Safety, Health Care, and Bonding Within an Ecobehavioral Approach to Treating and Preventing Child Abuse and Neglect

This paper describes Project SafeCare, an ecobehavioral research and treatment project with families reported or at risk for child abuse or neglect. Preliminary demographic data are reviewed along with indirect assessment data. Four case studies are described to exemplify the effects of training provided to families. The implications for the current assessment data, treatment, and outcome are discussed.     

Consumer Evaluation of an Ecobehavioral Program for Prevention and Intervention of Child Maltreatment

This study was conducted to evaluate parental satisfaction and acceptability of Project SafeCare, an intensive parent training program to prevent and treat child abuse and neglect with a focus on three areas of intervention: (1) home safety, (2) infant and child health care, and (3) bonding and stimulation. Social validation questionnaires were employed to evaluate the acceptability, the effectiveness, and the outcome of treatments based on parents' perspectives. The questionnaires were divided into four categories: outcome measures, process and procedures, staff performance, and training modes. Overall, Project SafeCare was reported to be very successful and parents reported high satisfaction with all three training programs. Parents rated the procedures, staff, and outcomes very positively. Although parents liked the videos and rated them positively, they seemed to prefer training by counselors to training by video. Data were collected on 45 families and the training was conducted over 15 weeks.     

Cognitive problem-solving training to improve the child-care judgment of child neglectful parents

Child neglect, the failure to adequately meet a youngster's care needs, is the most frequent form of child maltreatment reported to welfare authorities. However, there have been few empirical reports of treatment outcomes for adjudicated, child neglectful parents. In the current study, an initial assessment of three neglectful parents revealed substantial deficits in cognitive problem-solving skills related to child care judgment. Treatment, consisting of modeling, shaping, practice, and feedback was used to improve each parent's child care problem-solving skills in a multiple baseline design. Skill enhancement was also found for untrained (generalization) problem situations, and independent caseworker ratings of each family's functioning provided external validation of the intervention's clinical impact.     

Personality Disorders in a Sample of Parents Accused of Physical Abuse or Neglect

The objective of this study was to provide a psychological profile of parents who have been formally accused of child maltreatment. A clinical group of 16 parents accused of physical abuse and 22 parents accused of neglect were compared with 18 parents from a control group. The MCMI-III was administered individually for each parent. Both groups of maltreatment showed significant differences on different scales of the MCMI-III. No difference was seen between the parents of both groups of child maltreatment. Many parents of both child maltreatment groups reported at least one form of abuse during their childhood, suggesting that a childhood marked by abuse or neglect on the part of a parent could result in personality disorders and that these disorders may have something to do with the intergenerational transmission of abuse.     

Providing Interdisciplinary Services to At‐Risk Families to Prevent the Placement of Children In Foster Care

Grandparents need support to take on the responsibility of children whose parents cannot care for them due to drug addiction, mental health issues, HIV illness, or other health problems. Without support and assistance, these families and children are likely to end up enmeshed in the already overburdened child abuse and neglect system. The University of Maryland has created a model program providing social work and legal services to at‐risk grandparent families to help avoid the unnecessary placement of these children in foster care. In this new program, student attorneys and student social workers worked with the grandparent client to help stabilize the family, providing representation or advice on housing, public benefits, custody, and school‐related issues. Joint education of student attorneys and student social workers in a clinical experience enhances their understanding of their roles and those of the other profession and prepares them for a more thoughtful and informed approach to family law, child welfare cases, and at‐risk children.     

Family and social factors associated with substantiation of child abuse and neglect reports

One hundred fifty-nine families who were reported for child abuse or neglect to a country social services agency in a single fiscal year were studied empirically to test the ecological model of child abuse and neglect. Several family and social factors were studied. Only two, size of family and stage in family developmental cycle, were significantly associated with an increased risk of substantiation of the report. Two potential sources of social support, the use of regular child care and the presence of an extended family member, were tested for their effect on substantiation in those cases where risk factors such as the two mentioned above and combinations of risk factors such as single parenthood and unemployed head of household were associated with higher rates of substantiation. In every case, these two examples of social support reduced the substantiation rate. The influence of the use of regular child care was especially strong in mitigating the effect of the family and social risk factors.     

Project SafeCare: Improving Health, Safety, and Parenting Skills in Families Reported for, and At-Risk for Child Maltreatment

Project SafeCare was a 4-year, in-home, research and intervention program that provided parent training to families of children at-risk for maltreatment, and families of children who were victims of maltreatment. Parents were trained in treating children's illnesses and maximizing their own health-care skills (Health), positive and effective parent–child interaction skills (Parenting), and maintaining low hazard homes (Safety). The effectiveness of these training components was evaluated as the change in the parents' scores on roleplay situations for child health problems, hazards present in the home, and the frequency and quality of parent–child interactions during activities of daily living. Statistically significant improvements were seen in child health care, home safety, and parent–child interactions.     

Biology, childhood trauma, and murder: rethinking justice

This article reviews recent findings in the developmental neurophysiology of children subjected to psychological trauma. Studies link extreme neglect and abuse with long-term changes in the nervous and endocrine systems. A growing body of research literature indicates that individuals with severe trauma histories are at higher risk of behaving violently than those without such histories. This article links these two research areas by discussing how severe and protracted child abuse and/or neglect can lead to biological changes, putting these individuals at greater risk for committing homicide and other forms of violence than those without child maltreatment histories. The implications of these biological findings for forensic evaluations are discussed. Based on new understanding of the effects of child maltreatment, the authors invite law and mental health professionals to rethink their notions of justice and offender accountability, and they challenge policymakers to allocate funds for research into effective treatment and for service delivery.     

Gender Inequity Associated with Increased Child Physical Abuse and Neglect: a Cross-Country Analysis of Population-Based Surveys and Country-Level Statistics

Gender inequity is proposed as a societal-level risk factor for child maltreatment. However, most cross-national research examining this association is limited to developing countries and has used limited measures of gender inequity and child homicides as a proxy for child maltreatment. To examine the relationship between gender inequity and child maltreatment, we used caregivers’ reported use of severe physical punishment (proxy for physical abuse) and children under 5 left alone or under the care of another child younger than 10 years of age (supervisory neglect) and three indices of gender inequity (the Social and Institutional Gender Index, the Gender Inequality Index, and the Gender Gap Index) from 57 countries, over half of which were developing countries. We found all three gender inequity indices to be significantly associated with physical abuse and two of the three to be significantly associated with neglect, after controlling for country-level development. Based on these findings, efforts to prevent child abuse and neglect might benefit from reducing gender inequity.     

Knowledge of child abuse and neglect in nursing students: Assessment and perspectives

Misdiagnosis of child abuse and neglect can delay early treatment. Some authors have pointed out that nurses can miss child abuse and neglect diagnoses due to a lack of knowledge. It is unclear whether the lack of knowledge is due to students' insufficient preparation in nursing school and/or a deficiency in continuing education. An 18-item questionnaire was administered to final-year nursing students to assess their degree of knowledge on child abuse and neglect and to evaluate if the lack of knowledge was due to insufficient teaching/training during nursing school. The students were also asked to evaluate themselves by assigning a score to their knowledge. A statistical comparison was performed to define whether sufficient/insufficient results were associated with the following variables: sex, pediatric or general nursing student, attending pediatric lectures, training in pediatric wards/ambulatories, and attending specific lectures on child abuse and neglect. The study population comprised 175 students (154 females, 20 males, 1 unknown). Exactly 66.3% of the participants had ≤9/18 correct answers. Of all students, 77.7% self-evaluated their level of knowledge as ≤5/10. The comparisons yielded statistically significant differences between the groups with sufficient objective knowledge and those unrelated to training in pediatric wards/ambulatories or pediatric nursing students. Overall, there was little objective knowledge on the subject, which may be related to insufficient teaching/training in nursing schools. Useful corrective strategies include further teaching on child abuse and neglect, preferably using a practical approach. Further, common teaching/training programs should be conducted by both pediatric and general nursing schools.     

Risk Factors Associated with the Chronicity of High Potential for Child Abuse and Neglect

The present 4-year follow-up study involves 56 mothers who were evaluated by social agencies as being abusive and neglectful or at high risk for child abuse and neglect. The aim of the study is to analyze the relationship between psychosocial risk factors (relating to the history and current situation of the mothers) that were present at the time the families were initially recruited and the fact that some of the mothers continue to show a high potential for child abuse and neglect (chronic abuse and neglect), whereas others were able to overcome the problem (transitory abuse and neglect). Results indicate that the following variables are particularly associated with situations involving chronic problems of abuse and neglect: initial level of severity of potential for abuse and neglect; dual-parent status; a large number of children at the time of intervention (3.13 times more risk of chronicity for large families); the fact that as a child the mother herself had been placed in a foster home (3.7 times more risk); that she had been sexually abused (3.5 times more risk); and that as an adolescent she had run away from home (3.02 times more risk). Our results indicate that mothers who have a combination of more than eight risk factors are four times more likely to be in the chronic group.     

Social-cognitive skills training with a sexually abused and abusive child psychiatric inpatient: Training,generalization, and follow-up

This paper describes the clinical application of a social-cognitive skills training program for an 11 1/2-year-old child psychiatric inpatient with a history of sexual abuse and neglect who was referred for hospitalization after sexually molesting a neighborhood girl. The content and procedures of the program are outlined in detail to facilitate replication. Results indicated that improvements were found on analogue role-play scenarios administered during training-which then generalized to several specific and general measures of social adjustment/competence on the inpatient unit. A 1-year follow-up assessment revealed the maintenance of these therapeutic gains. The implications of this therapeutic approach with maltreated children and need for more rigorous empirical outcome studies are discussed.     

Inadvertent clavicular fractures caused by "chiropractic" manipulations in an infant: an unusual form of pseudoabuse

A nine-month-old child was found unresponsive in his crib, five hours after his last feeding. At autopsy, there were no external or internal signs of abuse or neglect, and a few visceral pleural and epicardial petechiae were consistent with the sudden infant death syndrome (SIDS). However, postmortem total body radiographs revealed healing, symmetrical clavicular fractures and a healing left medial humeral epicondyle fracture. The parents had no explanation for these injuries and denied causing any harm to the child. The location and nature of the fractures strongly suggested abusive origin, and the case was reported to the police and the district attorney's office as child abuse. During the investigation, information from the parents indicated that the child had undergone "chiropractic" manipulations by an unlicensed therapist, between three and four weeks prior to death, to correct supposed "shoulder dislocations." This time interval correlated with the histologic age of the injuries, and the history explained their unusual bilateral location and appearance. The parents were exonerated of abuse charges, and the death was ascribed to SIDS.     

Treatment of Concurrent Substance Dependence,Child Neglect and Domestic Violence: A Single Case Examination Involving Family Behavior Therapy

Although child neglect and substance abuse co-occur in greater than 60% of child protective service cases, intervention outcome studies are deplorably lacking. Therefore, a home-based Family Behavior Therapy is described in the treatment of a woman evidencing child neglect, substance dependence, domestic violence and other co-occurring problems. Treatment included contingency management, self control, stimulus control, communication and child management skills training exercises, and financial management components. Results indicated improvements in child abuse potential, home hazards, domestic violence, and drug use, which were substantiated by objective urinalysis testing, and tours of her home. Validity checks indicated the participant was being truthful in her responses to standardized questionnaires, and assessors were “blind” to study intent. Limitations (i.e., lack of experimental control and follow-up data collection) of this case example are discussed in light of these results.     

Developmental Impacts of Child Abuse and Neglect Related to Adult Mental Health, Substance Use, and Physical Health

This study examined the association between officially recorded child abuse and neglect and adult mental health, substance use, and physical health outcomes. Data are from a longitudinal study of more than 30 years in which individuals were interviewed most recently in their mid—30s. Analyses consisted of group comparisons using chi-square tests for categorical variables and independent samples t-tests for continuous measures. Logistic and linear regressions controlled for gender and childhood SES, adult age, marital status, and education. Adults maltreated in childhood reported more symptoms of adult depression, anxiety, and more impairment due to mental and physical health problems. A higher percentage of those with maltreatment histories reported lifetime alcohol problems and appear at greater risk for substance abuse. Most findings of these bivariate analyses remained significant after accounting for gender and childhood socioeconomic status. Somewhat fewer significant results were observed after controlling for adult age, marital status, and education.     

Breaking The Cycle Of Intergenerational Child Maltreatment: A Case For Active Efforts For Dependent Minor Parents And Their Children In State Custody

Dependent minor parents placed in foster care with their children often face significant hurdles. These parents are responsible to make caregiving decisions for their children, while they themselves fall under the caregiving responsibility of the state child welfare system. As such, dependent minor parents live in a “twilight zone” – they hold full parental rights, but limited rights as teenagers. For a number of reasons, the children of minor parents in foster care often come into state custody. When two generations are in foster care at the same time, states must balance the safety and best interests of the children with the rights of minor parents to care for their own children. Currently, the state child welfare system is only required to provide “reasonable efforts” to reunify parents with children when they have been removed from their care for abuse, neglect, or dependency. However, dependent minor parents in state custody often require more supportive services in order to successfully reunify with their children than in a typical child welfare case. This article places the circumstance just described in the context of dependent minor parents’ constitutionally protected rights, and advocates for a higher standard which would require states to provide “active efforts” to protect and preserve these young families.     

Crimes against children in nineteenth-century France

Abuse of children is not entirely a modern phenomenon but the definition and classification of abusive practices has changed. Modern concepts of child abuse date only from the 1880s in France. Child abuse in twentieth-century terms of emotional and physical assault, neglect, abandonment, and sexual molestation was not considered a crime during most of the past century. Prior to the 1880s, only two acts, abortion and infanticide, constituted crimes against children. Child abandonment, rather than a crime, was the state supported, societally acceptable alternative to abortion and infanticide. After abandonment, malnourishment and neglect of these children, even to the point of death, likewise were not crimes. With changes in attitudes of the 1880s, parental neglect, assault, and starvation of children became defined as child abuse as did perceived immoral behavior of the parents such as habitual drunkenness and debauchery. Under these new definitions of abuse, state officials could deprive parents of their legal rights and make the children wards of the state for their own protection. The state becamein loco parentis. This essay explores the changing perceptions of child abuse, and the increasing state intervention for the care of abused children after the 1880s.     

THE FOSTER CARE OMBUDSMAN: APPLYING AN INTERNATIONAL CONCEPT TO HELP PREVENT INSTITUTIONAL ABUSE OF AMERICA'S FOSTER YOUTH

Children today are often abused while in foster care, undermining the theoretical goal of the modern foster care system: to create a temporary, safe, homelike setting to protect and nurture children who are unable to live with their biological parents due to various reasons such as abuse, neglect, or abandonment. Often this abuse is worse than the type for which they were removed from their parents’ care in the first place. First examining the reasons why this complex problem exists, this Note recommends an internationally based, innovative concept as a partial solution: the foster care ombudsman. This Note explains the concept of an ombudsman and demonstrates how it can be particularly helpful to foster children, highlighting existing child welfare ombudsman offices in California, Rhode Island, and New Jersey, as well as international approaches. It also illustrates how a foster care ombudsman can complement class action litigation of foster care abuse claims.     

Advisability of substance abuse testing in parents who severely maltreat their children: the issue of drug testing before the juvenile/family courts

The authors discuss the advisability of juvenile courts requiring urine testing for parents who severely maltreat (abuse and/or neglect) their children. While urine testing for substance abuse is not sufficient to ensure adequate treatment, it is important as part of the overall substance abuse treatment in a selected group of parents. An objective of this article is to offer specific urine testing guidelines in the context of child maltreatment cases in which the court considers removing children from parental custody to state custody. Although potentially useful, urinalysis to detect abused substances has limitations and is appropriate only in well-defined situations. Effective treatment of the substance-abusing, child-maltreating parent must be multimodal, with treatment of substance abuse as the first and most important step.