among 2890 children evaluated by child abuse pediatricians, 61 (2.1%) patients presented after IPV exposure. Of the 61, 11 (18.0%) were exposed to IPV, but had no direct involvement in the IPV event, 36 (59.0%) sustained inadvertent trauma during IPV, and 14 (23.0%) were directly assaulted during IPV. Thirty-six patients (59.0%) had an injury: 31 (51.0%) had cutaneous injuries and 15 (24.6%) had internal injuries including fracture(s), intracranial or intra-abdominal injury. Of the 15 patients with internal injuries, 14 (93.3%) were less than 12 months old. Among the 36 patients with injuries, 16 (44.4%) had no report of direct injury, a report of a mechanism that did not explain the identified injuries, or a report of trauma without a specific mechanism. Five (13.9%) did not have physical examination findings to suggest the extent of their internal injuries. Injuries are present in a significant proportion of children presenting to Emergency Departments after IPV exposure. History and physical examination alone are insufficient to detect internal injuries especially in infants. These preliminary results support the need for future, prospective studies of occult injury in children exposed to IPV.     

The relationship between parental psychiatric disorder and child physical and sexual abuse: findings from the Ontario Health Supplement

OBJECTIVE: The study's goal was to examine the relationship between a history of parental psychiatric disorder and a history of child abuse in a general population sample of Ontario residents. METHOD: A representative community sample of 8548 respondents who participated in the Ontario Mental Health Supplement (OHSUP) were interviewed about parental psychiatric history and completed a self-report measure of childhood physical and sexual abuse. RESULTS: The lifetime prevalence of either parent with a psychiatric disorder was as follows: 14.1% for depression, 3.7% for manic depression, 2.4% for schizophrenia, 2.4% for antisocial behavior, and 17.3% for any parental psychiatric disorder. Respondents reporting a parental history of depression, mania, or schizophrenia had a two to threefold increase in the rates of physical, sexual, or any abuse. Parental history of antisocial disorder increased the risk of exposure to physical abuse (adjusted odds ratios [OR 6.1] and any abuse [OR 7.5]). There was no statistically significant difference between parental psychiatric disorder and childhood physical or sexual abuse by gender of the respondent. There was a trend for increasing risk associated with father only, mother only, and both parents having any psychiatric disorder. CONCLUSIONS: The elevated risk for physical and sexual abuse among respondents reporting a parental history of psychiatric illness highlights the need to examine the mechanism for this association. Such information is important in developing approaches to assist families where the risk of child maltreatment is increased.     

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.