Helping Children in the Child Welfare Systems Heal from Trauma: A Systems Integration Approach

Numerous organizations touch the lives of children and their families following incidents of maltreatment, including family/dependency courts, child welfare agencies, foster parent associations, foster care agencies or substitute care facilities, mental health agencies, and others. The way these organizations work together is critically important. They have the potential to promote child safety and reduce the harmful impact of maltreatment on children, but also, unfortunately, at times their actions may worsen the traumatic experience for children and their families. The National Child Traumatic Stress Network conducted a survey of 53 child‐serving organizations in 10 states, to assess the ways the organizations gather and share trauma‐related information and the basic training about child trauma their staffs receive. The goal was to determine how the various service systems, including the courts, communicate with each other about trauma and the extent to which, alone or in combination, they promote children's healing following traumatic events. The survey results point to a need to improve collaboration on issues associated with child maltreatment and trauma. Judges can be important leaders in bringing about necessary changes. Recommendations for judges and courts are included.     

Assessing child maltreatment risk in the recently divorced parent-child relationship

Reports of single-parent-child relationships characterized by child maltreatment have increased in recent years. The present paper discusses Belsky's child maltreatment/parenting model concerning parenting and the etiology of this problem. The model may serve as a source of conceptual unification of this risk in single-parent homes. It is proposed that the model also may have heuristic value in identifying highest risk single-parent families who warrant intervention.     

Family‐Centered Practice in Florida: Family Court Actions and Perceptions

Family and dependency courts can become valuable partners in efforts to stem the tide of child maltreatment using a family‐centered strategy. Florida's response to a 2008 federal Child and Family Services Review included a commitment to implement family‐centered practice in child protection services and the courts that hear these cases. Evidence of this implementation was documented in a formative evaluation conducted in 2010 and 2011. Findings based on interviews with dependency judges, Children's Legal Services attorneys, and Guardian ad Litem volunteers provide useful insights on how these practices were perceived and implemented.     

Legal Outcomes of Suspected Maltreatment Cases Evaluated by a Child Abuse Pediatrician as Part of a Multidisciplinary Team Investigation

Child abuse pediatricians often carry the stigma that their sole role is to diagnose maltreatment. In reality, child abuse pediatricians use their clinical experience and current evidence-based medicine to make the best medical diagnoses for the children they evaluate. To better understand the legal conclusion of suspected maltreatment cases with medical examinations, this study sought to: (i) evaluate the percentage of children seen for suspected maltreatment that led to a clinical diagnosis of maltreatment, (ii) determine the number and type of criminal charges associated, and (iii) analyze the legal outcomes of cases as they proceeded through the judicial system. This study retrospectively reviewed the legal outcomes of 1698 children medically evaluated in 2013–2014 as part of an investigation by a multidisciplinary team at a children’s advocacy center in a mid-sized city in Oklahoma. Data were collected from electronic medical records, the district attorney’s office, and a public court docket. Of the original cohort, 477 (28.09%) children yielded a medical diagnosis of at least one type of maltreatment. Further analysis yielded 115 unique court cases involving 138 defendants and 151 children. A total of 286 charges were filed resulting in 190 convictions. While maltreatment allegations yield a high number of children that must be evaluated, a comprehensive medical evaluation helps determine which cases do not have sufficient medical findings for a diagnosis of maltreatment. The findings in this study indicate that a majority of suspected maltreatment cases seen by child abuse pediatricians did not result in criminal court outcomes.     

Patterns of Risk and Protective Factors in the Intergenerational Cycle of Maltreatment

This study investigates the continuation and discontinuation of the intergenerational transmission of child maltreatment within the first 13 months of the child’s life. Differences in risk factors and parenting styles between families who initiate (Initiators), maintain (Maintainers) or break (Cycle Breakers) the intergenerational cycle of child maltreatment are explored in comparison to control families (Controls). One hundred and three Health Visitors were trained to assess risk factors and parenting styles of 4,351 families, at both 4–6 weeks and 3–5 months after birth. Maintainers, Initiators and Cycle Breakers had a significantly higher prevalence for the majority of risk factors and poor parenting styles than Controls. Protective factors of financial solvency and social support distinguished Cycle Breakers from Maintainers and Initiators. Therefore, it is the presence of protective factors that distinguish Cycle Breakers from families who were referred to Child Protection professionals in the first year after birth. A conceptual, hierarchical model that considers history of abuse, risk and protective factors, in turn, is proposed to assess families for the potential of child maltreatment.     

The Impact of Extreme Emotional Distance in the Mother-Child Relationship on the Offspring’s Future Risk of Maltreatment Perpetration

Emotional qualities of the parent-child relationship are thought to influence the offspring’s risk for perpetrating child maltreatment in adulthood. The current study examined whether having grown up in an enmeshed or disengaged mother-child relationship, hence a relationship characterized by extremes on the continuum of emotional distance, increased the offspring’s risk of child maltreatment perpetration in a sample of 178 undergraduate students attending a large rural public university. A history of extreme emotional distance experienced with mothers significantly increased the grown offspring’s risk of maltreatment perpetration, as measured by two risk indicators. Emotional reactivity, but not empathy, mediated this effect for the offspring’s child abuse potential. Extreme amounts of emotional distance within the mother-child relationship also predicted the offspring’s child abuse potential over and above maltreatment occurring in that relationship, whereas maltreatment rather than emotional distance predicted the offspring’s unrealistic expectations of children. Clinical implications are discussed.     

Using Reasonable Efforts Determinations to Improve Systems and Case Practice in Cases Involving Family Violence and Child Maltreatment

The Adoption and Safe Families Act (ASFA) of 1997 reinforced that the safety, permanency, and well‐being of the child should be the primary concerns when making decisions about child protection interventions, child placement, and efforts at reunification. The court's role in oversight of agency practice in individual cases through the requirement of specific judicial findings as a condition of receipt of certain funding was also maintained and strengthened by ASFA. Based on the recognition of the number of cases where there is a co‐occurrence of domestic violence and child maltreatment, there is a need for communities and agencies to set reasonable expectations of good practice for responding to the issues raised. As the community sets the expectations of good practice through agency policy, training, and service delivery, the judiciary, through the findings regarding “continuation in the home” or “reasonable efforts” in each individual case, provides the oversight of practice required by ASFA. This article will explore the current applications of reasonable efforts, discuss ways that courts and communities are defining the concept, and examine the need for the development of a reasonable efforts protocol.     

Ecological correlates of neglect in infants and toddlers

Infants and toddlers are more likely to be victims of neglect than any other form of maltreatment. Infants and toddlers are at highest risk of fatality because of maltreatment and experience behavioral, social, academic, medical, and cognitive consequences of neglect during their most formative years. Within an ecological framework, this study examines the correlates of the substantiation of neglect in children 0 to 36 months of age. Using an ex post facto design and a random sample of 148 child protective services cases, bivariate analysis revealed significant differences in families who were substantiated for neglect in the areas of child characteristics, home environment, social environment, caregiver, and maltreatment situations. Multivariate analysis found children who were substantiated for neglect were exposed to greater environmental dangers and had caregivers who had poor parenting skills. Implications for practice and future research are discussed.     

Maltreatment Chronicity Defined with Reference to Development: Extension of the Social Adaptation Outcomes Findings to Peer Relations

The purpose of this study was to extend work seeking to improve research definitions of chronic maltreatment by contrasting a definition based on patterns of CPS reports across childhood developmental stages to a previously used definition based upon duration of the period including reports, using teacher-estimated peer relations to represent an extrafamilial outcome domain of social adaptation. The sample includes 387 children who are participating in a multi-site longitudinal study and had been reported for abuse or neglect to CPS between birth and age 8. CPS records from this time period provided the basis of two chronicity constructs: 1) an ordinal categories (OC) definition based upon four Eriksonian stages, and 2) a durational definition (time between first and last reports). Block-wise regression analyses were conducted to examine the relative degree to which the two chronicity definitions contributed to prediction of teacher-estimated peer relations at the age 8 interview. Chronicity characterized with reference to developmental stages significantly predicted troubled peer relations, with child age, sex, and minority status, family income, geographic location, and time of first report taken into account. The effect was pronounced with regard to aggressive peer relations. Duration of maltreatment reports also predicted aggressive peer relations, but significantly less so than did the OC definition. The findings support the view that maltreatment chronicity is usefully defined by taking children’s development into consideration to characterize patterns of maltreatment across developmental stages. Practice and research implications are suggested.     

An examination of the questioning styles of police officers and caregivers when interviewing children with intellectual disabilities

Purpose. This research provided a detailed analysis of the types of questions and verbal strategies used by police officers and caregivers when interviewing children with intellectual disabilities about events. Method. Twenty eight children aged 9 to 13 years with a mild or moderate intellectual disability participated in a staged event at their school. Each child was then interviewed on separate occasions by the child's primary caregiver and by a police officer who was authorized to conduct investigative interviews with children. Results. While the approach used by the police officers was broadly consistent with best‐practice recommendations (i.e. their interviews contained few leading, coercive or negative strategies), they frequently interrupted the child's account and used relatively few minimal encouragers and other strategies designed to keep the child talking. The caregivers used a high proportion of direct, leading and coercive strategies to elicit information from their children. Even when caregivers used open‐ended questions, their children provided less event‐related information than they did to the police interviewers. Conclusion. The quality of evidence obtained from children with intellectual disabilities is likely to be dependent (albeit in part) on the degree to which police interviewers adhere to best‐practice guidelines, as well as the children's general experience with an open‐ended style of communication.     

Best Interest of the Child and Parental Alienation: A Survey of State Statutes

State statutes regarding the best interests of the child (BIC) in deciding disputed custody were reviewed and independently coded with respect to three issues (i) the child's preference and any limits (ii) parental alienation and (iii) psychological maltreatment. Results revealed that many states allowed for the child's preferences to be considered and none qualified that preference when undue influence has occurred; parental alienation as a term was not found in any state statutes but 70% of the states included at least one BIC factor relevant to its core construct of the parent supporting the child's relationship to the other parent; and many states included a history of domestic violence or child abuse but only three states explicitly mentioned psychological maltreatment. These findings highlight yet another way in which the BICS factors lack specificity in ways that could negatively impact children caught in their parents’ conflict.     

An Evaluation of Hawaii’s Healthy Start Program Using Child Abuse Hospitalization Data

This retrospective study had a twofold focus: (1) to assess the utility of a perinatal screening and assessment protocol for identifying families with an elevated child maltreatment risk and (2) to assess the effectiveness of an intensive home visitation program designed to prevent severe maltreatment. Among 15,864 families screened and assessed for child maltreatment risk, elevated risk was identified in 4,464 families, 1,738 of whom received intensive home visiting services and 2,728 who did not. Subsequently, data on hospitalizations with a child maltreatment diagnosis were used as outcome measures. Among the 1,738 served by home visitors, there were five hospitalized cases of child maltreatment; among the 2,278 families not served, there were 34 cases. The results of chi squared analyses suggest that the screening and assessment protocol successfully differentiates between families with greater and lesser degrees of risk for maltreatment and that hospitalization occurred significantly more often among unserved families (p?=?<.001).     

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.     

The King County (Washington) Systems Integration Initiative: A First Look at the Kent District Dual System Youth Pilot Program

King County is one of five counties in Washington State participating in the John D. and Catherine T. MacArthur Foundation's Models for Change juvenile justice reform initiative. One key aspect of King County's Models for Change participation involves ongoing “systems integration” work intended to improve how youth who have cross‐over involvement in multiple systems—e.g., juvenile justice, child welfare, education, mental health, and/or others—are handled. These cross‐over cases often present a range of challenges to juvenile courts including substantial risk factors that increase their likelihood of continuing system involvement. This article provides a first look at an emerging pilot project in King County that is intended to improve how cross‐over cases are handled by child welfare and juvenile probation with the longer term goal of improving outcomes for these difficult cases.     

Science in the Courtroom: Vital to Best Interests and Reasonable Efforts

This essay was adapted from a speech presented by the author on February 12, 2008 at a Colloquium entitled “What's Best for Children? How Judges Use Neuroscience to Break the Cycle of Child Maltreatment.” The colloquium was sponsored by the Harvard Center on the Developing Child and held at Harvard Law School. It focuses on the wealth of knowledge that has been discovered about infant and child development and the importance of incorporating that knowledge into judicial decision making in child maltreatment cases.     

Practice tips for managing challenges in parenting capacity assessments in child protection court

Courts frequently rely on parenting capacity assessments to make decisions about visitation and case progress in child protection court. Although these evaluations can provide valuable information to courts, they often involve assessing areas of human behavior that are not clearly defined in the literature. For example, mental health professionals are often tasked with identifying risk and protective factors for child maltreatment while identifying factors that can impede progress towards reunification. Although some of these factors may be easy to identify and assess (e.g., symptoms of mental illness or substance abuse), others may be more challenging. For example, factors such as denial and minimization about risk factors and maltreatment, a parent(s)’ ability to protect their child(ren) from future incidents of maltreatment, the parent(s)’ potential for change, and the consideration of what is in the best interest of the child are hard to assess. This article will provide a summary of the research in these areas, provide tips for managing these areas, and highlight directions for future investigation that will help inform parenting capacity assessments in child protection court.     

The use of multiple informants to assess children's maltreatment experiences

Most researchers rely exclusively on the reports of protective service workers to determine children's abuse history. In this report, information about children's maltreatment experiences is obtained from protective service workers and three supplementary sources of data: parents, medical records, and clinical observations. Fifty-six children from 34 families receiving protective services for verified reports of physical abuse, neglect, sexual abuse, and/or emotional maltreatment participated in the study, with most children known to have experienced more than one type of abuse. The supplementary data provided important information about the range and severity of children's maltreatment experiences. Review of the parent and medical record data led to identification of 28 children who had additional types of maltreatment experiences that were not reported by their protective services workers—nine cases of physical abuse, two cases of neglect, five cases of sexual abuse, and 12 cases of emotional maltreatment. Supplementary data also revealed information about incidents of specific types of abuse that were more severe than those reported by the children's protective service workers in an additional 24 cases. A method was devised to synthesize information provided from the different sources of data examined in this report to derive 0–4 point ratings of four categories of maltreatment experiences: (1) physical abuse, (3) neglect, (3) sexual abuse, and (4) emotional maltreatment. The Kappa reliability coefficients for each of these scales were .88, .73, .83, and .90, respectively. Data demonstrating the relationship between these maltreatment ratings and various indices of the children's socioemotional and cognitive functioning were also presented to provide preliminary support for the validity of these scales. The findings from this study suggest that multiple sources of data should be examined in order to obtain accurate assessments of children's maltreatment experiences, and that independent raters can synthesize discrepant data to obtain reliable and valid estimates of children's abuse history. Clinical and methodological issues relevant to the improved assessment of children's maltreatment experiences are also discussed.     

Childhood Maltreatment Experiences and Child Abuse Potential: Temperamental Sensitivity as Moderator?

This study aimed to examine the relationship between negative experiences in childhood (physical-, sexual-, and emotional abuse and emotional neglect) and the risk for an individual to become a perpetrator of child maltreatment in adulthood. Participants were 337 female college students who completed self-report measures of childhood trauma and temperament. Risk for child abuse was assessed with the Child Abuse Potential Inventory. Results showed experiences of emotional neglect significantly predicted higher child abuse potential. Additionally it was shown that experiences of physical abuse significantly predicted higher child abuse potential but only in those individuals with high temperamental orienting sensitivity. These results underline the potentially damaging long-term effects of emotional neglect in childhood and indicate temperamental sensitivity may moderate the relationship between being abused as a child and being at risk for maltreating one’s own offspring.     

The Co-occurrence of Child and Intimate Partner Maltreatment in the Family: Characteristics of the Violent Perpetrators

This study considers the characteristics associated with mothers and fathers who maltreat their child and each other in comparison to parents who only maltreat their child. One hundred and sixty-two parents who had allegations of child maltreatment made against them were considered. The sample consisted of 43 fathers (Paternal Family—PF) and 23 mothers (Maternal Family—MF) who perpetrated both partner and child maltreatment, together with 23 fathers (Paternal Child—PC) and 26 mothers (Maternal Child—MC) who perpetrated child maltreatment only. In addition, 2 fathers (Paternal Victim—PV) and 23 mothers (Maternal Victim—MV) were victims of intimate partner maltreatment and perpetrators of child maltreatment and 7 fathers (Paternal Non-abusive Carer—PNC) and 15 mothers (Maternal Non-abusive Carer—MNC) did not maltreat the child but lived with an individual who did. Within their family unit, 40.7% of parents perpetrated both intimate partner and child maltreatment. However, fathers were significantly more likely to maltreat both their partner and child than mothers and mothers were significantly more likely to be victims of intimate partner violence than fathers. PF fathers conducted the highest amount of physical and/or sexual child maltreatment while MC and MV mothers perpetrated the highest amount of child neglect. Few significant differences between mothers were found. PF fathers had significantly more factors associated with development of a criminogenic lifestyle than PC fathers. Marked sex differences were demonstrated with PF fathers demonstrating significantly more antisocial characteristics, less mental health problems and fewer feelings of isolation than MF mothers. MC mothers had significantly more childhood abuse, mental health problems, parenting risk factors and were significantly more likely to be biologically related to the child than PC fathers. This study suggests that violent families should be assessed and treated in a holistic manner, considering the effects of partner violence upon all family members, rather than exclusively intervening with the violent man. Requests for reprints should be sent to Louise Dixon, Center for Forensic and Family Psychology, School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.     

Somnophilia and Sexual Abuse Using Vaginal Administration of Triazolam

Somnophilia is a rare paraphilia, a form of sexual fetishism which is characterized by the desire to have sex with an unconscious human object who is unable to respond. To the author's knowledge, this is the first case study concerning somnophilic sexual abuse associated with vaginal administration of triazolam. The perpetrator video‐recorded his sexual acts with two unconscious female victims with whom he also had normal sexual intercourse and who were unaware of his paraphilic activities. His Internet conversations with other persons whom he thought to be interested in somnophilic sex and his plans to kidnap a child were recorded by the police. It was evident that sex with an unconscious object played a specific fetishistic role for this man. He obviously used a combination of drugs mixed with alcoholic drinks to make his victims fall sleep and videotaped vaginal administration of triazolam used to deepen the victim's unconscious state.