Families at risk of poor parenting: A descriptive study of sixty at risk families in a model prevention program

Sixty families assessed to be at risk of poor parenting were the subject of this study. These families were participants in a model multidisciplinary program designed for the secondary prevention of poor parenting and the extremes of child abuse and neglect. The model program consists of special medical, psychological, social and developmental services to families on an inpatient, outpatient, and in-home basis. Demographic information on these 60 families was tabulated. Each family was given a monthly rating on a simple measure of family function. Ratings over lime were observed, and families were characterized in terms of a family rating vector (up. up-plateau, plateau, fluctuating, and down). Families were also described in terms of the constellation of problems brought to the therapy situation. Problem lists for each family were subjected to factor analysis. Five factor constructs which made clinical sense emerged from the analysis. Each factor could be labeled as a “family type.” These types were: (I) Abusive Family. (II) Neglectful or Antisocial Family. (III) Family with an Emotionally Unstable Parent, (IV) Family with Cultural or intellectual Limitation, and (V) Family with Child-Rearing Difficulties. Approximately 20% of these families did not fit the typology. Families were then divided into two groups—those who were relatively long-term, ongoing recipients of services, and those who left the program in the observation interval. Families were categorized according to family function rating vector and “family type.” It was noted among long-term families, measured improvement in family function was most evident in families with transient situational crisis (who did not fit the typology) and those with intellectual and cultural deficits (Type IV). Among the families who dropped from the program. 15% were no longer at risk. Sixty-three percent of the remaining families were not improving. These techniques may be useful in determining which at risk families are more successful candidates for prevention efforts.     

Exploring policies for the reduction of child physical abuse and neglect

Policies can be powerful tools for prevention given their potential to affect conditions that can improve population-level health. Given the dearth of empirical research on policies’ impacts on child maltreatment, this article (a) identifies 37 state policies that might have impacts on the social determinants of child maltreatment; (b) identifies available data sources documenting the implementation of 31 policies; and (c) utilizes the available data to explore effects of 11 policies (selected because they had little missing data) on child maltreatment rates. These include two policies aimed at reducing poverty, two temporary assistance to needy families policies, two policies aimed at increasing access to child care, three policies aimed at increasing access to high quality pre-K, and three policies aimed at increasing access to health care. Multi-level regression analyses between within-state trends of child maltreatment investigation rates and these 11 policies, controlling for states’ childhood poverty, adults without a high school diploma, unemployment, child burden, and race/ethnicity, identified two that were significantly associated with decreased child maltreatment rates: lack of waitlists to access subsidized child care and policies that facilitate continuity of child health care. These findings are correlational and are limited by the quality and availability of the data. Future research might focus on a reduced number of states that have good quality administrative data or population-based survey data on child maltreatment or reasonable proxies for child maltreatment and where data on the actual implementation of specific policies of interest can be documented.     

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.     

Neighborhood alcohol outlet density and rates of child abuse and neglect: Moderating effects of access to substance abuse services

This study investigates the relationship between concentrations of on- and off-premises alcohol outlets and rates of child abuse and neglect. Additionally, the study seeks to locate protective features of a neighborhood's built environment by investigating the potentially moderating role that access to substance abuse treatment and prevention services plays in the relationship between alcohol outlet density and child maltreatment. Using a cross-sectional design, this ecological study utilized data from 163 census tracts in Bergen County, New Jersey, on reports of child abuse and neglect, alcohol outlets, substance abuse treatment and prevention facilities, and the United States Census to investigate the linkages between socioeconomic structure, alcohol availability, and access to substance abuse service facilities on rates of child abuse and neglect. Findings indicate areas with a greater concentration of on-premises alcohol outlets (i.e., bars) had higher rates of child neglect, and those with easier access to substance abuse services had lower rates of neglect, controlling for neighborhood demographic and socioeconomic structure. Additionally, the relationship between on-premises alcohol outlet density and rates of child neglect was moderated by the presence of substance abuse service facilities. A greater concentration of off-premises outlets (i.e., liquor stores) was associated with lower rates of physical abuse. Findings suggest that the built environment and socioeconomic structure of neighborhoods have important consequences for child well-being. The implications for future research on the structural features of neighborhoods that are associated with child well-being are discussed.     

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.     

Risk factors for child physical abuse and neglect among Chinese young mothers

Although studies have reported a linkage between young pregnancy and child maltreatment risk, it is still unclear about what factors place young mothers at greater risk of maltreating their child in Chinese context. Based on the socio-ecological model, risk factors in 4 domains: family background/structure, maternal stressors, mother-child interaction, and child behavioral issue in relation to physical assault, neglect, both physical assault and neglect, and either physical assault or neglect among Chinese young mothers in Hong Kong were assessed. 392 young mothers were recruited from an integrated supportive program for young mothers. The mean age of mothers at delivery was 21.8 (SD = 3.0) and 52.3% were married. Individual risk factors and cumulative risk domains related to different child maltreatment groups were examined. Our results show both overlapping and unique risk factors across the domains associated with physical assault and neglect. Further, young families exposed to higher number of risk domains show higher rates for physical assault and neglect, co-occurrence of physical assault and neglect, and either form of maltreatment. In addition, various risk domains were found to be particularly important for different forms of maltreatment: family background/structure domain was found to be an important risk domain for neglect; mother-child interaction domain for both physical assault and neglect; family background/structure and maternal stressors domains for either physical assault or neglect. Closer examination of a subgroup of adolescent mothers aged 18 and below shows that family background/structure was an important risk domain for this group.     

Child abuse and neglect re-report rates for young children with developmental delays

The study objective was to examine the likelihood and magnitude of child abuse and neglect (CAN) re-reports for young children (0–71 months) with delays in cognitive, language, and adaptive development, compared to typically developing children. The National Survey of Child and Adolescent Well-Being (NSCAW II), a nationally representative and longitudinal survey, was used to examine CAN re-reports at two follow-up waves, 18- and 36-months post baseline assessments. Logistic regression models were employed to determine the correlation between number of developmental delays and a CAN re-report at waves 2 and 3. Results indicate that children with three or more domains of delays had odds 4.73 times higher than children without developmental delays of re-report to CPS at wave 2 but not at wave 3. In this study, children with multiple developmental delays have elevated rates of CAN re-reports when compared to typically developing children. Allocation of child welfare resources should include strategies for preventing maltreatment risk among children with developmental delays.     

Major findings from the Canadian incidence study of reported child abuse and neglect

OBJECTIVE: To present key findings from the Canadian Incidence Study of Reported Child Maltreatment (CIS) in sufficient detail to provide a basis for international comparisons in terms of forms and severity of maltreatment and the age and sex of victims. METHOD: A survey conducted in a random sample of 51 child welfare service areas across Canada tracked child maltreatment investigations conducted during the months of October to December 1998, produced a national sample of 7672 child maltreatment investigations. Information was collected directly from investigating workers on child and family background, perpetrator characteristics, severity and types of maltreatment and service and court outcomes of investigations. RESULTS: Forty-five percent of investigations were substantiated and in a further 22% of investigations maltreatment remained suspected. Primary reasons for investigation were physical abuse (31%), sexual abuse (11%), neglect (40%), and emotional maltreatment (19%). A larger proportion of physical abuse cases are isolated incidents involving older children and are more likely to lead to injuries. Sexual abuse, neglect and emotional maltreatment involve more chronic situations with children showing signs of emotional harm. Rates of investigated and substantiated maltreatment are lower in Canada compared to the United States, but are higher than rates reported in Australia. CONCLUSIONS: The CIS provides much needed information for developing a better understanding of the profile and needs of children and families investigated by child welfare authorities in Canada. The study also serves as a point from which international comparisons can be made.     

The protective effect of neighborhood social cohesion in child abuse and neglect

Relations between parents within a neighborhood have the potential to provide a supportive environment for healthy and positive parenting. Neighborhood social cohesion, or the mutual trust and support among neighbors, is one process through which parenting may be improved. The current study investigates the association between neighborhood social cohesion and abuse and neglect, as well as specific types of abuse and neglect. The sample for the study is comprised of 896 parents in one urban Midwestern County in the United States. Participants were recruited from Women, Infants, and Children clinics. Negative binomial regression is used to examine the association between neighborhood social cohesion and child maltreatment behaviors, as measured by the Conflict Tactics Scale, Parent-to-Child Version (Straus et al., 1998). In this sample of families, neighborhood social cohesion is associated with child neglect, but not abuse. In examining the relationship with specific types of abuse and neglect, it was found that neighborhood social cohesion may have a protective role in some acts of neglect, such as meeting a child's basic needs, but not potentially more complex needs like parental substance abuse.     

Fatal child neglect: Characteristics,causation, and strategies for prevention

Research in child fatalities because of abuse and neglect has continued to increase, yet the mechanisms of the death incident and risk factors for these deaths remain unclear. The purpose of this study was to systematically examine the types of neglect that resulted in children's deaths as determined by child welfare and a child death review board. This case review study reviewed 22 years of data (n = 372) of child fatalities attributed solely to neglect taken from a larger sample (N = 754) of abuse and neglect death cases spanning the years 1987–2008. The file information reviewed was provided by the Oklahoma Child Death Review Board (CDRB) and the Oklahoma Department of Human Services (DHS) Division of Children and Family Services. Variables of interest were child age, ethnicity, and birth order; parental age and ethnicity; cause of death as determined by child protective services (CPS); and involvement with DHS at the time of the fatal event. Three categories of fatal neglect – supervisory neglect, deprivation of needs, and medical neglect – were identified and analyzed. Results found an overwhelming presence of supervisory neglect in child neglect fatalities and indicated no significant differences between children living in rural and urban settings. Young children and male children comprised the majority of fatalities, and African American and Native American children were over-represented in the sample when compared to the state population. This study underscores the critical need for prevention and educational programming related to appropriate adult supervision and adequate safety measures to prevent a child's death because of neglect.     

Long-term effects of child abuse and neglect on emotion processing in adulthood

To determine whether child maltreatment has a long-term impact on emotion processing abilities in adulthood and whether IQ, psychopathology, or psychopathy mediate the relationship between childhood maltreatment and emotion processing in adulthood. Using a prospective cohort design, children (ages 0–11) with documented cases of abuse and neglect during 1967–1971 were matched with non-maltreated children and followed up into adulthood. Potential mediators (IQ, Post-Traumatic Stress [PTSD], Generalized Anxiety [GAD], Dysthymia, and Major Depressive [MDD] Disorders, and psychopathy) were assessed in young adulthood with standardized assessment techniques. In middle adulthood (M_age = 47), the International Affective Picture System was used to measure emotion processing. Structural equation modeling was used to test mediation models. Individuals with a history of childhood maltreatment were less accurate in emotion processing overall and in processing positive and neutral pictures than matched controls. Childhood physical abuse predicted less accuracy in neutral pictures and childhood sexual abuse and neglect predicted less accuracy in recognizing positive pictures. MDD, GAD, and IQ predicted overall picture recognition accuracy. However, of the mediators examined, only IQ acted to mediate the relationship between child maltreatment and emotion processing deficits. Although research has focused on emotion processing in maltreated children, these new findings show an impact child abuse and neglect on emotion processing in middle adulthood. Research and interventions aimed at improving emotional processing deficiencies in abused and neglected children should consider the role of IQ.     

Interdisciplinary Training Program (ITP) in child abuse and neglect: Long term effects

BackgroundUniversity of Oklahoma Health Sciences Center has offered Interdisciplinary Training Program (ITP) for Child Abuse and Neglect since 1987. However, there are limited evaluations on multidisciplinary/interprofessional training for early professionals in the field of child abuse and neglect.ObjectiveThis study aimed to examine the effects of the ITP on young professionals in developing their careers and taking leadership roles in the field of child abuse and neglect.MethodsThe anonymous online survey was conducted for students who completed in the ITP from 1989 to 2016 (n = 405, with contact information out of total 508 graduates). One hundred seventy nine alumni (44.2%) responded to the survey.ResultsSatisfaction for the ITP was high (m = 9.3, sd = 0.97 on a 10 point scale with higher numbers being positive). Their current contributions to the field of child abuse and neglect were widely seen in child advocacy (43.0%), clinical treatment (39.1%), primary prevention (29.6%), or research (27.9%). Graduates reported they made 133 presentations to civic or professional groups and published 69 articles since they finished the ITP.ConclusionThe ITP trainees have made significant contributions to the field in clinical treatment, research, and child advocacy. Alumni were highly satisfied with their experience and continue to see the importance of the ITP to their jobs and career.     

Growing up with parental alcohol abuse: exposure to childhood abuse, neglect, and household dysfunction

OBJECTIVE: This study is a detailed examination of the association between parental alcohol abuse (mother only, father only, or both parents) and multiple forms of childhood abuse, neglect, and other household dysfunction, known as adverse childhood experiences (ACEs). METHOD: A questionnaire about ACEs including child abuse, neglect, household dysfunction, and exposure to parental alcohol abuse was completed by 8629 adult HMO members to retrospectively assess the relationship of growing up with parental alcohol abuse to 10 ACEs and multiple ACEs (ACE score). RESULTS: Compared to persons who grew up with no parental alcohol abuse, the adjusted odds ratio for each category of ACE was approximately 2 to 13 times higher if either the mother, father, or both parents abused alcohol (p < 0.05). For example, the likelihood of having a battered mother was increased 13-fold for men who grew up with both parents who abused alcohol (OR, 12.7; 95% CI: 8.4-19.1). For almost every ACE, those who grew up with both an alcohol-abusing mother and father had the highest likelihood of ACEs. The mean number of ACEs for persons with no parental alcohol abuse, father only, mother only, or both parents was 1.4, 2.6, 3.2, and 3.8, respectively (p < .001). CONCLUSION: Although the retrospective reporting of these experiences cannot establish a causal association with certainty, exposure to parental alcohol abuse is highly associated with experiencing adverse childhood experiences. Improved coordination of adult and pediatric health care along with related social and substance abuse services may lead to earlier recognition, treatment, and prevention of both adult alcohol abuse and adverse childhood experiences, reducing the negative sequelae of ACEs in adolescents and adults.     

Mixed-methods feasibility study on the cultural adaptation of a child abuse prevention model

The current study utilized mixed-methods analyses to examine the process of adapting a home-based parenting program for a local Latino community. The study examined the: (a) acceptability and cultural congruence of the adapted SafeCare^® protocol, (b) adherence to the core components of SafeCare^® while adapting to local community culture, and (c) social validity of the new model in addressing SafeCare^® target areas (parenting, home safety, and child health). Participants were 28 Latino mothers and eight providers. After training in the adapted model, providers demonstrated improved knowledge and skills. All providers reached national certification standards for SafeCare^®, demonstrating fidelity to the core components of the original model. Positive consumer–provider relationships were developed as reflected by the results on the Working Alliance (collaboration between caregivers and parents). Themes from the integrated results of the social validity measures and individual interviews with parents were perceived benefits of the program on targeted areas and cultural congruency of the approach. Recommendations are to consider using adaptation guidelines as outlined to promote local culturally congruent practices.     

Influence of the referral process by a child protective agency on the outcome of psychiatric-psychological assessments of child abuse/neglect cases

Many Child Protective agencies in the United States have guidelines for referring certain kinds of abuse/neglect cases for psychiatric-psychological assessments which leave up to the referring agent such decisions as: choice of assessor (psychiatrist, psychologist, other), purpose of evaluation, and part of the family system to be evaluated. In order to develop a more systematic approach to comprehensive evaluations of abusive families, the referral process from the Hawaii Child Protective Services Agency to a child guidance center was analyzed through chart review, and its influence on the outcome of psychiatric-psychological assessments was examined. Evaluations by psychiatrists were also compared with those of psychologists. The results showed that the great majority of the cases referred for assessment were victim-children and that recommendations paralleled this trend by being child rather than adult or family oriented. In addition, referral questions and resulting recommendations centered more on diagnosis than on issues of intervention (treatment, placement, legal needs), suggesting an underutilization of the assessors' clinical skills. Differences between psychiatrists and psychologists are also reported. These findings point to a need for greater commitment to family pathology. Implications for developing more effective referral guidelines and for training are discussed.     

Oral health in children investigated by Social services on suspicion of child abuse and neglect

Child abuse and neglect (CAN) are likely to have negative consequences on health; however, for oral health, studies on associated outcomes are sparse. The purpose of this study was to assess oral health and oral health behaviors in relation to suspected CAN among children being investigated by the Swedish Social Services. The material comprised data from the Social Services and dental records; the sample, 86 children and 172 matched controls. The children in the study group had a higher prevalence of dental caries than the control group; in addition, levels of non-attendance and dental avoidance were high, as was parental failure to promote good oral health. We found four factors that, taken together, indicated a high probability of being investigated because of suspected CAN: prevalence of dental caries in primary teeth, fillings in permanent teeth, dental health service avoidance, and referral to specialist pediatric dentistry clinics. If all four factors were present, the cumulative probability of being investigated was 0.918. In conclusion, there is a high prevalence of dental caries, irregular attendance, and a need for referral a pediatric dental clinic among Swedish children under investigation due to suspected CAN. Social context is an important factor in assessing the risk of developing dental caries, the inclination to follow treatment plans, and the prerequisites for cooperation during treatment. Routinely requesting dental records during an investigation would provide important information for social workers on parental skills and abilities to fulfill the basic needs of children.     

Prevention of child abuse and neglect through early diagnosis of serious disturbances in the mother-child relationship in Italy

At the obstetrical clinic of Modena University and a family center of the same municipality during the first six months of 1980 a questionnaire based on "Risks of Child Abuse" by Kempe, Gray and others was administered to 33 expectant mothers during the third trimester of pregnancy, a few days after delivery, and a month and one-half after childbirth, for the purpose of examining the mother-child relationship. Two principal groups of "risk factors" which may lead to child abuse and neglect appeared: mothers with preceding personal and social experiences, and cases of medical intervention (e.g., prematurity, caesarean). Use of a questionnaire that permitted early diagnosis made possible help in establishing a good mother-child relationship in the first months of life. Such help can be given by the hospital and public centers both before and after birth.     

Child abuse and neglect: Training needs of student teachers

Increasing awareness of child abuse and neglect (CAN) raises questions about how well teachers are prepared for their role in child protection. This paper assesses and differentiates training needs of first-year students (n = 216) in Northern Ireland. Multiple-choice tests were used to assess knowledge of CAN statistics; recognising and reporting; policies, procedures, and legislative frameworks; and direct work with children. Considerable gaps in knowledge were found. Results between student groups varied and provide evidence of the need to develop pre-service child protection training. The importance of differentiation between student groups in terms of training content is emphasised.