Project interact: A study of patterns of interaction in abusive, neglectful and control families

Child Abuse refers to non-accidental physical and psychological injury to a child under the age of 18 as a result of acts of omission or commission perpetrated by a parent or caretaker. Conceptual problems abound in part because we are clearly dealing with behavior which falls along a continuum of caregiver-child relationships. At one end of the continuum we have seemingly innocuous verbal punishment — disparagement, criticism, threat and ridicule. Or, we have fairly typical forms of physical punishment such as a slap on the hand or a swat on the bottom. Then there are forms of physical punishment that exceed current community standards — hitting the child with a closed fist or with an object such as a razor strap, belt, cord, or paddle, slamming the child against the wall, kicking him, burning the child with a cigarette, scalding the child with hot water, torturing or even killing the child. It is not always clear where a particular case should be placed on this conceptual continuum. What is more devastating to the development of a child, a single occasion where a parent loses control and slams a child across the room, in the process knocking out a tooth and breaking a child's arm, or the persistent day-by-day, month-by-month, year-by-year use of ridicule, criticism and sarcasm toward that child? Nor is it always clear whether acts of omission which are harmful to the child (i.e., neglect) are functionally equivalent to acts of commission that harm the child. This problem of definition and the establishment of a uniform response class is but one of many problems plaguing the systematic study of child abuse. Other problems such as the tendency to dramatize the bizarre and extreme use of physical violence or aggression at the expense of more subtle forms of verbal punishment, the tendency to equate child abuse either with psychopathology, on the one hand, or with poverty, on the other, and the tendency to rely upon impressionistic accounts of behavior also have retarded the accumulation of sound knowledge about the causes, consequences, treatment and prevention of abusive behavior.     

Mobilization of community resources to work with abusive and neglectful families: Community organization in New York state

This article describes the community organization experience of the Family Life Development Center at Cornell University in connection with the federally financed Resource Center on Child Abuse and Neglect which it has operated since 1975. Early on, the Center decided to concentrate its efforts on organizing local task forces on child abuse and neglect which would work at the community level to improve services for families and children afflicted with the problem. As a result, over 50 such groups were organized and they have stimulated creation of over 100 new services including Parents Anonymous chapters, parent aides, multidisciplinary teams and parenting education projects. In short, the local community organization approach enabled a small state level staff to stimulate a major mobilization of resources for child abuse and neglect at the community level throughout the state. The process began with several “trial and error” experiences in rural New York. This led to technical assistance in task force formation for a dozen more counties and finally to regional workshops on task force organizations. The process culminated with formation of a statewide federation of the local groups. The Center is now implementing the approach in New Jersey, Puerto Rico and the Virgin Islands.     

Patterns of maternal behavior among neglectful families: implications for research and intervention

OBJECTIVE: The heterogeneity within neglecting caregivers has not been explored in an empirical fashion. The current study sought to address this limitation by utilizing archival data in order to explore variability of maternal behavior among neglectful families. METHOD: The current study utilized archival data containing caseworker and self-report information on 100 mothers for whom neglect had been substantiated and was the primary referral concern. Cluster analysis was used to describe patterns of maternal behavior. Subsequent analysis was used to determine differences between the clusters on degree of neglect, maternal depression, perceived social support, and other demographic characteristics (income, education). RESULTS: Five distinct patterns of maternal behavior emerged, each with different ratings of maternal confidence, relatedness, impulse control, and willingness to engage in verbal interactions. The clusters differed on ratings of neglect, life stressors, resource problems and adult problems. The clusters were similar in terms of maternal education, number of children in the home, and monthly income. Additionally, women in all clusters reported similar levels of depression, similar number of children, and a comparable amount of social support. CONCLUSIONS: The five clusters are described and implications for intervention approaches are discussed.     

Clusters of abusive parenting: A latent class analysis of families referred to Child Protective Services in Portugal

From the perspective of ecological models, it is suggested that a thorough behavior analysis of parental mistreatment and neglect is undertaken from a general approach to a more comprehensive and multi-dimensional perspective. Hence, the main goal of the present study was to determine if meaningful groups or clusters of abusive parenting in Portugal could be identified based on the characterization of the children and adolescents, their parents and context variables. An instrument was developed to assess variables of the children or adolescents, the family and the social context, all of which have been shown to be important in the literature. Child and Youth Protection Commissions from the whole of Portugal participated in the study, a total of 504 cases. Latent class analysis was applied in order to identify distinct parenting abusing behavior. The results showed four distinct clusters of families which are clearly defined in light of the types of risk and associated variables. The four groups are probabilistic and propose the composition of clusters with socio-demographic variables related to the types of risk. The significant interrelationships of different profiling characteristics are directly related to parenting abusing behavior. The results of this study confirmed our hypothesis of heterogeneous abusive parenting in Portugal. The findings yield useful policy-oriented results. Meaningfully organizing abusive parenting may be an important step not only in understanding the origins of abuse and neglect, but also in integrating this information into intervention models with children, young people and their families.     

The role of parental stress in physically abusive families

This study examines the role of several components of parental stress in physically abusive and nonabusive families with conduct-disordered children. The 123 families studied were seen in a parenting clinic aimed at improving parent-child interactions in families with a highly oppositional child. Data were collected over a several-week period and included both mother and father self-report measures and independent observations by trained researchers. Parental stress was found to play an important role in abusive families. Physically abusive families were significantly more often low income, had younger mothers with less education, more frequently reported a family history of child abuse, and were more likely to be abusing alcohol or drugs. Abusive mothers reported more stress due to frequent life events, and had a more negative perception of these events. Further, these mothers had higher rates of both depression and state anxiety. Abusive fathers spanked their children significantly more often than the nonabusive fathers, and abusive mothers had the highest frequency of critical statements directed at their children. Children from abusive households had significantly more behavior problems. Finally, abusive mothers reported more marital dissatisfaction and social isolation than their nonabusive counterparts.     

Factors associated with successful and unsuccessful intervention with child abusive families

The authors conducted a treatment outcome study on 79 patients engaged in a program for maltreating parents. Treatment modalities included individual psychotherapy and counseling, group therapy, home visiting, and telephone advocacy with the duration of treatment ranging from 6 sessions to 36 months. On the basis of ratings by the primary therapist consensually validated by other staff, $\text{2}\text{3}$ of the sample demonstrated at least symptomatic improvement, whereas 28% improved significantly. Overall improvement was highly correlated with more subtle indices of childrearing, perception of the child, object relations, insight, and capacity for self-observation. The profiles of those maltreating parents who improved and those who did not emerged with respect to the impact of critical demographic, psychological, and therapeutic variables. Favorable outcomes were unlikely among parents who themselves had a history of maltreatment, who inflicted the more severe injuries, who entered the program involuntarily or who terminated against advice; while positive results were more prevalent in those parents with a less abusive childhood experience and who perceived a need for involvement in the program. Home visiting and advocacy appeared to enhance the potential for improvement.     

The school closure issue and the Chicano community: A follow-up study of theAngeles case

The present study is a follow-up study of theAngeles school closure case in which three predominantly Chicano elementary schools in Santa Barbara, California were closed due to declining enrollment in the District. Nearly 600 Chicano children were dispersed to five predominantly Anglo schools. The plaintiffs were a group of Chicano parents and their children, claiming the exclusive burden of the closures was placed on minorities. The present study is an attempt to investigate several adverse effects hypotheses predicted at the trial by the author who testified as an expert witness. Specifically, four major hypotheses were investigated that dealt with psychological maladjustment, academic decline, parental involvement decline, and adverse community impact. The subjects of the study were 50 respondent Mexican American mothers, randomly chosen from the closed schools' population. The respondents were primarily Spanish-speaking and of very low socioeconomic status. Based on the results of a comprehensive home interview, it was concluded that there is convincing evidence that the closures have indeed created a significant burden on a large majority of the children and their families. The long term implications of the closures are complex, but there is a strong possibility that the adverse impact of the closures will increase the already high probability of school problems and failure for the affected children as they progress through the educational system.     

Treatment integrity and acceptability with families: A case study of a child with school refusal

This article describes a graduated re-entry behavioral intervention implemented over an eight week period to treat a child with school refusal who would run away from school if taken there against his will. A multi-method evaluation procedure was used. Baseline data were collected over a five day period documenting school attendance and running away behaviors. In addition, a comprehensive psychological test battery was administered to the child, and clinical interviews conducted with the child's parents and teacher were used to develop the most appropriate treatment program. Based on these data, an initial graduated exposure to school combined with positive reinforcement for staying in school was chosen. As the intervention proceeded the greatest concern became the need to minimize the reinforcing impact of the child's mother on the child's school refusal. The intervention was eventually changed to a rapid exposure to school. By the third week of the intervention, the child was attending school all day for five consecutive days. He maintained this attendance record for the remainder of the treatment program. Follow-up data collected at bi-weekly intervals for a seven month time period until the end of the school year and follow-up for the first two months of the next school year showed stable and continued efficacy of the intervention, with no reoccurrence of refusal to attend or remain at school once he had arrived. © 1996 John Wiley & Sons, Inc.     

Primary prevention of pediatric abusive head trauma: A cost audit and cost-utility analysis

ObjectivesTo obtain comprehensive, reliable data on the direct cost of pediatric abusive head trauma in New Zealand, and to use this data to evaluate the possible cost–benefit of a national primary prevention program.MethodsA 5 year cohort of infants with abusive head trauma admitted to hospital in Auckland, New Zealand was reviewed. We determined the direct costs of hospital care (from hospital and Ministry of Health financial records), community rehabilitation (from the Accident Compensation Corporation), special education (from the Ministry of Education), investigation and child protection (from the Police and Child Protective Services), criminal trials (from the Police, prosecution and defence), punishment of offenders (from the Department of Corrections) and life-time care for moderate or severe disability (from the Accident Compensation Corporation). Analysis of the possible cost-utility of a national primary prevention program was undertaken, using the costs established in our cohort, recent New Zealand national data on the incidence of pediatric abusive head trauma, international data on quality of life after head trauma, and published international literature on prevention programs.ResultsThere were 52 cases of abusive head trauma in the sample. Hospital costs totaled $NZ2,433,340, child protection $NZ1,560,123, police investigation $NZ1,842,237, criminal trials $NZ3,214,020, punishment of offenders $NZ4,411,852 and community rehabilitation $NZ2,895,848. Projected education costs for disabled survivors were $NZ2,452,148, and the cost of projected lifetime care was $NZ33,624,297. Total costs were $NZ52,433,864, averaging $NZ1,008,344 per child. Cost-utility analysis resulted in a strongly positive economic argument for primary prevention, with expected case scenarios showing lowered net costs with improved health outcomes.ConclusionsPediatric abusive head trauma is very expensive, and on a conservative estimate the costs of acute hospitalization represent no more than 4% of lifetime direct costs. If shaken baby prevention programs are effective, there is likely to be a strong economic argument for their implementation. This study also provides robust data for future cost–benefit analysis in the field of abusive head trauma prevention.     

Extended follow-up of neurological,cognitive, behavioral and academic outcomes after severe abusive head trauma

Studies about long-term outcome following abusive head trauma (AHT) are scarce. The aims of this study were to report long-term neurological, cognitive, behavioral and academic outcomes, ongoing treatments and/or rehabilitation, several years after AHT diagnosis, and factors associated with outcome. In this retrospective study, all patients admitted to a single rehabilitation unit following AHT between 1996 and 2005, with subsequent follow-up exceeding 3 years, were included. Medical files were reviewed and a medical interview was performed with parents on the phone when possible. The primary outcome measure was the Glasgow Outcome Scale (GOS). Forty-seven children (out of 66) met the inclusion criteria (mean age at injury 5.7 months; SD = 3.2). After a median length of follow-up of 8 years (range 3.7–12), only seven children (15%) had “good outcome” (normal life – GOS I) and 19 children (40%) presented with severe neurological impairment (GOS III and IV). Children sustained epilepsy (38%), motor deficits (45%), visual deficit (45%), sleep disorders (17%), language abnormalities (49%), attention deficits (79%) and behavioral disorders (53%). Most children (83%) had ongoing rehabilitation. Only 30% followed a normal curriculum, whereas 30% required special education services. Children with better overall outcome (GOS I and II) had significantly higher educated mothers than those with worse outcomes (GOS III and IV): graduation from high school 59% and 21% respectively (p = 0.006). This study highlights the high rate of severe sequelae and health care needs several years post-AHT, and emphasizes the need for extended follow-up of medical, cognitive and academic outcomes.     

A follow-up study of dyslexic boys

Over 500 men who attended the Gow School, an independent school for boys with developmental dyslexia, were given a follow-up questionnaire from 1 to 38 years after they left the school. More than half had graduated from college; business was the most frequently chosen major in college; most were employed in managerial or related business positions; and their adult reading habits and attitudes did not compare well with those of other men of similar socioeconomic backgrounds. Socioeconomic status and IQ were not predictive of adult outcome among these men in contrast to their effect in the general population. An important result was that severity of the reading problem upon entrance to Gow and the academic and remedial progress of the men while at the school were highly predictive of adult educational, occupational, and attitudinal status. This work was supported by funds from NIH grant HD00486, the Gow School, and the John F. Kennedy Institute.     

现代课堂教学设计案例及解析 --以"压力和压强"课为例

现代课堂教学设计应把"以学生的学习为本、以学生的发展为本"作为基本理念,注重教学方案的动态设计,关注学生学习过程和学习方式的优化.     

Psychometric properties of a youth self-report measure of neglectful behavior by parents

Objective

This study aimed to empirically assess psychometric properties of a multi-dimensional youth self-report measure of neglectful behavior by parents.

Method

Data were gathered from 593 12-year-old youth participating in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) consortium; 272 also had data at age 14. Youth responded to a 25-item measure of their experiences of neglect. Expert raters classified items into 4 factors, followed by confirmatory factor analyses. We evaluated cross group measurement equivalence by gender and longitudinal measurement equivalence from age 12 to age 14. Validity was assessed by the relationships between factor scores and (1) neglect reports to child protective services (CPS), (2) quality of parent-child interactions, and (3) parental monitoring.

Results

A 3-factor model (Physical Needs, Emotional Support, and Parental Monitoring) of neglect was obtained, with equivalence across gender and longitudinally (age 12-14). The pattern of correlations between the factor scores, CPS reports, and measures of the parent-child relationship offered modest to moderate support for convergent validity.

Conclusions

The findings suggest a promising and relatively brief youth self-report measure of neglect to help advance research in this area.     

Homeless families: A treatment outcome study

In response to the needs of the growing numbers of homeless families, different program approaches need to be considered to interrupt the incidence of homelessness. This specific program reflects a life-skills learning model, using an "action plan" format and self-evaluation to develop an internal locus of control among its participants.     

Data gathering and analysis for needs assessment: A case study

Various data‐gathering and analysis methods available in our profession's literature, current and past, provide rich options for conducting quality needs assessments. These methods assisted with a thorough needs assessment for a billable hours issue in the parts and service department of a large, power tool and equipment retailer based in the Midwestern United States.